• Ethics
• Journalism/Mass media
• Bills, Laws and Cases
• Suicide/Assisted Suicide
• Research Ethics

In their article ‘Suicide tourism: a pilot study on the Swiss phenomenon,’1 Gauthier et al claim that cases of suicide tourism identified in the Canton of Zurich, Switzerland, have ‘doubled' in recent years, that such assistance is uniquely available in Switzerland due to laxity in Swiss laws, and that the situation is problematic enough that the European Court of Human Rights ‘recently ruled that Switzerland has to issue regulations for prescribing lethal medication….’ These statements are wrong, misleading and inflammatory. To little surprise, the mass media readily lapped up on the hype-news of ‘doubling’.ⁱ The study by Gauthier and colleagues is riddled with methodological, analytical and reporting flaws which strip it of its credibility. What is the background and what are the flaws of the ‘study’ by Gauthier et al?

The method of data collection and analysis by Gauthier et al is not explicitly justified by the authors and leads to serious misrepresentations of the factual situation in Switzerland. The authors analysed only assisted suicides (AS) in which the Zürich Institute of Legal Medicine had been involved and only those that occurred between 2008 and 2012. Cases of non-Swiss residents in which other Institutes of Legal Medicine have been involvedⁱⁱ were not considered. The authors claim to have included 611 cases (‘all foreign residents who had been given assistance in suicide during the period 1 January 2008–31 December 2012’), but Dignitas alone assisted 632 non-Swiss residents during that period.2

Why did the ‘researchers’ choose the years 2008–2012? Had the authors included just two more years, 2006 and 2007, they would have found that the number of assisted suicides decreased from 2006 until 2009, and then increased until 2012 to reach the level of 2006.2 In consequence, the hype-claim of ‘doubling’ is relativised. All research necessarily involves limitations on data collection and analysis, but, to avoid serious errors in interpretation of the data, there must be a principled basis for selecting an appropriate data collection timeframe. Gauthier et al do not report any reason at all for their choice of the timeframe of 2008–2012. Even more problematic is the fact that the authors base subsequent claims on this flawed representation of the statistical picture. Gauthier et al claim that legal laxity in Switzerland accounts for the increase in such deaths, an ‘increase’ that is based only on their flawed data collection.

Further flawed assertions include for example:

• ‘Assisted suicide is not clearly regulated by law in Switzerland’. However, in accordance with Swiss Criminal Code article 115, it is clearly lawful to assist another in suicide, provided there are no selfish motives for providing assistance. ‘Selfish motives’ was explained by the government before the law came into force in 1942.

• ‘…the European Court of Human Rights recently ruled that Switzerland has to issue regulations for prescribing lethal medication such as sodium pentobarbital’. This is not factually accurate. The Court concluded that ‘Swiss law, while providing the possibility of obtaining a lethal dose of sodium pentobarbital on medical prescription, does not provide sufficient guidelines ensuring clarity as to the extent of this right’3 (emphasis added). Besides, the case concerned situations in which ‘…an individual has come to a serious decision, in the exercise of his or her free will, to end his or her life, but where death is not imminent as a result of a specific medical condition.’4

• ‘The medical professional code allows doctors to provide assistance in suicide in certain circumstances, when they assume that the end of life is near or the patient is in the end stage of a terminal illness.’ However, this code are guidelines by the Swiss Academy of Medical Sciences (SAMS) which do not have the formal quality of law, being that the SAMS is a non-governmental organisation which has no power to set law.ⁱⁱⁱ

• ‘…each case of AS results in legal investigation, which costs approximately 3000 Swiss Francs….’ Interestingly, the publication offers no proof for the sum mentioned. Furthermore, the authors imply that a legal investigation occurs because of a presumption that an intentional death is illegal. In fact, legal investigation is initiated by the organisations that provide assistance in dying as a matter of efficient and respectful provision of information about the voluntary nature of the death.

