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Assisted suicide: Germany weighs autonomy and ethics

Lisa Hänel | Rina Goldenberg
July 4, 2023

Accompanied suicide ― a form of assisted suicide ― has been exempt from punishment in Germany since 2020. The Bundestag is working on a law covering the practice. Will the country become a pioneer in end-of-life choice?

A glass vase holding a single white flower
Image: Gudrun Krebs/Pahnter Media/picture alliance

Should individual autonomy include the choice to die? In 2020, Germany's Federal Constitutional Court determined: Yes, autonomy is the overriding concern. Every person can decide for themselves.

Any person helping an individual who has chosen to end their life cannot be penalized for doing so. The condition, however, is that the person who ends their life makes that decision freely and carries full responsibility.

Previously, section 271 of the criminal code —  introduced after much debate in 2015 — made assisted suicide almost impossible in Germany, as it stipulated that anyone who aided someone to take their own life could be jailed for up to three years. That law was intended to stop assisted suicide associations, which gather money from their members.

But since the 2020 judgement, such associations have been operating with impunity in Germany, offering accompanied suicide or arranging medical assistance.

What makes assisted suicide so controversial?

Now, the Bundestag — Germany's federal parliament — is launching a new attempt at regulation. Two draft laws are being put forward for parliamentary debate this week.

One of the drafts proposes that assisted suicide be fundamentally punishable by law but allows for possible exceptions. These include that the person who wants to die is an adult, has been examined at least twice by a specialist in psychiatry and completes a counselling interview several weeks before making a decision.

The other draft proposes to enshrine the right to self-determined death in law. Under this plan, there would be no criminal regulation for assisted suicide. People wanting to die should receive access to lethal drugs if they had previously sought counseling. In extreme cases, when there is an existential state of suffering with persistent symptoms ― a doctor should be allowed to prescribe the medication even without prior counseling.

Assisted suicide in other countries

Assisted suicide refers to the procedure when someone who is willing to die is provided a fatal drug and administers it to themselves.

Actively administering a fatal drug to another person, however, is and remains illegal. Such assistance in dying, sometimes referred to as voluntary euthanasia, remains prohibited in Germany, where the concept is seen to hark back to the time of the Nazi regime, where thousands of disabled people were killed in a program of mass murder by involuntary euthanasia.

In Netherlands and Luxembourg, for example, it is allowed to administer fatal drugs to a patient upon request. And recently, Portugal's parliament approved assisted suicide.

The debate on how to regulate assisted suicide is a phenomenon in the industrialized countries of Europe, North America, and Australia, Lukas Radbruch, one of the leading palliative care doctors in Germany, told DW.

"These are the countries where the laws are changing because autonomy is the dominant value. Other countries have more collective decision making. Families are much more strongly involved," and in these places, assisted suicide is much rarer, he explained.

The right to die: Autonomy until death

Lea Koch, who asked to use a pseudonym to protect her identity, is in her early seventies. She is a suicide companion. Hardly anyone in her circle of friends and family knows about her volunteer work.

Three years ago, a woman who was paraplegic asked Koch whether she was willing to accompany her to her death. She agreed, and the time that followed also changed Lea Koch's own life. When the woman died, her last words were "Thank you, thank you, thank you."

With every person Koch attends to, she asks herself whether she is doing the right thing. She will not reveal how many people she has accompanied in their deaths, but an eternal candle burns on her terrace in remembrance of them.

"So far, I have always experienced the assisted suicides as very peaceful," Koch told DW, "because these decisions have been very well-considered."

Assisted suicide associations play a delicate role

There are several assisted suicide associations in Germany. Some of them are transparent about how many people they help to die. The "Verein Sterbehilfe" (assisted suicide association) took part in the deaths of 139 people last year. The German Society for Dying with Dignity (DGHS) conducted 229 accompanied suicides. The vast majority were people with severe physical illnesses.

The DGHS says it proceeds very carefully. Multiple conversations with lawyers and doctors are involved to make absolutely sure that the person wants to die of their own free will.

Since the judgement of the Federal Constitutional Court, they have received a lot of positive feedback from members and their relatives. 

"Many say that it is for themselves, for the families, a great relief that things can come to an end in the way that they want them to, without the feeling that they are stepping outside the law or the need to travel to Switzerland for the procedure. We are already hearing a lot of thankfulness for this," Wega Wetzel from the DGHS told DW.

Fundamental ethical questions

However, some palliative care specialists and ethicists think that it is not a good sign that the same people counseling patients on their end-of-life choices are also the ones carrying out or mediating assisted suicide.

"The problem with consultations at assisted suicide organizations is that people are more likely to be advised on how to do it, not whether to do it," Radbruch said.

For philosopher and medical ethicist Jean-Pierre Wils, all practical questions also raise very fundamental ethical questions: For example, the ruling of the Federal Constitutional Court does not specify any criteria for the wish to die. Theoretically, physically healthy people could avail themselves of assisted suicide; even age is also no barrier. Does it suffice when a person, as the court calls it, has "had enough of life?" In fact, the Verein Sterbehilfe states that in 2022, three people without any illness had an assisted suicide.

A person's individual autonomy is the central criterion, Wega Wetzel from the DHGS maintains: "If the right to self-determination is highly valued throughout life, that should also be the case at the end of life."

Editor's note: If you are suffering from serious emotional strain or suicidal thoughts, do not hesitate to seek professional help. You can find information on where to find such help, no matter where you live in the world, at this website: https://www.befrienders.org/

This article was originally published in German.

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