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Have factors associated with suicides assisted by right-to-die organisations in Switzerland changed during the recent increase in the years 2009 to 2013?

English title Have factors associated with suicides assisted by right-to-die organisations in Switzerland changed during the recent increase in the years 2009 to 2013?
Applicant Zwahlen Marcel
Number 160171
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 01.05.2015 - 31.10.2017
Approved amount 166'781.00
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All Disciplines (4)

Discipline
Public Health and Health Services
Medico-Social Problems of the Elderly
Medical Statistics
Geriatrics

Keywords (11)

33CS30_148415; The Swiss National Cohort 2.0; large nested project; right-to-die organisations; 33CS30_148415; suicide; assisted suicide; swiss national cohort study; large nested project; Switzerland; The Swiss National Cohort 2.0

Lay Summary (German)

Lead
Haben sich mit dem Anstieg an begleiteten Suiziden von 2009 bis 2013 die mit den Suiziden assozierten Faktoren verändert? Mit einer gesamtschweizerischen Kohortenstudie wird die Häufigkeit und die Entwicklung der begleiteten Suizide in der Schweiz untersucht. Insbesondere wird analysiert, ob die Rolle von Prädiktoren wie Geschlecht, Bildung, Grösse des Haushalts und Religion sich nach 2008 geändert hat.
Lay summary

Im Gegensatz zu den meisten andern Ländern kennt die Schweiz kein Verbot der Hilfeleistung beim Suizid, sofern diese nicht aus eigennützigen Interessen geleistet wird. Sterbehilfe-Organisationen wie Exit und Dignitas begleiten ihre Mitglieder beim Suizid, wenn diese schwer krank sind. Eine frühere Studie in der Swiss National Cohort (SNC) zeigt, dass Frauen und Alleinstehende sich überdurchschnittlich häufig Suizidhilfe in Anspruch nehmen, aber auch höher Gebildete und Menschen in wohlhabenderen Wohngegenden. Die meisten Menschen, die Suizidhilfe in Anspruch nahmen, hatten Krebs. Von 2009 bis 2013 hat sich die Zahl der durch Sterbehilfe-Organisationen begleiteten Suizide verdreifacht. Es ist unklar, ob und wie sich die sozio-demografischen Prädiktoren in dieser Zeit verändert haben. Mit der SNC, die anonym die Daten der Volkszählungen 2000 / 2010 mit der Todesursachenstatistik des BFS verlinkt, ist eine einzigartige gesamtschweizerische Kohortenstudie möglich, um die zeitliche Entwicklung der begleiteten Suizide und deren Einflussfaktore zu untersuchen.

Ziel des Projektes ist es, die Zahl der durch Sterbehilfe-Organisationen begleiteten Suizide zu beschreiben und zeitliche Trends zu untersuchen. Dabei werden Änderungen der mit den begleiteten Suiziden assozierten sozio-demographischen Eigenschaften analysiert. Hat sich die Rolle von Prädiktoren wie Geschlecht, Bildung, Grösse des Haushalts und Religion nach 2008 geändert? Weiter wird untersucht, ob die Verteilung der mit den begleiteten Suiziden assozierten Krankheiten sich über die Zeit verschoben hat.

Durch Sterbehilfe-Organisationen begleitete Suizide sind in der Schweiz umstritten und seit Jahren Gegenstand einer gesellschaftlichen und politischen Debatte. Diese Studie wird wichtige Informationen für diese Diskussionen liefern und die epidemiologische Entwicklung der vergangenen Jahre aufzeigen. Sie wird helfen, mögliche Probleme zu identifizieren und damit zu allfälligen politischen Lösungen beitragen.

