by Prof Mark Taubert, Consultant in Palliative Medicine and Vice-President of the European Association for Palliative Care

Alice and Ellen Kessler, the 1960s pop stars, have died by joint suicide at the age of 89. The identical twins chose to have a joint assisted death at their home in Grünwald, close to Munich, in mid November. The sisters were famous, in Germany, in the United States, but especially in Italy where they were credited for bringing glamour to the country’s television networks. Born in 1936 in Nerchau, Saxony, to parents Paul and Elsa Kessler, the girls started ballet classes at the age of six and then joined the Leipzig Opera’s child ballet program at age 11. In 1952, aged 16, their parents used a visitor’s visa for the family to escape East Germany. The twins became very successful in the West, famously performing at Eurovision, later appearing with Frank Sinatra, and they also posed for Playboy magazine.

Assisted suicide is legal in Germany, and is run by charity-funded assisted dying organisations, and operates outside the German healthcare system. The Kessler twins were reported to have been accompanied at home by a physician and a lawyer. They drank the suicide cocktail. The lawyer then phoned the police, as per local protocol, who attended and investigated the double-death, again, as per protocol. They found no cause for concern and the twins were pronounced dead.

Germany’s federal constitutional court decriminalised assisted suicide in 2020, deciding that personal autonomy must be the overriding concern when granting individuals permission to go through with it. Every person, according to this court ruling, should be allowed to decide for themselves whether they wish to take their own life, and that getting help from third parties would not be a criminal act.

Whilst the Kessler twins’ assisted suicides appear to have been free of complications, it has been notable that neither had a terminal illness. Germany has seen a number of assisted dying cases in recent years that have caused significant public concern and that have made their way through the German legal system. For instance in 2024, physicians were sentenced to three years in prison for assisting the suicides of patients deemed not mentally competent to take their own lives. Both patients had histories of significant psychiatric illnesses. Whilst in both cases, assisted dying organisations had rejected their requests for assisted suicide, these physicians decided to branch out on their own and assist anyway as ‘private individuals’. It raised the question whether Germany’s permissible law was emboldening some doctors to go a few steps further into greyer areas, including supplying patients with questionable mental capacity with lethal drugs.

German law makers have been finding the ‘free will’ element – Freiverantwortlichkeit –  in assisted suicides, a particular challenge to define and agree on. The Kessler twins perhaps knew exactly what they wanted and had a clearly defined ‘free will’ to end their lives. In a letter written two days prior to their deaths, they explained their decision and further wrote: “It will surely spare us a great deal”. They scheduled their date of death for the 17th of November 2025.  According to the letter, which was received by a friend, Carolin Reibe, both feared a future life in which they no longer had the full control over their bodies and minds. Reibe further explained that the identical twins had cardiovascular problems and had lost their sense of taste and smell.

But former German Health Minister Karl Lauterbach, who describes himself as a supporter of assisted dying, called for much clearer legal regulations in Germany. In the news outlet Rheinische Post he explained that, without much clearer laws, there could be no assurance that individuals choosing assisted deaths were free from mental illnesses that impair their current judgment. Psychological soundness, autonomy, and the absence of other commercial interests needed to be guaranteed. He went on to say that the current situation in Germany allows forms of assisted suicide that are ethically unacceptable.

This is underlined by a study that was published tracking assisted deaths in Munich, published in 2023. Out of 77 assisted dying cases identified, only one individual had an acutely life-threatening condition prior to their death. Furthermore, researchers found that half of the assisted deaths where there had been previous, non-assisted dying suicide attempts, were not pre-examined by psychiatric specialists.

The UK is currently going through the process of potentially introducing an assisted dying law, with much discussion in parliament on whether more or less regulation is better. Proponents say that regulations cause barriers and red tape for individuals wanting to access an assisted death, whilst opponents point out the vulnerabilities in our society, as well as our health and care system. The Kessler twins have sparked a debate in Germany with many concerned that the law there is too unclear and poorly defined. Concerns also remain that those who are less certain, or lack decisional capacity, and are perhaps more vulnerable to being persuaded by third parties, including their own family members, will avail of this service.

Celebrities across the world, including here in the UK, have been weighing in heavily, wishing to support a law that will permit them to end their lives with medical assistance. What we lack, even from jurisdictions where this is legal, is evidence on how it affects vulnerable populations. Concepts like autonomy and ‘Freiverantwortlichkeit’ may be more straightforward for the successful, wealthy and strong-minded who are in the public eye. But it can be a minefield for those who have less resources and may be experiencing pressure to do ‘the right thing’.