748 cases of suicide assisted by a Swiss right-to-die organisation

In Switzerland, nonmedical right-to-die organisations offer instruction and personal guidance in committing suicide to members suffering from incurable diseases. Suicide is usually committed with a lethal dose of barbiturates prescribed by a physician. This study is a retrospective analysis of all case files of assisted suicide kept during the period 1990-2000 by "Exit Deutsche Schweiz", the largest Swiss right-to-die organisation.

Between 1990 and 2000 Exit assisted in 748 suicides among Swiss residents (0.1% of total deaths, 4.8% of total suicides). 54.4% of the deceased were women. Mean age at death was 73 years in males and 72 years in females (range 18-101 years). Assisted suicide was over-proportionately represented in the German-speaking (p <0.0001), more urbanised (p <0.0001), predominantly Protestant (p <0.0001) cantons. Over the study period the annual number of Exit deaths more than tripled (p <0.0001). Of the 331 who died in Canton Zurich, 47.4% had cancer, 11.8% cardiovascular/respiratory disease, 12.4% neurological disease and 7.3% HIV/AIDS. The remaining 21.1% suffered from other, usually non-fatal conditions; 76% of these were women. There were no significant changes in sex, age and distribution of diagnoses during the study period. At first all the lethal substances were taken orally, but by the end of the study period 14% were administered via infusion or PEG catheter. All assisted suicides in the City of Zurich were duly notified to the authorities.

The number of suicides assisted by "Exit Deutsche Schweiz" and the practices followed markedly expanded over this time. There was no apparent relaxation of the indications for assisted suicide. Notification of the authorities appeared to be total.