By Ruth Horn.
On 26th April 2020, the German Constitutional Court overturned a law of 2015 prohibiting ‘any business-like assisted suicide’. This included any potentially recurring suicide assistance that might be provided, with or without commercial interests, by a doctor, nurse, relative or member of a right-to-die organisation. Although suicide and therefore also assisted suicide are not a criminal offense in Germany, a person providing another person with a lethal drug could be found guilty of an offence under the law on drugs, and a doctor providing suicide assistance could be sued for medical negligence. The 2015 ban of ‘business-like’ suicide was an attempt to respond to the ambiguity in law that has led, in the past, to a series of events where individuals or right-to-die organisations tried to test the limits and establish organised suicide assistance.
A number of plaintiffs including patients, palliative doctors, lawyers and right-to-die organisations brought the case before the highest Court, complaining that the 2015 law could criminalise ethically and socially accepted standards in medical practice (e.g. use of high doses of pain treatment and withdrawing treatment), and violate the right to dignity and self-determination. The Court’s ruling confirmed that the ban of ‘business-like assisted suicide’ is unconstitutional because ‘[t]he right to a self-determined death involves the liberty to take one’s own life. The individual’s decision to end his/her own existence according to his/her understanding of quality of life and meaning of his/her own existence ought initially to be respected by the State and society as the act of autonomous self-determination. […] The autonomous determination of [the ending of] one’s own life is the direct expression of the idea of free personal development that is intrinsic to human dignity.’
The high priority given to respecting autonomy, dignity and free personal development echoes the first principles of the German constitution as well as the influence of the recent German history, i.e. the practices of Nazi doctors that led to the establishment of the ethical principles fixed in the Nuremberg Code. Nevertheless, the rejection of the ban of ‘any form of business-like assisted suicide’ raises important ethical questions about the autonomous nature of the suicide where the assistance involves commercial interests or leads to uncontrolled provision. In order to protect the autonomous character of suicide and guarantee good ethical practice, a regulatory framework needs to be in place, which is the focus of my recent paper for the Journal of Medical Ethics.
Author: Ruth Horn
Affiliations: The Ethox Centre; Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford.
Competing interests: None