What is dying with dignity? And who decides about that? These questions are among the most sensitive that a society can ask itself. In Germany, the Federal Constitutional Court decided in 2020: Above all, every person decides for themselves. Autonomy in dying as the top priority. The verdict represented a radical about-face. Previously, any form of euthanasia was forbidden in Germany. People who wanted to take advantage of them had to go to Switzerland, for example. Since 2020, euthanasia associations in Germany have been operating with impunity, offering assisted suicide or finding doctors. Now the German Bundestag wanted to end the previously unregulated situation and pass a law on it. But after months of deliberations, no majority was achieved.
Euthanasia – this can include many things: getting a drug or self-administering. The difference is crucial: If a person triggers an infusion that directs a deadly drug into the veins, they take advantage of an assisted suicide, also known as assisted suicide. For example, if a doctor administers the drug to him or her, this is active euthanasia. It is still banned in Germany. In the Netherlands, for example, or in Luxembourg, this process is allowed. Only recently the parliament in Portugal approved active euthanasia.
In 2020, the Federal Constitutional Court changed the view of euthanasia in Germany with its judgmentImage: Uli Deck/dpa/picture alliance
Whether active or passive, euthanasia is basically a phenomenon of the industrialized countries of Europe, North America and Australia. “These are the countries where the legislation is changing accordingly because autonomy is the dominant value. Other countries have collective decision-making processes. Families are much more involved,” says Lukas Radbruch, one of Germany’s leading palliative care physicians . He deals with death and farewells every day, sits on an ethics committee and consults with his colleagues about the wishes and suffering of his patients. He would not offer assisted suicide, he could not reconcile that with his understanding of a doctor who should honor and protect life.
autonomy until death
There are rifts that run: between doctors, with lawyers, in society: should the autonomy of the individual include their own death? The Federal Constitutional Court affirms that. However, the prerequisite is that the person makes the decision “freely responsible”. At a time when people can freely and independently decide their path in life, one cannot deny them that in death.
It is a maxim to which Lea Koch has committed her whole life. The early 70-year-old, who actually has a different name, accompanies people to their death on a voluntary basis, she is a suicide attendant. Hardly anyone in her environment knows about her voluntary work. She has only been accompanying people since 2020, since she has been acting with impunity. “If you had asked me three years ago whether I would do that, I would have said: never,” says the resolute woman, who does not want to read any references to her place of residence in an article.
But then a paraplegic woman asked if she would accompany her. After a motorcycle accident, the woman was seriously ill. It was a life-changing time for both of them, says Lea Koch. At the end of it, the woman’s death was with the last words, according to Lea Koch: “Thank you, thank you, thank you.”
To this day, she is moved by the trust that people have in her. And with every person she accompanies, she asks herself if she is doing the right thing. But she can always agree with herself and say: “I’m really behind that.” She doesn’t say how many people died with her, but an eternal candle burns on her terrace to commemorate the people. “I’ve always found the assisted suicides to be very peaceful,” says Lea Koch, “because they are very well-considered decisions.”
Euthanasia associations in Germany
Euthanasia associations and people who carry out assisted suicide were discredited in society for a long time. They would profit from death, making money off the members’ suffering. That has changed somewhat since the judgment of the Federal Constitutional Court, even if the influential churches in Germany are still critical of the associations. There are now several euthanasia associations in Germany. Some disclose transparently how many people accompany them to their deaths. At the “Verein Euthanasia” there were 139 suicide accompaniments last year. At the “German Society for Human Dying” (DGHS) there were 229 assisted suicides last year. Strictly speaking, however, the DGHS is not a euthanasia association, but a patient protection organization that primarily advises on living wills, for example, but also arranges suicide assistance for its members. The vast majority of people with serious physical illnesses make use of assisted suicide services.
In Germany, the demand for assisted suicide has risen sharply in recent yearsImage: Sami Belloumi/dpa/picture alliance
The DGHS says of itself that it proceeds very carefully, several discussions with lawyers and doctors are part of the procedure in order to determine with absolute certainty that the person wants to leave of their own free will. Since the judgment of the Federal Constitutional Court, they have received a lot of positive feedback from their members and their families: “Many say it is a great relief for us, for the family, that it could end the way the person wanted it, without having to has the feeling that one has one foot in illegality or has to go to Switzerland. We hear a lot of gratitude from that,” says Wega Wetzel from the DGHS.
Separate advice and implementation
But for some palliative care physicians and ethicists, it is not a good sign that those who advise about the end are also the ones who carry out or mediate the assisted suicide. “The problem with advice from euthanasia organizations is that you’re more likely to be advised on how to do it, not whether,” says Radbruch.
On Thursday (July 6th) there was no majority in the German Bundestag for a new regulation on assisted suicide. There were two bills. Among other things, it was envisaged that the consultations should be outsourced, not at the euthanasia associations themselves. While one draft law was fundamentally liberal in orientation, the other wanted to regulate assisted suicide again via criminal law and thus regulate it more strongly and strictly.
The parliamentarians Renate Künast (left, Greens) and Katrin Helling-Plahr (FDP) present their draft law on assisted suicide Image: Michael Kappeler/dpa/picture alliance
How do we see death in the future?
For the philosopher and medical ethicist Jean-Pierre Wils, all practical questions also raise fundamental ethical ones: the judgment of the Federal Constitutional Court no longer defines any criteria for the wish to die. In theory, healthy people can also take advantage of assisted suicide, and age is also irrelevant. If a person, as the court calls it, is “full of life,” that’s enough. In fact, the association for euthanasia states that in 2022 three people without illness took advantage of assisted suicide.
A worrying development, thinks Wils: “The verdict has catapulted the debate into a European avant-garde of the discussion about euthanasia.” Because no other country goes as far as Germany when it comes to assisted suicide. “What I fear, which will increase, is the option of suicide as a rational option – so if I want to lead my life as an autonomous person, if I live self-determined, ultimately suicide is a rational option.”
Active euthanasia, killing on request, is and will remain prohibited in GermanyImage: G. Vockel/picture alliance
For suicide attendant Lea Koch, this is an idea that she cannot confirm in practice. “Life is precious. The conversations I had were all so individual. I don’t see imitation effects.” But: The criterion of fullness of life is a legitimate justification for them. She can understand if someone wants to leave after a long life. However, age does play a role for her.
And even if you ask the DGHS, the central criterion is human autonomy: “If the right to self-determination is a very valuable asset throughout life, that should also be the case at the end of life,” says Wega Wetzel.
For some, like the philosopher Jean-Pierre Wils, this leaves an uneasiness. He fears that suicide and assisted suicide will be normalized: “The whole tragedy and drama of suicide disappears. There is a certain normalization effect.”
These are fundamental questions that will only become more pressing in the future. Figures from the Netherlands already show that more and more people want to use euthanasia.
This article was published on 7/2/2023 and updated on 7/6/2023.
Deutsche Welle reports cautiously on the topic of suicide, as there are indications that some forms of reporting can lead to imitation reactions. If you are having suicidal thoughts yourself or are in an emotional distress, do not hesitate to seek help. Visit the website to find out where help is available in your country befrienders.org. In Germany you can find help from the telephone counseling service on the toll-free numbers 0800/111 0 111 and 0800/111 0 222.
Farewell without fear – dying with company
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