For years there has been a struggle in Germany about regulations on euthanasia. On Thursday, two bills presented for this purpose in the Bundestag failed to achieve a majority. New proposals could be drawn up in the near future – even without a legal framework, euthanasia offers are still legally possible. Green MP Renate Künast made it clear that she does not expect another attempt in this electoral term. Her FDP colleague Benjamin Strasser said that with a little distance one would discuss whether and how for a new start.
Active euthanasia is currently a punishable offense in this country. However, the termination of life-sustaining measures is permitted if this corresponds to the will of the patient, as is indirect euthanasia. This is spoken of when it comes to relieving a patient’s pain and the corresponding drugs result in his dying earlier. Assisted suicide is also not punishable – it can consist of obtaining or providing a lethal drug, but the patient takes it himself.
In 2021 alone, euthanasia organizations active in Germany helped with almost 350 suicides, according to a report presented in early 2022 by the German Society for Human Stuffing (DGHS), among others.
What are the experiences in other countries like Switzerland and the Netherlands, where active euthanasia has been allowed for a long time?
In Switzerland, the number of assisted suicide cases has been increasing sharply for several years, says Markus Zimmermann from the University of Friborg (Switzerland). The development is comparable in Belgium and the Netherlands. There are currently around 1,300 cases a year in Switzerland, not counting the deaths of those who wish to die from abroad.
“In my opinion, in the discussion in Germany far too little – namely not at all – is spoken about the person helping and their motives,” explains ethics professor Zimmermann. From an ethical point of view, however, this is the decisive point if one accepts assisted suicide in principle. “Is the person acting out of compassion, caring, making money, other reasons?” Suicide assistance cannot be provided after an hour of discussion like on an assembly line. If euthanasia becomes a medical service, as in the Netherlands, that would be precarious for the medical profession.
The Netherlands was the first country in the world to allow killing on demand more than 20 years ago. Doctors there can, under certain circumstances, end life if they wish or assist in suicide. According to the so-called RTE report, 1885 cases were still counted in 2003, but by 2013 there were already 4829. For 2021, 7666 cases of euthanasia were recorded – which, according to the information, corresponded to 4.5 percent of all deaths in the Netherlands in that year. There, euthanasia is possible for children from the age of twelve.
The euthanasia law in Belgium is even more liberal: in 2014 the age limit was completely abolished here. According to a 2015 study from the country, not only did the number of requests for euthanasia increase significantly from 2007 to 2013, but so did the number of permits – a finding that critics see as evidence that supply creates demand.
In addition, the proportion of older people in general and those living in old people’s homes increased. Efforts to make euthanasia available to older people who are not terminally ill but no longer have the will to live are already being made in the Netherlands, for example. According to a study by the local Ministry of Health, the majority of people with such a desire are women, and many are poorly educated. Factors mentioned included feelings of being a burden to others, loneliness and money worries. For half of those surveyed, the death wish fluctuated, partly depending on the time of year.
What must be avoided in euthanasia regulations, but cannot be prevented by any law in the world, is a “politically initiated, insidious, systematic, commercial euthanasia that, despite legal restrictions, can be triggered solely by the advertising offer and can slip into an automatism “, says Christine Bartsch from the Berlin School of Economics and Law. It should not happen that people feel under pressure to use euthanasia so as not to be a burden to anyone or cause unnecessary costs.
In Switzerland, the lobby of assisted suicide associations is already huge, explains Bartsch, who holds a professorship in forensic medicine. The associations would introduce one legislative initiative after another in order to be able to expand their business to as many institutions as possible, such as old people’s and nursing homes, hospitals and hospices. “Once the doors and gates have been opened to these clubs, from our research perspective there is actually no stopping and, above all, no more control.”
In Germany it is important to determine who is allowed to give help when dying, what this should look like in concrete terms, what it may cost and who pays for these costs. Is it about medical professional groups or unknown club players with business activities and high remuneration per case? Should assisted suicide become a health insurance benefit or remain a private matter? “Those are definitely the most important questions.”
A new regulation is necessary in Germany because in 2020 the Federal Constitutional Court overturned a ban on commercial euthanasia that had existed since 2015. It saw the individual’s right to self-determined death violated. “Business-like” does not refer to a financial aspect, but means “designed to be repeated”. The verdict opened a door for organized offers.
The chairman of the German Bishops’ Conference, Georg Bätzing, had promoted a culture of life affirmation and mutual care in the run-up to the vote on Thursday. “As a society, we have to make sure that no situation arises in which an elderly or sick person or a person in an existential crisis finds a good infrastructure of suicide assistance rather than sufficient and appropriate framework conditions to trustfully go into care,” said the bishop.
