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The epidemiology of suicide assisted by right-to-die organisations in Switzerland

English title The epidemiology of suicide assisted by right-to-die organisations in Switzerland
Applicant Zwahlen Marcel
Number 133139
Funding scheme Project funding (Div. I-III)
Research institution Institut für Sozial- und Präventivmedizin Universität Bern
Institution of higher education University of Berne - BE
Main discipline Public Health and Health Services
Start/End 01.05.2011 - 30.04.2014
Approved amount 250'565.00
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All Disciplines (3)

Discipline
Public Health and Health Services
Medico-Social Problems of the Elderly
Psychology

Keywords (8)

suicide; assisted suicide; cohort study; right-to-die organisations; Switzerland; right-to-die organization; epidemiology; Swiss National Cohort 2.0

Lay Summary (German)

Lead
Lay summary
Lead: Mit einer gesamtschweizerischen Kohortenstudie wird das Projekt die Häufigkeit und die Entwicklung der Selbsttötungen analysieren, die durch Sterbehilfe-Organisationen in der Schweiz zustande kamen. Zudem wird die Rolle von individuellen Prädiktoren wie Geschlecht, Zivilstand, Bildung und Religion beim assistierten Suizid beschrieben. Hintergrund: Im Gegensatz zu den meisten andern Ländern kennt die Schweiz kein Verbot der Hilfeleistung bei der Selbsttötung, sofern diese nicht im eigenen Interesse geleistet wird. Die Aktivität von Sterbehilfe-Organisationen wie Exit und Dignitas ist aber ethisch und rechtlich umstritten. Die vorhandenen Daten zur Aktivität dieser Organisationen lassen auf eine Zunahme der Fälle von assistiertem Suizid in den vergangenen Jahren schliessen. Das Bundesamt für Statistik (BFS) ist daran, alle diese Fälle rückwirkend bis 2001 zu identifizieren. Mit der Swiss National Cohort (SNC), die anonym die Daten der Volkszählung 2000 mit der Todesursachenstatistik des BFS verlinkt, ist damit in der Schweiz eine einzigartige gesamtschweizerische Kohortenstudie zu den Selbsttötungen unter Mithilfe von Sterbehilfe-Organisationen möglich. Das Ziel: Ziel des Projektes ist es, die Häufigkeit und die Entwicklung der Zahl der Fälle von Selbsttötungen unter Mithilfe von Sterbehilfe-Organisationen von 2001 bis 2010 zu beschreiben. Zudem wird die Rolle von Prädiktoren auf der Ebene des Individuums, des Haushalts und der Gemeinde beschrieben werden. Dies könnten neben Geschlecht und Alter zum Beispiel Zivilstand, Bildung, Religion oder Grösse des Haushalts sein. Bedeutung: Sterbehilfe-Organisationen gibt es in der Schweiz seit knapp 30 Jahren. In den vergangenen Jahren hat sich in Öffentlichkeit und Politik eine bisweilen scharf geführte Debatte über ethische und rechtliche Legitimation der Aktivität dieser Organisationen entwickelt. Auf Bundesebene laufen derzeit Vorbereitungen zu einer genaueren gesetzlichen Regelung der Aktivität von Sterbehilfe-Organisationen. Über die Epidemiologie der Selbsttötungen unter Mithilfe dieser Sterbehilfe-Organisationen in der Schweiz, sowie die Rolle von sozio-demografischen Prädiktoren ist bisher nur wenig bekannt. Hier kann die Studie Lücken schliessen und zu einer sachlichen Diskussion beitragen.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population.
Steck N, Egger M, Zwahlen M. (2016), Assisted and unassisted suicide in men and women: longitudinal study of the Swiss population., in The British journal of psychiatry , 208, 484-490.
Time-trends in assisted and unassisted suicides completed with different methods: Swiss National Cohort.
Steck N, Zwahen M, Egger M (2015), Time-trends in assisted and unassisted suicides completed with different methods: Swiss National Cohort., in Swiss Medical Weekly, 145, w14153.
Suicide assisted by right-to-die associations: a population based cohort study.
Steck Nicole, Junker Christoph, Maessen Maud, Reisch Thomas, Zwahlen Marcel, Egger Matthias, Swiss National Cohort (2014), Suicide assisted by right-to-die associations: a population based cohort study., in International journal of epidemiology, 43(2), 614-22.
Euthanasia and assisted suicide in selected European countries and US states: systematic literature review.
Steck Nicole, Egger Matthias, Maessen Maud, Reisch Thomas, Zwahlen Marcel (2013), Euthanasia and assisted suicide in selected European countries and US states: systematic literature review., in Medical care, 51(10), 938-44.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Public Health Conference Talk given at a conference The epidemiology of assisted suicide in Switzerland 31.08.2012 Lausanne, Switzerland Egger Matthias; Steck Nicole; Zwahlen Marcel;