• ‘A draft bill, restricting AS to people who had lived in the Canton of Zurich for….’ However, there has not been such a draft bill, but in fact two people's initiatives in the Canton of Zürich, brought in by two small, purportedly Christian, political parties. Both initiatives were soundly rejected, one by 84 % and the other by 78% of the voters.5

• ‘Organisations such as Dignitas and Exit are still forbidden by Law’ (in the UK and Ireland). In fact, there are organisations quite similar to Exit and Dignitas in the UK. Two examples are SOARS6 and Dignity in Dying.7 While it is the case that these organisations do not provide assistance in all of the ways that Dignitas and Exit do, the authors’ statement misrepresents the purpose and primary activities of organisations such as Dignitas and Exit. All such organisations are dedicated to preserving life with dignity; they do not provide assistance with dying ‘on demand’ or as a matter of first recourse. In fact, despite the long-established avenue of accompanied/assisted death by Swiss self-determination membership societies, such as Exit and Dignitas, deaths in Switzerland with such assistance account for only about 1% of all deaths each year, the latter being a stable number of around 60 000 for many years.8

Much is at stake when researchers, through sloppy research methods and analysis, mislead other researchers, news media and the public. Information about the study by Gauthier and coworkers has been disseminated outside of Switzerland and misrepresents the factual and legal situation of assisted dying in Switzerland.9 ,10 With their very use of the term 'suicide tourism', Gauthier et al set a tone of disrespect for people who—far from enjoying a tourist's experience of Switzerland—are confronting momentous decisions for themselves and their families. Even if these researchers did not themselves develop the term, each researcher bears responsibility for respectful reference to people making lawful decisions. This is true even if the researcher would choose differently for him or herself. Indeed, this is the foundation of reliable research. These researchers’ bias is evident and discrediting by their use of a derogatory term for the subjects of their research.

Unfortunately, the Gauthier study is not the only significantly flawed study of assisted dying in Switzerland. Common characteristics of these studies are inclusion of researchers already biased against the idea of providing assistance with dying, with the bias often originating in religious beliefs held by the researcher. An example is that of the National Research Programme ‘End of Life’ (NRP 67).11

In 2010, when Federal Council member Eveline Widmer-Schlumpf failed in her attempt to push through her proposal for a very restrictive law on assisted dying for Switzerland, the defeated opponents of freedom of choice in 'last matters' looked for new ways to undermine the long-established legal status quo and practice of assisted dying in Switzerland. Being that on Federal just as much as on Cantonal Zürich level clear politician's and people's majorities voted against a change of the law,12 the way it has existed for many decades,^iv infiltrating institutions which are not in direct public focus and which are assumed to consist of scientists and experts, became a new playground for these opponents. Interestingly, quite a number of new 'experts' appearing in such institutions and projects are not from Switzerland—but expatriate Germans and several of them with a theological background.

Markus Zimmermann-Acklin, a catholic moral-theologian from Germany lecturing at the University of Fribourg, was elected president of the steering committee of the NRP 67.13 In his dissertation,14 he has rejected ideas of assisted dying.

Of the initially 27 research projects15 within the NRP 67, some 40% fully or partially dwell on this issue of assisted suicide.16 But only one of all these projects anticipated research cooperation with Swiss self-determination members’ societies. These societies have over 30 years of experience in the field and can reach out to some 100 000 members.17 This one project called ‘Assisted suicide in Switzerland—Developments over the last 30 years’, in which Thomas Reisch and Christine Bartsch (two of Gauthier's coauthors) are involved, started with Exit (in Zürich) and Dignitas cooperating. However, it soon became obvious that the project lacked a sufficiently independent and scientific approach. After detection of further inconsistencies, it all resulted in a (still ongoing) court case against the Swiss National Science Foundation (SNSF),18 which is the Foundation leading the NRP 67, a joint press conference of the Swiss self-determination societies, and a subsequent break in cooperation with this project and the NRP 67.^v

The study by Gauthier et al comes after an earlier study on assisted suicide by the SNSF, in which Thomas Reisch was also involved: ‘Suicide assisted by right-to-die associations: a population based cohort study’19 which also included several inaccuracies and suspect conclusions.20