When will the euthanasia reform come?

The topic is not suitable for an election campaign hit: suicide. Around 10,000 people in Germany take their own lives every year – because of a serious illness, fear of old age or lovesickness. The majority, 76 percent, are men, the average age of those affected is 60 years. Anyone who helps them die will not be punished. Assisted suicide is not prohibited in Germany, even if it is paid for.

But very few want to talk about it. The topic is taboo, socially and politically. In the Bundestag there are a number of MPs who nevertheless absolutely want to debate euthanasia in parliament – with the aim of finding a legal regulation for it. Their motives are different.

Some want to strengthen the self-determination of those willing to die, to establish a kind of right to suicide. Others want to prevent a “normalization” of assisted suicide. Not only are political differences colliding on the subject, but moral values ​​too. It’s a case study of how difficult it gets when politics is a matter of life and death.

From liberal to restrictive: three proposals are on the table

In the current election period, all attempts to create a legal framework for assisted suicide have failed. Now the members of the next Bundestag inherit this ethically sensitive task. What could a reform look like? What role does the result of the federal election play in this? And how can you prevent “assisted suicide” from becoming a business model?

The fact that politics is dealing with the issue has to do with a ruling by the Federal Constitutional Court from February 2020. At that time, the Karlsruhe judges declared the “prohibition of commercial euthanasia” to be unconstitutional and overturned Section 217 of the Criminal Code, which was introduced in 2015. The general right of personality includes “the freedom to take your own life and in doing so to fall back on the voluntary help of third parties”, it says in the judgment. Euthanasia has been exempt from punishment since then. Only killing on demand is prohibited. Getting or selling a lethal cocktail of drugs to someone is legal; but not administering the poison.

Three groups of members of the Bundestag now want to create a legal framework for assisting suicide. Everyone agrees that assisted suicide must be possible without impunity. The question of how is disputed.

The most liberal bill comes from a group around FDP MP Katrin Helling-Plahr, which also includes SPD health expert Karl Lauterbach and left-wing politician Petra Sitte. They want to establish the impunity of assisted suicide and secure access to drugs for suicide, such as the sleeping pill sodium pentoarbital. Assistance to suicide should above all be a medical task. This is supposed to deprive euthanasia associations of the basis of their business. There should also be a right to advice.

The design by the Green politicians Renate Künast and Katja Keul goes in a similar direction. However, a distinction is made according to the motive of suicide. “Doctors are the right people to talk to for those willing to die with a fatal illness,” says Künast. “For everyone else, independent government agencies are required to offer advice and provide the appropriate medication.” Stricter requirements, such as longer waiting times, should apply to them.

The most restrictive concept comes from a group around the CDU politician Ansgar Heveling, who is supported by the religious policy spokesmen of the Union, SPD and FDP. They want to make business-like euthanasia, i.e. regularly offered, a criminal offense – with exceptions that are tied to strict conditions. “It is important to have independent ethical and social advice, an assessment by experts from the psychiatric field and compliance with deadlines during the reflection period,” says Heveling.

Unlikely to compromise

It is true that the three concepts agree in many ways. There is consensus, for example, that no one should be obliged to assist in dying. It is unlikely that the three groups will find a compromise because their goals are too different.

CDU man Heveling wants to prevent suicides in particular. He wants to set the hurdles for euthanasia particularly high. The FDP politician Helling-Plahr, on the other hand, puts Karlsruhe’s right to self-determination up to death in the foreground: “We have to meet those affected at eye level, take their free choice seriously,” she demands.

Medical ethics professor Bettina Schöne-Seifert from the University of Münster sees politics as facing a double task. “On the one hand, voluntary support for self-determined suicides should realistically be made possible; on the other hand, suicides must be prevented that would not take place freely responsibly, ”she says. It is a fine line that is difficult to find: How much time must pass before it is unequivocally established that a death wish is permanent and freely determined? And who should be responsible for this: an authority, the family doctor, a committee of experts?

No “suicide on account”

Eugen Brysch from the German Patient Protection Foundation wants to get away from “legislative protection concepts” such as time limits for reflection periods or an obligation to provide advice for those willing to die: “It will not be possible to do anything else than look at those assisting suicide,” he says. “The person should document the process, demonstrate their own expertise and be able to demonstrate in a comprehensible manner that there was no external pressure on those willing to die.” Anyone who violates this should be punished.

Financing is also controversial. Everyone agrees that something like “suicide on account” cannot be a business model. But what about an expense allowance for the euthanasia? “If money is involved, for example in the form of a fee or membership, assisting suicide is prohibited,” says Brysch. That endangers the self-determination of the suicidal person. The CDU politician Heveling sees it that way too.

But euthanasia – advice and medication – costs money. The ethicist Schöne-Seifert believes that this is “not offensive as such.” Euthanasia associations, for example, have to finance their activities. “That also applies to doctors who want to assist suicide.”

Many experts see doctors’ offices as the right places for assisting suicide. Most death wishes are based on a medical cause, an illness or the onset of dementia. Psychosocial motives such as lovesickness are rarely the reason for suicide. The National Academy of Sciences Leopoldina demands that doctors in particular should be responsible for euthanasia. “They know the complaints, prognoses and treatment options of their patients and can ensure safe suicide,” says Schöne-Seifert, who is a member of the Leopoldina.

But that contradicts the professional ethics of many medical professionals. The German Medical Association nevertheless removed the ban on assisted suicide from its professional code this year.

If the three groups of MPs have their way, a statutory regulation on euthanasia will soon follow. All three want to put their proposals to the vote as soon as possible in the coming parliamentary term. How it turns out also depends on the outcome of the federal election, says FDP politician Helling Plahr: “The stronger the Union, the more difficult it will be. Should more progressive people move in with the SPD and the Greens, a solution would be easier to implement. “

If none of the three concepts finds a majority, there is a fourth option: that euthanasia remains without legal regulation – and thus remains in a kind of legal gray area.