Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 153 No. 3 (2023)

Long-term development of assisted suicide in Switzerland: analysis of a 20-year experience (1999–2018)

  • Giacomo  Montagna
  • Christoph Junker
  • Constanze Elfgen
  • Andres R. Schneeberger
  • Uwe Güth
Cite this as:
Swiss Med Wkly. 2023;153:40010


AIMS OF THE STUDY: The legalisation of assisted suicide is one of the most debated topics in the field of medical ethics worldwide. In countries in which assisted suicide is not legal, public discussions about its approval also encompass considerations of the long-term consequences that such legalisation would bring, for example, how many people will use this option, from what conditions would they be suffering, would there be differences between male and female assisted suicide and which developments and trends could be expected if there were to be a marked increase of cases of assisted suicide over time?

METHODS: In order to answer these questions, we present the development of assisted suicide in Switzerland over a 20-year period (1999–2018; 8738 cases) using data from the Swiss Federal Statistical Office.

RESULTS: During the observation period, the number of assisted suicides rose significantly: when four 5-year periods (1999–2003, 2004–2008, 2009–2013, 2014–2018) were analysed, the number of assisted suicide cases doubled over each period compared with the preceding one (Χ = 206.7, 270.4 and 897.4; p <0.001). The percentage of assisted suicides among all deaths rose from 0.2% (1999–2003; n = 582) to 1.5% (2014–2018: n = 4820). The majority of people who chose assisted suicide were elderly, with increasing age over time (median age in 1999–2003: 74.5 years vs 2014–2018: 80 years), and with a predominance of women (57.2% vs 42.8%). The most common underlying condition for assisted suicide was cancer (n = 3580, 41.0% of all assisted suicides). Over time, assisted suicide increased similarly for all underlying conditions; however, the proportion in each disease group remained unchanged.

CONCLUSIONS: It is a matter of one’s viewpoint whether the rise of assisted suicide cases should be considered alarming or not. These figures reflect an interesting social development but still do not appear to represent a mass phenomenon.


