The Journal of Medical Ethics published a study in August 2014 entitled Suicide Tourism: a Pilot Study on the Swiss Phenomenon, which brought renewed public interest to Switzerland’s assisted suicide laws. In Switzerland, assisted suicide is legal and not clearly regulated, allowing foreign citizens to travel to the country for suicide assistance. The result is being called “Suicide Tourism.” The authors of the study noted the increase of Suicide Tourism over the last decade and examined the impact of the increase on the assisted suicide laws in other European countries.
PBS gave the United States a detailed look at the Swiss phenomenon in The Suicide Tourist, a 2010 documentary that highlighted the Swiss nonprofit organization, Dignitas. The documentary followed an American citizen suffering from ALS as he made the choice to end his life with Dignitas’ help. Although there are other right-to-die groups in Switzerland, Dignitas is currently the only assisted suicide clinic. Following Dignitas’ lead, one right-to-die group, Exit, recently applied to convert its office into an assisted suicide clinic. The move is reportedly motivated by an increase of assisted-suicide requests and Exit’s inability to keep up with demand efficiently.
Exit currently provides members with a variety of services including living wills, palliative care, counseling and suicide prevention. Exit’s website says becoming a member is “like taking out an insurance policy.” For eligible persons, Exit’s services include assisted suicides, typically carried out in group-homes or hospitals. If Exit successfully becomes an assisted suicide center, it could carry out assisted suicides on-site at its facility.
While the study focuses on Europe, the rise in Suicide Tourism could impact the United States as well. Only three states in the U.S. have enacted laws permitting assisted suicide: Oregon in 1997, Washington in 2009, and Vermont in 2013. In 2009, the Montana Supreme Court in a 5-4 decision ruled that physician-assisted suicide for competent patients did not contravene public policy under Montana law but carefully avoided ruling on whether it was protected under the Montana Constitution. Baxter v. State, 224 P.3d 1211 (Mont. 2009). The decision upheld a doctor’s ability to use a patient’s consent as a defense to criminal liability for assisted suicide, but the Montana legislature has not further addressed the legality of assisted suicide. In January 2014, a New Mexico District Court declared that New Mexico Citizens have a constitutional right to assisted suicide. New Mexico Attorney General Gary King appealed the ruling in March and the matter is now pending. Assisted suicide remains illegal in the other 45 states.
Dignitas and Exit both emphasize a person’s right to self-determination. A person’s freedom to act in the manner they choose is emphasized throughout the American legal system, not only in constitutional rights such as free speech, but also in legal principles such as in contract and property law. Theoretically, the right to self-determination aligns with these legal principles. But accepting assisted suicide as a fundamental right requires us to re-evaluate social norms and distinguish homicide and traditional suicide from the informed, medical choice to end one’s life. New Mexico and Vermont’s actions suggest that the United States could be increasingly open to legalizing assisted suicide. With New Mexico’s decision on appeal, debate on the subject is likely to rise. But with 45 states upholding the illegality of assisted suicide, the United States doesn’t seem ready to follow Switzerland’s lead.