Germany seeks to regulate assisted suicide

"We want to set the record straight — everyone has a right to self-determined death."

With these words, Free Democrat Member of Parliament Katrin Helling-Plahr introduced a cross-party draft bill to the German parliament that would regulate legal assisted suicide for the first time.

The ban on so-called business-like assisted suicide in Germany was lifted almost a year ago by a ruling of the constitutional court. But without legislation to regulate the process, the right has existed "only on paper" for many people, as Helling-Plahr put it on Twitter.

According to the bill, which was introduced by Helling-Plahr along with center-left Social Democrat and medical doctor Karl Lauterbach and Left party MP Petra Sitte, the person willing to die has to want to end his or her life "out of autonomously-formed free will." They must be able to "weigh the pros and cons on a sufficient basis of assessment in a realistic manner" and "the suicide-willing person must be aware of alternative courses of action to suicide."

However, under the draft no one should be forced into assisted suicide, a point which is particularly important for physicians. Those seeking to commit suicide should be able to obtain the appropriate medication in Germany without having to go abroad.

What is 'business-like' assisted suicide?

The debate around assisted dying has been a contentious issue in Germany for a number of years. Neighboring countries like Switzerland, Belgium and the Netherlands have long allowed greater freedom for those living with painful and incurable conditions who want to end their lives.

Statistics agency Statista reported that Germans have topped the list of nationalities who traveled to Switzerland to end their lives every year since 2001.

The specific ban on "business-like" assisted suicide in Germany was introduced in 2015 under Paragraph 217. The ban referred to "anyone who, with the intention of assisting another person to commit suicide, provides, procures or arranges the opportunity for that person to do so and whose actions are intended as recurring."

"If a doctor helped his wife to end her life with her consent, that would not have been illegal, but if he had done it as part of his job then it would have been," medical ethics expert Wolfgang Putz explained to DW. Putz was a plaintiff in the overturning of Paragraph 217 by the constitutional court in February 2020, which he described as the "most important" moment of his legal career.

'Self-determination may fall by the wayside'

Despite the careful wording of the new bill to avoid assisted suicide being turned into a business, opponents say that the risk still exists.

"The fact that assisted suicide for payment is not a punishable offense is a mistake," Eugen Brysch, chairman of the German Foundation for Patient Protection told DW in a statement. "If organized assisted suicide has to be paid for, the self-determination of the person willing to die falls by the wayside," he added.

But ethics expert Putz said that patients in Germany are already well-protected under a different law — Paragraph 216.

"We have some of the strictest legislation against assisting suicide without consent under Paragraph 216," he said. "Anyone found guilty of this can face life in jail."

The draft bill put forward Friday also requires a lengthy counselling period for patients. This aims to allow for changes of heart and to remove the possibility of a patient being forced.

But Brysch believes this will not go far enough. "Even state-legitimized counseling centers cannot determine whether a decision has reached a decision autonomously," he said. "There are no checklists, nor deadlines, nor undefined legal terms that are suitable for this purpose."

Catholic Church will not actively help

And even if the bill is passed into law, some medical organizations in Germany may still refuse to directly offer assisted suicide, instead referring patients to other organizations.

"There can be no offer made [of assisting in suicide] in Catholic institutions," Peter Neher, president of Germany's largest charitable employer Caritas, told DW in a statement. The Catholic organization manages hundreds of assisted living homes and retirement facilities across the country.

"In our facilities, it cannot be our task to organize the suicide of residents," he added. "Instead, it consists of accompanying people and opening up alternatives." 

"Self-determination is a valuable asset for which he have the highest respect; but Catholic organizations will not actively offer assistance to suicide," a spokeswoman added.

In the Protestant Church, the issue has been debated more freely, with some prominent German members supporting doctors in their facilities directly aiding in suicide.

But the new bill will "never force a doctor to assist in suicide," Left party MP Sitte stressed in parliament. "Nobody has to help — but everyone is allowed to," Helling-Plahr explained.

Time running out

As a draft, the bill will now enter a lengthy discussion period in parliament.

"It would be good if we could agree on the regulation before the end of this legislative period," Karl Lauterbach said, referring to the end of the current German parliament sitting this fall.

"It would not be ideal if that was dragged into the election campaign," lawyer Putz said. "It is a very polemical issue."

Health Minister Jens Spahn, of Chancellor Angela Merkel's center-right Christian Democrats, has largely kept out of the debate so far. But in a statement following the introduction of the bill, his ministry said, "It is only logical that the parliament abide by a decision, which was made by the constitutional court."

However this debate ends, parliament does not have the power to overturn the decision of the constitutional court. Assisted suicide under certain, specific circumstances will remain legal in Germany — but the decision for how it will be regulated now lies with the parliament.