Accompaniment of dying patients: any medical support and human aid for the dying, as long as there is no shortening of life. The dying patient is not left alone but cared for, next-of-kin and friends are at his/her side.
Accompanied suicide: Comprising elements of assistance with a self-determined end of life and accompaniment of dying patients, it most precisely pinpoints what is made possible for members of associations like DIGNITAS, EXIT, etc. The person wishing to put an end to his/her own life commits a carefully prepared and well-thought out suicide and is not left alone but cared for and is accompanied, generally in the presence of next-of-kin and friends and usually at his/her home.
Assistance (by physicians or others) with a self-determined end of life: in contrast with the different forms of “euthanasia”, the decision-making process remains with the person who wishes to end his/her own life. The patient decides on the end of his/her life and intentionally brings about his/her own death. In Switzerland, this assistance is legal as long as anyone abetting or helping another person to commit suicide does not have any selfish motives (article 115 of the Swiss Penal Code).
Direct active euthanasia on express request (voluntary euthanasia): the person wishing to end his/her own life requests and permits a third person to put an end to his/her life, for example by injection of a lethal drug. This “killing on request” is prohibited in Switzerland (article 114 of the Swiss Penal Code) – however, it is legal under strict guidelines and provided by doctors in Belgium, Luxembourg and The Netherlands, but only for residents.
Direct active euthanasia without express request (non-voluntary euthanasia): this is generally illegal.
Euthanasia: from the Greek, meaning “good, well, death”. As this term may relate to different issues, ranging from help at the end of life and putting down animals to the atrocities of the Nazi regime, it is not precise and should not be used in the context of assisted and accompanied suicide.
Indirect active euthanasia (double effect): the patient receives drugs to lessen the pain and/or distress of his/her suffering at a dosage which unintentionally but not always unavoidably shortens the patient’s life and brings about death earlier. For example: palliative treatment / terminal sedation of cancer patients. This form of assistance at the end of life is not explicitly regulated by law, yet it is generally acknowledged and widely practiced.
Palliative Treatment (also “Palliative Care”): all medical measurements in order to relieve the suffering of a terminally ill person and thus give the patient the maximum quality of life possible until the end. Palliative care is a treatment with a palliative aim, for example with untreatable tumours, the abatement and prophylaxis of the symptoms caused by the tumour. The drugs (palliatives) used will not treat the cause but the symptoms. Palliative care is specific approach and treatment which aims at improving the quality of life of patients and their close ones in cases of life-threatening illness. Palliative care reaches this goal by aiming to actively look for physical pain and other physical, psycho-social and spiritual sufferings and to treat them accordingly.
Passive euthanasia (termination of treatment, “to let die”): ending (or not starting) life-maintaining and life-prolonging therapies, renouncing treatments, waiving food and drink. This is legal.
Terminal Sedation (also “Palliative Sedation”): usually a medically induced (“artificial”) coma. Generally applied in palliative medicine for patients in a terminal phase, once the patient feels the suffering to be unbearable and explicitly requests the sedation. Basically, this term means all consciousness-affecting measurements in order to alleviate the distressing symptoms at the end of life. A palliative treatment can be followed by a terminal sedation. Example: a patient has given instructions not to be ventilated; an increasing shortness of breath (for example due to lung cancer) is being treated palliative, with appropriate dosages of morphine; is this not sufficient or is the danger of suffocation imminent, which can only be avoided by the not-wanted ventilation, a terminal sedation is induced.
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