Awards

Title Year
Nicole Steck received the price for the best scientific abstract at Swiss Public Health Conference in Lausanne on 31 August 2012. 2012

Associated projects

Number Title Start Funding scheme
160171 Have factors associated with suicides assisted by right-to-die organisations in Switzerland changed during the recent increase in the years 2009 to 2013? 01.05.2015 Project funding (Div. I-III)
108806 The Swiss National Cohort: a platform for longitudinal research in Switzerland 01.07.2006 Cohort Studies Large

Abstract

Background: In Switzerland the incidence of suicide is in the top third of Europe, and in the top quintile worldwide. An increasing number of suicides are planned, generally in the context of terminal illness or chronic suffering, and assisted by members of one of three “right-to-die” organisations. In contrast to most other countries, providing assistance to individuals wishing to commit suicide is legal if no self-interest is involved (Article 115 of Penal Code). Little is known about the incidence and determinants of suicide assisted by right-to-die organisations in Switzerland, and such suicides have not been consistently coded until recently. Aim: To create a population-based cohort to describe the epidemiology of suicide assisted by right-to-die organisations in Switzerland in terms of time, place and person, and to identify determinants at the level of the individual, household and community.Objectives: (i) To establish the incidence of assisted suicide 2001-2008 and by socio-demographic and socio-economic characteristics; (ii) To identify independent determinants of assisted suicide at the level of the individual (for example, sex, marital status, educational level, religion), household (number of persons living in household) and community (mean taxable income of community); (iii) To analyze the co-morbidities mentioned on the death certificates of assisted suicides, and compare these with co-morbidities mentioned on death certificates of suicides that were not assisted. Several specific hypotheses will be tested. Methods: The Federal Statistical Office is in the process of consistently re-coding all suicides assisted by one of the three right-to-die organisations active in Switzerland (EXIT - Deutsche Schweiz, EXIT - Association pour le Droit de Mourir dans la Dignité Suisse Romande, Dignitas) , using a dedicated ICD-10 code (X61.8). We will link these data with the 2000 census, within the framework of the Swiss National Cohort, a large study of mortality in Switzerland, which is funded by SNSF. The study will be based on the 2000 census, and the 1600-2000 assisted suicides expected to be recorded during the 8-year study period. Analyses will include persons aged 30 years or older, with follow-up ending either at the time of death, the time of emigration, or 31 December 2008. We will use univariable and multivariable Cox models to identify determinants of assisted suicide, controlling for age and other confounding factors. We will estimate the cumulative incidence of assisted suicide while accounting for censoring due to the competing risk of death from other causes. Finally, we will use logistic regression to analyze the probability of co-morbidities (for example cancer or neuro-degenerative diseases) being mentioned on the death certificate of assisted and non-assisted suicides, controlling for age and other socio-demographic factors.Significance: Suicide assisted by right-to-die organisations is a relatively recent phenomenon in Switzerland, which many perceive as disturbing and morally wrong. Churches campaign for banning assisted suicide, some politicians and parties support the current legal framework, whereas others, including the government, support a revision of the law from 1918, which would regulate activities of right-to-die organisations more closely. At the same time, little is known about the incidence of suicides assisted in this way, the socio-demographic and socio-economic factors associated with such suicides, and the co-morbidities involved. Our study will provide important information to inform this debate, and contribute importantly to the international literature on this issue.
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