  1. Borasio GD, Jox RJ, Gamondi C. Regulation of assisted suicide limits the number of assisted deaths. Lancet. 2019 Mar;393(10175):982–3. DOI:
  2. Gamondi C, Borasio GD, Limoni C, Preston N, Payne S. Legalisation of assisted suicide: a safeguard to euthanasia? Lancet. 2014 Jul;384(9938):127. DOI:
  3. Lo B. Beyond Legalization - Dilemmas Physicians Confront Regarding Aid in Dying. N Engl J Med. 2018 May;378(22):2060–2. DOI:
  4. McPherson A. Dying and choosing. Lancet. 2009 Oct;374(9698):1325. DOI:
  5. Snyder Sulmasy L, Mueller PS, Ethics P ; Ethics, Professionalism and Human Rights Committee of the American College of Physicians. Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper. Ann Intern Med. 2017 Oct;167(8):576–8. DOI:
  6. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and Practices of Euthanasia and Physician-Assisted Suicide in the United States, Canada, and Europe. JAMA. 2016 Jul;316(1):79–90. DOI:
  7. Parliament of Victoria. Voluntary Assisted Dying. Available at: Accessed 22.10.2021.
  8. Death With Dignity. Available at: Accessed 22.10.2021.
  9. Wikipedia. Asssited suicide. Available at: Accessed 20.10.2021.
  10. Rada AG. Spain will become the sixth country worldwide to allow euthanasia and assisted suicide. BMJ. 2021 Jan;372(147):n147. DOI:
  11. Porter K, Warburton KG. Physicians’ views on current legislation around euthanasia and assisted suicide: Results of surveys commissioned by the Royal College of Physicians. Future Healthc J. 2018 Feb;5(1):30–4. DOI:
  12. Crumley ET, Sheppard C, Bowden C, Nelson G. Canadian French and English newspapers’ portrayals of physicians’ role and medical assistance in dying (MAiD) from 1972 to 2016: a qualitative textual analysis. BMJ Open. 2019 May;9(4):e020369. DOI:
  13. Sperling SK. Oregon’s Death With Dignity Act. JAMA Oncol. 2018 May;4(5):747–8. DOI:
  14. Ziegler SJ, Bosshard G. Role of non-governmental organisations in physician assisted suicide. BMJ. 2007 Feb;334(7588):295–8. DOI:
  15. Bartsch C, Landolt K, Ristic A, Reisch T, Ajdacic-Gross V. Assisted Suicide in Switzerland: An Analysis of Death Records From Swiss Institutes of Forensic Medicine. Dtsch Arztebl Int. 2019 Aug;116(33-34):545–52. DOI:
  16. Bosshard G, Jermini D, Eisenhart D, Bär W. Assisted suicide bordering on active euthanasia. Int J Legal Med. 2003 Apr;117(2):106–8. DOI:
  17. Sprung CL, Somerville MA, Radbruch L, Collet NS, Duttge G, Piva JP, et al. Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective. J Palliat Care. 2018 Oct;33(4):197–203. DOI:
  18. Steck N, Junker C, Maessen M, Reisch T, Zwahlen M, Egger M ; Swiss National Cohort. Suicide assisted by right-to-die associations: a population based cohort study. Int J Epidemiol. 2014 Apr;43(2):614–22. DOI:
  19. Steck N, Junker C, Zwahlen M ; Swiss National Cohort. Increase in assisted suicide in Switzerland: did the socioeconomic predictors change? Results from the Swiss National Cohort. BMJ Open. 2018 Apr;8(4):e020992. DOI:
  20. Compassion and Choices. Medical Aid In Dying Is Not Assisted Suicide, Suicide or Euthanasia. Available at: Accessed 02.07.2021, 2021.
  21. Federal Statistical Office (FSO). Cause of death statistics. Assisted Suicide and suicide in Switzerland. Available at: Published 2016. Accessed 20.10.2021.
  22. The Federal Assembly of the Swiss Confederation. Federal Act on Data Protection. Available at: Accessed 20.10.2021.
  23. Montagna G, Junker C, Elfgen C, Schneeberger AR, Güth U. Assisted suicide in patients with cancer. ESMO Open. 2022 Feb;7(1):100349. DOI:
  24. Federal Statistical Office. (FSO. Death and its main causes in Switzerland, 2018. Availabe at: Published 2021. Accessed 26.04.2022.
  25. Federal Statistical Office. (FSO. Life expectancy in Switzerland, 2000-2020. Available at: Published 2021. Accessed 26.04.2022.
  26. Federal Statistical Office (FSO). Structural Survey. Population and Households Statistics. Available at: Published 2016. Accessed 20.10.2021.
  27. EXIT. Der Altersfreitod ist mehrheitsfähig. Available at: Published 2014. Accessed 20.10.2021.
  28. Burkhardt S, La Harpe R. Debates about assisted suicide in Switzerland. Am J Forensic Med Pathol. 2012 Dec;33(4):410–3. DOI:
  29. Onwuteaka-Philipsen BD, Brinkman-Stoppelenburg A, Penning C, de Jong-Krul GJ, van Delden JJ, van der Heide A. Trends in end-of-life practices before and after the enactment of the euthanasia law in the Netherlands from 1990 to 2010: a repeated cross-sectional survey. Lancet. 2012 Sep;380(9845):908–15. DOI:
  30. Chambaere K, Vander Stichele R, Mortier F, Cohen J, Deliens L. Recent trends in euthanasia and other end-of-life practices in Belgium. N Engl J Med. 2015 Mar;372(12):1179–81. DOI:
  31. Hedberg K, New C. Oregon’s Death With Dignity Act: 20 Years of Experience to Inform the Debate. Ann Intern Med. 2017 Oct;167(8):579–83. DOI:
  32. Sulmasy DP, Finlay I, Fitzgerald F, Foley K, Payne R, Siegler M. Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate. J Gen Intern Med. 2018 Aug;33(8):1394–9. DOI:
  33. Swiss Academy of Medical Sciences. Care of patients in the end of life. Available at: Published 2013. Accessed 20.10.2021.
  34. Swiss Academy of Medical Sciences. Management of dying and death. Available at: Published 2018. Accessed 20.10.2021. DOI:
  35. FMH-Swiss Medical Association. Stellungnahme der FMH zu den SAMW-Richtlinien «Umgang mit Sterben und Tod». Available at: Published 2018. Accessed 20.10.2021.
  36. The Federal Assembly of the Swiss Confederation. Swiss Criminal Code of 21 December 1937. Available at: Accessed 20.10.2021.
  37. Canton of Zurich. Wahlen & Abstimmungen. Available at: Published 2011. Accessed 20.10.2021.
  38. Brauer S, Bolliger C, Strub JD. Swiss physicians’ attitudes to assisted suicide: A qualitative and quantitative empirical study. Swiss Med Wkly. 2015 May;145:w14142. DOI:

Most read articles by the same author(s)