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In its ruling on Friday, the Constitutional Court (VfGH) lifted the criminal responsibility for “participation in suicide” (Article 78 of the Penal Code) with effect from January 1, 2022. The crime of “participation in suicide” violates the right to self-determination, according to the highest court. The Constitutional Court determined that it was unconstitutional to prohibit any type of suicide assistance without exception. However, article 77, “kill on demand”, remains a crime.
Four plaintiffs, including two seriously ill and a doctor, had sued the Constitutional Court. They challenged both paragraphs. They invoked, among other things, the right to life, the prohibition of torture, human dignity, the right to self-determination and the right to privacy. Constitutional judges had to weigh these rights and the duty of the state to protect vulnerable people. The federal government had raised this as an argument in favor of keeping the bans. The prohibition of active euthanasia serves to protect the lives of others, according to the argument.
The plaintiffs, supported by an attorney, placed personal autonomy and freedom of choice as a valuable asset. According to his argument, the state should not have the right to dictate to the people how they wanted to die, or whether they wanted to suffer or not. The main argument from the opposite side: allowing active euthanasia opens a wide range of possibilities for abuse. Sick people may be subjected to social pressure to commit suicide, for example, so as not to “become a burden” on their relatives.
Pressure on people could increase
Bioethicist Susanne Kummer of the Institute for Medical Anthropology and Bioethics assumes that killing on demand was possibly “too hot a topic” for the VfGH. “I think it is the best solution if critical individual issues are not decisive for the legal basis. In general, it is good for a society to give priority to the protection of life,” Kummer tells the “Wiener Zeitung”.
The bioethicist also sees a “queue of other problems” that go hand in hand with the now permitted assisted suicide: “It is about the pressure on people in crisis situations who are physically or mentally handicapped, very old or disabled. So he says to people: “You can choose not to be a burden to others.” With the legalization of active euthanasia, a fundamental argument for seeking alternatives is lost. “If the state now extends its hand to commit suicide, killing on demand cannot be stop in the medium term. “
Because as clear as the legal distinction between the two paragraphs sounds, the practice is not. “There are always gray areas.” If, for example, poison is put into the mouth of someone who can no longer put it in their mouth, on the grounds that it can be swallowed or spit out, the question arises as to whether that is still help or murder on demand.
Passive euthanasia is allowed in Austria
Kummer’s alternative is to refuse medical treatment: “The decision of which therapy is not desired is always up to the patient.” There are also living wills and power of attorney: “This means that a person I trust can enforce my wishes and my rights when I can no longer do it myself.” Passive euthanasia is not a direct murder and is permitted in Austria.
Assisted suicide or homicide on demand is currently legally permitted in Switzerland, the Netherlands, Luxembourg, Belgium, Canada, some US states, and Australia, Colombia, and more recently Germany. That may go hand in hand with a growing number of suicides, Kummer says. The example of Switzerland shows, for example, that more than 900 of the 2,000 suicides a year were carried out with the support of euthanasia associations. In the Netherlands there were 17 active euthanasia cases per day in 2019.
In Austria, the rate of suicide reports is decreasing. In 1986 there were 2,300 cases per year, in 2018 it was around 1,200. Yet that is still nearly three times as many fatalities as in road traffic.
Kummer fears that active euthanasia could act as a trigger: “The threshold sinks with the possibilities. We observe that this initiates a cultural change: the caring community is replaced by a dictate of action.” Especially in an aging society with increasingly scarce resources, it is a wrong signal: “It is also cynical to present this to the people as the cheapest option for the state.”
There is no evidence that abuse is increasing
Viennese lawyer Wolfram Proksch, who represented the plaintiffs before the VfGH, contradicts Kummer’s argument. He also finds untenable the frequently made argument that impunity for active euthanasia opens the door to a far-reaching risk of abuse: “There is no evidence anywhere in the world that abuse has occurred on a relevant scale in a country with regulations more liberal, “he says. him in conversation with the “Wiener Zeitung”.
Abuse is always possible in all areas of human coexistence and can never be completely prevented with criminal prohibitions. In this argument, the lawyer sees “scare tactics”: “The sale of kitchen knives should also be prohibited, with which many women are murdered every year.”
The “dam breaking argument,” according to which the number of cases is drastically increased by allowing assisted suicide, doesn’t work for Proksch either. “In Switzerland, where euthanasia has been allowed for 50 years, this fear has not been confirmed,” he says, contradicting the bioethicist Kummer. The number of suicides there would stagnate at the same level. According to Proksch, the number of people who have moved there through “death tourism” and in whose countries of origin assisted suicide is prohibited, but not the number of Swiss suicides. “You have to make a clear distinction.”
“Palliative medicine offers good opportunities”
“My end belongs to me!”, The “Austrian Society for an End of Human Life” (ÖGHL) argued against paragraphs 77 and 78. Kummer, on the other hand, speaks of an inflated concept of self-determination. “Self-determination is a very valuable asset. We do not live on an island of blessed autonomy, it depends largely on the environment.” People with suicidal intentions also give less physical pain as legitimation: “The most common reasons are loneliness, loss of autonomy and others are a burden – more than 90 percent,” says Kummer. “My appeal would be for the state to do its homework in palliative care and expand psychiatric care.”
Herbert Watzke, Head of the Clinical Department of Palliative Medicine at the Vienna General Hospital, who was summoned by the Federal Government to provide information to the VfGH, also sees it this way. Palliative medicine offers good opportunities to allow a dignified death. The multiple experiences of his work are also: “Healthy people believe that one day they will need the possibility of assisted suicide. With the sick we later see in the hospice unit, one gets the impression that they don’t need it. “Often they wouldn’t even take advantage of the palliative sedation that they can get there, says Watzke.
Bad timing in the crown crisis?
It is also problematic for Kummer to talk about euthanasia amid the crown crisis, in which there are more mental illnesses and also suicides. The October survey conducted by the Department of Psychotherapy and Biosocial Health at the Danube University in Krems shows that psychological stress has increased significantly in the pandemic. While four percent of the population had depressive symptoms last year, it was 20 percent in September.
According to Peter Stippl, president of the Austrian Federal Association for Psychotherapy, the unemployed are particularly affected. They show depressive symptoms 70 percent more often than those who are also not materially threatened in their existence.
Until the spring, as in other years, it will not be statistically evaluated how much the number of suicides has increased. Stippl knows, however, “that we are noticing an increase in the suicide rate among colleagues. That would also correspond to the international trend and past crisis experiences.” And: a high unemployment rate always goes hand in hand with a high suicide rate.
“The longing for death is often only a short term”
On the other hand, it is more optimistic to realize that when unemployment ends, depressive symptoms also usually go away on their own. In general, says Stippl: “For most of them, suicidal tendencies are a temporary set of symptoms that last between six and twelve weeks, even into old age. When people survive this critical period, they often experience a change. 180 degrees later. ” Even bipolar disorder, where the tendency to suicide is clearly greater, can be controlled with specialized medical and psychotherapeutic treatment. Stippl prefers pain and psychotherapeutic help even in very difficult cases. “There is no sadism behind the rejection of active euthanasia, which wants to make people suffer, but the realization that the death wish is often only short-term.”
Reports and talk of suicides do not necessarily generate copycats, said Gerald Tomandl of the Vienna Crisis Intervention Center. On the other hand. “About 30 percent of everyone who goes to the crisis intervention center has suicidal thoughts. But suicide does not happen, because the issue was analyzed and discussed. Talk about it.”
