Assisted suicide as conducted by a "Right-to-Die"-society in Switzerland: A descriptive analysis of 43 consecutive cases

Background and methods: the Swiss "Right-toDie"-society EXIT enables assist ed suicide by providing terminally ill members with a lethal dosage of barb iturates on request. This practice is tolerated by Swiss legislation. EXIT insists on its assumption that people with serious illness and suffering ha ve the competency to take such a decision. The case of two patients who com mitted suicide a short time after their release from a psychiatric clinic r aised some doubts about the practice of EXIT. The files of all 43 cases of suicide assisted by EXIT between 1992 and 1997 in the region of Basle kept in the Institute of Forensic Medicine were examined for accuracy of the med ical data. This sample was compared for age, gender-ratio and prior psychia tric treatment with 425 ordinary suicides in the same region. An attempt wa s made to assess whether only terminally ill and people with intolerable su ffering had been assisted with suicide and what efforts EXIT had made to ru le out psychiatric illnesses or poor social conditions as the reason for th e wish to die. Results: a medical report of the treating doctor(s) was in the files in onl y five cases. The "EXIT" cases where older than the "ordinary"-sample. Amon g those over 65 years old there were almost mice as many women as men. 16 o f the 24 women older than 65 years were widowed. There were 20 cases of can cer; but in eleven cases medical files revealed no apparent medical conditi on to explain a death-wish. Five of the patients declared a social loss or fear of such loss as the reason for their wish to die. Six persons had form erly been in psychiatric care, though this was not mentioned in the files. Conclusions: due to the scarcity of information in the files as regards pre vious palliative care, the high proportion of old women and the high percen tage of people not suffering from a terminal illness compared to the litera ture we conclude that psychiatric or social factors are not an obstacle for EXIT to assist with suicide.