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The involvement of a physician is usually considered a necessary safeguard in assisted suicide and euthanasia. Legislation in Holland, Belgium, and the US state of Oregon all require it, as did the legalisation of euthanasia in Australia's Northern Territories. 1 â[euro]" 4 Physicians are trusted not to misuse these practices; along with pharmacists they are in control of prescription drugs. Physicians are believed to know how to ensure a painless death, and they are in a position to offer palliative care knowledgeably.
Switzerland seems to be the only country in which the law limits the circumstances in which assisted suicide is a crime, thereby decriminalising it in other cases, without requiring the involvement of a physician. Consequently, non-physicians have participated in assisted suicide. The law has explicitly separated the issue of whether or not assisting death should be allowed in some circumstances, from that of whether physicians should do it. This separation has not resulted in moral desensitisation of assisted suicide and euthanasia.
Summary points
Most legislation condoning assisted suicide or euthanasia stipulates that a physician must be involved
The acceptability of voluntary death is not entirely contained within the framework of medicine
Assisted suicide is not a criminal act under Swiss law if it is motivated by altruistic considerations
Sharp controversy surrounds assisted suicide in Switzerland, but the few data that exist suggest that the public supports it
Methods
We describe the history of the Swiss law for assisted suicide, the current debate, and the existing data on euthanasia and assisted suicide in Switzerland. This review is based on the relevant literature and on the experience of participants in these debates.
History of the Swiss law
In 1918, a comment by the Swiss federal government on the first federal penal code stated: "In modern penal law, suicide is not a crime â[euro]¦ Aiding and abetting suicide can themselves be inspired by altruistic motives. This is why the project incriminates them only if the author has been moved by selfish reasons." 5 At the time, the attitudes of the Swiss public were shaped by suicides motivated by honour and romance, which were considered to be valid motives. Motives related to health were not an important concern, and the involvement of a physician was not needed....