What does assisted suicide cost and who pays for it?

How does assisted suicide work in Switzerland?

What is commonly referred to as “euthanasia” is more accurately described as “assisted suicide“. According to Art. 115 StGB, anyone who “induces or assists someone to commit suicide for selfish reasons” is liable to a custodial sentence of up to five years or a monetary penalty. The act leading to death (e.g. ingestion of a narcotic) must be carried out by the person who wishes to die. However, third parties may provide assistance, for example by providing means to die. This regulation and court practice in recent decades have led to the development of various key points and institutions that are intended to ensure that assisted suicide is carried out in a legally and ethically acceptable manner.

According to the law and legal precedents, assisted suicide is only permissible if all of the following conditions are met:

• Sound judgment: The person willing to die must be able to act rationally. In other words, she or he must be able to form the (dying) will without deficiencies and implement it through appropriate actions (“must know what she or he is doing”).
  It is not impossible for mentally ill persons (e.g. with mild or moderate dementia) to make use of assisted suicide. However, they must be of sound mind with regard to the decision to die, i.e. be able to assess the consequences. This is assessed by expert opinions and, if necessary, an ethics committee.
• Constancy: The wish to die must be constant, i.e. of a certain duration. This is intended to rule out the possibility of someone deciding to commit suicide in the heat of the moment – for example immediately after a stroke of fate such as a cancer diagnosis. This criterion is implemented in practice through waiting periods (around 90 days in the case of EXIT).
• Autonomy: The wish to die must of course be based on the person’s own inner conviction. It must not have been influenced by third parties, in particular if they are pursuing their own interests (often of a financial nature).
• Balance of interests: The decision to commit suicide must be made in full knowledge and with serious consideration of possible alternatives (e.g. palliative medical treatment). This criterion can be verified by medical consultations or informational discussions.
• Documentation: In addition, there are the documents required for the dispensing of the prescription-only euthanasia medication. This is a current medical diagnosis letter, a doctor’s confirmation of power of judgement and a doctor’s prescription for an euthanasia drug such as sodium pentobarbital.
• Actual authorship: As stated above, the person who wishes to die must carry out the act of killing themselves; a third person doing this for them would be liable to prosecution. Assisted suicide is therefore not, or only to a very limited extent, accessible to people who are in a coma or are paralyzed throughout their body.

These requirements are the minimum requirement stipulated by judicature. Various organizations that support people who wish to die stipulate further requirements in their statutes or regulations. The largest and most important organizations in Switzerland are EXIT and DIGNITAS. They accompany and support their members at their explicit request (usually in the form of a written application, usually with a personal justification) towards a self-determined end of life.

EXIT, for example, describes the additional requirements for assisted suicide as follows: “…in the case of illness leading to death; subjectively unbearable discomfort; unreasonable disability; suffering in and old age, whereby due consideration should also be given to the psychosocial aspects”. The prescription-only euthanasia medication is not simply dispensed for free disposal, but only handed over on a specified date for supervised use. Finally, the principle of age priority applies: long-standing club members are given priority over new members or non-members.

How much do assisted suicide measures cost?

Cost accounting for assisted suicide is a complex issue. However, an important barrier results from the above-mentioned Art. 115 StGB: Since assisted suicide for “selfish motives”, which includes profit orientation, is prohibited, assisted suicide organizations in Switzerland must operate on a non-profit basis. They may not generate any significant profits from their activities that go beyond the sustainable financing of their offering.

In general, depending on the method of calculation and the scope of the services included, you should expect costs in the higher four-digit Swiss franc range. A large proportion of the costs is due to the documentation work involved in the above-mentioned written documents and assessments. In addition, the organizations must be able to cover their own costs (wages for permanent staff, rental of association premises, public relations work, etc.).

• At EXIT, the costs depend on the duration of membership: the annual membership fee is CHF 45; a lifetime membership costs CHF 1,100. The minimum membership period for free assisted suicide is three years. For shorter membership periods, the organization charges a contribution of between CHF 1,100 and CHF 3,700. According to Managing Director Bernhard Sutter, the full cost of a suicide with EXIT is over CHF 7,000 (see the Blick.ch interview from 08.06.2023). However, EXIT only supports people with Swiss citizenship or residence in Switzerland.
• The DIGNITAS association charges a one-off entry fee of CHF 220; the minimum annual membership fee is normally CHF 80. The organization provides detailed information on its website about the costs incurred in connection with assisted suicide and special membership fees: CHF 4,000 is charged for non-binding preliminary evaluations. Two consultations with a doctor and the costs for issuing a prescription for a death remedy amount to CHF 1,000. Personnel costs for assisted suicide itself amount to CHF 2,500. If DIGNITAS provides optional funeral services, it will charge a further CHF 2,500 for these and CHF 1,000 for visits to the authorities. DIGNITAS therefore estimates a total of CHF 11,000 if the burial issues are also settled and a total of CHF 7,500 if they are omitted. Discounts are possible in justified individual cases by arrangement.
• With the organization Eternal Spirit, the costs for non-Swiss residents who wish to die were summarized down as follows: “Preliminary examination procedure: CHF 1,500 to 3,000; main examination procedure, medical assessment, assisted suicide: CHF 3,240; burial: CHF 2,800 = total: CHF 9,040” (read the article “3,500 or 10,000 francs – how much does an assisted suicide really cost?” on watson.ch).

These amounts do not include individual travel costs for persons from abroad who wish to make use of assisted suicide in Switzerland.

Who pays for the assisted suicide?

The organizations that offer assisted suicide and euthanasia support in Switzerland cover most of their costs from the above-mentioned membership fees, and in some cases also from donations or private funding. Ihre Finanzierungsmodelle nehmen bewusst Abstand von «Geschäftemacherei» und sind daher auf längerfristige Mitgliedschaften aufgebaut.

At present, the costs of assisted suicide are not covered by social insurance in Switzerland. They are not covered by compulsory health insurance, nor are the costs covered by accident insurance if the person has caused the death themselves. Why is that? These insurance policies always have a therapeutic or palliative objective. They aim to remunerate medical treatment to preserve, prolong and improve life, and not measures that end life.

As the fees for assisted suicide can therefore be difficult to afford, especially for people who are ill or in poor health, many organizations offer discounts on a case-by-case basis by arrangement. So it’s advisable to approach the organizations if you have financial problems and to describe your personal and financial situation. Since these are non-profit organizations, there is often a willingness to accommodate individual needs in justified cases.

More articles on this topic

• Under what conditions is euthanasia permitted?
• What is the difference between end-of-life care and euthanasia?