Direct link to Lay Summary Last update: 22.04.2015

Responsible applicant and co-applicants

Employees

Name Institute

Publications

Publication
Increase in assisted suicide in Switzerland: did the socioeconomic predictors change? Results from the Swiss National Cohort
Steck Nicole, Junker Christoph, Zwahlen Marcel (2018), Increase in assisted suicide in Switzerland: did the socioeconomic predictors change? Results from the Swiss National Cohort, in BMJ Open, 8(4), e020992-e020992.
Suicide in adolescents: findings from the Swiss National cohort
Steck Nicole, Egger Matthias, Schimmelmann Benno G., Kupferschmid Stephan (2017), Suicide in adolescents: findings from the Swiss National cohort, in European Child & Adolescent Psychiatry, Epub ahead of print(xx), xx-xx.
Assisted and unassisted suicide in men and women: Longitudinal study of the Swiss population
Steck Nicole, Egger Matthias, Zwahlen Marcel (2016), Assisted and unassisted suicide in men and women: Longitudinal study of the Swiss population, in British Journal of Psychiatry, 208(5), 484-490.
Time-trends in assisted and unassisted suicides completed with different methods: Swiss National Cohort
Steck N, Zwahlen M, Egger M (2015), Time-trends in assisted and unassisted suicides completed with different methods: Swiss National Cohort, in Swiss Medical Weekly, 145, w14153.

Associated projects

Number Title Start Funding scheme
148415 The Swiss National Cohort 2.0: a platform for longitudinal research in Switzerland 01.07.2014 Cohort Studies Large
133139 The epidemiology of suicide assisted by right-to-die organisations in Switzerland 01.05.2011 Project funding (Div. I-III)

Abstract

Background: In contrast to most other countries, providing assistance to individuals wishing to commit suicide is legal in Switzerland if no self-interest is involved. In most cases members of right-to-die organisations assist suicides, generally in the context of terminal illness or chronic suffering. A previous study showed that in the period 2003 to 2008 suicides assisted by organisations were associated with female gender and situations that may indicate loneliness, but also with higher education and higher socio-economic position. Most people who died by assisted suicide had cancer. The number of suicides assisted by the three main organizations tripled in the last ten years and doubled from 2009 to 2013. It is not known whether socio-demographic characteristics associated with assisted suicide and the underlying diseases were different before and after 2008. Aim: To analyse time trends in suicides assisted by right-to-die organisations in a population based cohort study and to identify changes before and after 2008 in socio-demographic characteristics associated with assisted suicide as well as in the underlying diseases. Objectives: (i) To establish the incidence of assisted suicide and investigate time trends from 2003 to 2012; (ii) to examine if the gap between rates for women and men did decrease, persist or increase; (iii) to analyse whether determinants of assisted suicide changed before and after 2008 at the level of the individual and household; (iv) to analyse the co-morbidities mentioned on the death certificates of assisted suicides, and identify possible changes before and after 2008. Methods: The three main right-to-die organisations in Switzerland (Exit Deutsche Schweiz, Exit Suisse Romande and Dignitas) provide their anonymous data on assisted suicides since 2003 to the Federal Statistical Office (FSO). The FSO uses a dedicated ICD-10 code (X61.8) for assisted suicides in the mortality statistics. Therefore we can identify these data in the Swiss National Cohort, a large study of mortality in Switzerland, funded by SNSF. The study will be based on the characteristics of persons as collected at the census 2000 and the registry based census 2010 to 2012. In study time approximately 3,000 assisted suicides were reported. Analyses will include persons aged between 35 and 95 years, with follow-up ending either at the time of death, the time of emigration, the 95th birthday or 31 December 2012. To analyse time trends we will split the study time in calendar years. We will use univariable and multivariable Cox models to identify determinants of assisted suicide, controlling for age and other confounding factors. We will split study time in the years before and after 2008 to analyse time change in factors associeated with assisted suicide. We will use logistic regression to analyze the probability of co-morbidities being mentioned on the death certificate of assisted suicides, controlling for age and other socio-demographic factors.Significance: Suicide assisted by right-to-die organisations is an issue of ongoing debate in Switzerland. The European Court of Human Rights asked Switzerland in 2013 to clarify whether and under what conditions individuals not suffering from terminal illnesses can be helped to end their lives. The biggest right-to-die organisation, Exit Deutsche Schweiz, decided in 2014 to engage for assisted suicide for elderly who are not terminally ill. This study will inform this debate.
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