Assisted dying and suicide: “We as a society have to take a look”


Status: 06/24/2022 10:56 a.m

The Bundestag is debating the legal regulation of the right to take one’s own life and to be helped in doing so. Expert Schneider explains why this can lead to more suicides – and how politics should counteract this The Bundestag overwrites its debate with the title “euthanasia” – but also wants to enable help for suicide in every situation: Shouldn’t it be called “suicide assistance”?

Barbara Schneider: Absolutely. This is specifically about assisted suicide, not just about helping the terminally ill die, as is provided by palliative medicine, for example. Euthanasia includes letting someone die when they drop out of therapy. In the Bundestag, however, help with assisted suicide is being discussed. The draft laws then create legal access to drugs for those who want to die, as is used in the USA, for example, for the execution of people sentenced to death. That’s something different.

Cutter: Assisted suicide is about helping people to kill themselves, including by providing and procuring the deadly drug.

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To person

Prof. Barbara Schneider is the Director of the National Suicide Prevention Program for Germany. The chief physician in the Dependency Disorders, Psychiatry and Psychotherapy Department of the LVR Clinic in Cologne has many years of practical experience in the treatment of those at risk of suicide. Her scientific interests include suicide prevention, risk factors for suicide and suicidality. The Federal Constitutional Court has strongly emphasized the individual’s right to self-determination. That includes deciding when and how to end life – and getting help to do so. Do you support this broad definition from your work with suicidal people?

Cutter: That is certainly a very far-reaching concept of autonomy. The Federal Constitutional Court also included the concept of free responsibility in this judgment. According to Karlsruhe, the decision must be carefully considered, but there must be a certain firmness and permanence in the decision. The person must also be advised on other possible solutions – and there must be no outside influence and no acute mental disorder. In your opinion, does politics really have to make a regulation on assisted suicide after the judgment in Karlsruhe?

Cutter: This is very controversially discussed by various interest groups. What we from the ranks of suicide prevention consider necessary in any case: that there is a legal anchoring of suicide prevention parallel to this. This is not available at the moment – and is only mentioned as a recommendation for one of the three draft laws.

Cutter: In any case, the priority must be to strengthen suicide prevention structures in Germany. Especially in view of the high numbers that die every year in Germany – more than 9,000 people. We also assume a high number of unreported cases. And given that up to 30 times as many people attempt non-fatal suicide each year.

“Volatility and Impermanence of the Desire to Die” How sustainable does the wish to die then remain for these survivors?

Cutter: There is extensive research showing that out of 100 survivors of a suicide attempt, only 28 attempt another within ten years, of which only five actually die. This shows the volatility and impermanence of the wish to die. In practice, we often meet people who are temporarily cognitively restricted when they wish to die. This seems like a definite determination, but it often isn’t. Politicians want to regulate this, probably to prevent worse things from happening, but also to prevent the current lack of transparency in the measures – do you still see a need for improvement in the draft laws?

Cutter: From the perspective of suicide prevention, the term counseling and counseling structure is addressed in all three bills. We see this as very problematic. There are many psychosocial counseling centers, some of which are voluntary, where there is a great deal of suicide prevention expertise, but they are voluntary and often not sufficiently funded. We need financial security for the existing structure. Counseling before a possible suicide plays a crucial role. Why? Surely the person willing to die has already made his or her own free decision?

Cutter: That is a mistake. There is an ambivalence between ‘not being able to go on living like this’ and ‘not wanting to die’. People cannot go on living like this in the given situation. However, we know that changes can relieve the suicidal pressure to act – internally as well as externally in the environment of those affected. Be it through relationships with other people or an improvement in the external situation, such as a debt problem. Loneliness is often a reason to want to end life. Do you anticipate an increase in suicides, as happened with liberal legislation in Belgium and the Netherlands? It would sort of be a normal way to die?

Cutter: Unfortunately, one has to assume that. There is extensive scientific literature that indicates that suicide rates have increased in almost all countries. This is after legislation on assisted suicide became more liberal. Unassisted suicides increased, although assisted suicide is available there.

“The threshold is getting lower” How can this be explained? Because this way of dying is no longer a taboo?

Cutter: There is a very recent study that confirms what has been observed in practice for some time: it is assumed that people’s attitudes towards suicide are changing. And precisely in those countries where legislation is becoming more liberal. The threshold for unaided suicide is getting lower. Every year around 10,000 suicides occur, which corresponds to a plane crash over Germany about every 14 days – is society already doing enough to prevent suicide?

Cutter: Much of suicide prevention takes place in the voluntary sector. In order for society to be able to do something, it needs a lot more knowledge about how much you can help. Instead, myths persist: that if someone is suicidal, it will remain so. It is also wrong not to talk about it openly – for fear of bringing the person to this step first. The opposite is the case. As a society, we have to take a closer look and seek dialogue with those affected.

The interview was conducted by Corinna Emundts,

If you are having suicidal thoughts, please seek help immediately. With the anonymous telephone counseling service you will find contact persons around the clock. Telephone numbers of the telephone counseling service: 0800/111 0 111 and 0800/111 0 222

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