Death — there it is again. Germany's Constitutional Court has pulled death from the taboo zone, and that's a good thing. Because death is part of life, and everyone has to face it at some point, on or beside a deathbed.
The court in the city of Karlsruhe has overturned the ban on "business-like" assisted suicide and declared paragraph 217 of the penal code unconstitutional. The judges made it clear that the right to a self-determined death is part of the development of the right of personality, which is anchored in Germany's constitution, the Basic Law.
What is 'business-like' assisted suicide?
The ban on "business-like" assisted suicide, introduced in 2015, has lasted only five years. The legal definition of the term had led to a lot of uncertainty —many doctors, palliative care doctors, nurses and assisted-suicide associations demanded clarification because they felt they were being criminalized.
Legislators are now called on to make improvements. The ruling has once again opened the debate on assisted suicide in Germany. At last! A recent debate on donating organs shows how overdue the debate on death is in this country. About 850,000 people die every year in Germany. Death can't just be delegated to palliative care wards, we have to deal with it it everywhere.
Do terminally ill people need assistance when dying, or to die or both? What are the arguments for or against assisted suicide, active or passive? Do people have a right to assisted suicide? These questions must be answered by society as a whole.
No to 'killing by request'
Note that the decision is not about active assisted suicide as it is practiced in Belgium, the Netherlands and soon also in Portugal. Actively causing someone's death on request is banned by paragraph 216 in the German penal code. It is about balancing the right to a self-determined death on the one hand and the state's duty to protect life on the other.
Dying can be cruel. While nobody can take away the fear of death, one can alleviate the fear of being left alone when dying. Over the past two years, I have seen three close family members die. They did not want life-sustaining measures or being fed through a tube, but above all, they did not want to be in any more pain.
Despite everything, they fought for every minute of their lives, for themselves and also for their loved ones. Palliative care helped them keep their dignity in their struggle until the end. For that, I am deeply grateful.
However, terminal care and dealing with death also shows that there are cases of immeasurable suffering, where palliative care reaches its limits. In these cases, it is important for patients, doctors and relatives to know that they can end unbearable suffering when all treatment options have been exhausted.
Can Oregon be a model?
Knowing it is a possibility can be a relief, even if the option is never exploited. LIke in the US state of Oregon, where assisted suicide is generally punishable — unless carried out and documented by doctors under strict precautions.
A life-ending medication can be provided, but the patients must be able to take it themselves. Only one third of those affected have made use of the option.
I admit that you are never really prepared for death, even if you have had years to think about it. It helps to look death in the eye, be it by dealing with the issue of a living will, organ donation or assisted suicide. Ideological or religious feuding are not helpful on a person's deathbed. What counts are the wishes and the dignity of the dying person, the relatives' grief and the longing to be allowed to die in peace.