AUSTRIA – One year with an assisted dying law – first experiences
22 February 2023
Guest article by Heidemarie Hurtl, ÖGHL – Austrian Society for a Humane End of Life
At the beginning of 2022, the “Federal Act on Establishing Advance Directives for Assistance in Suicide” (“Bundesgesetz über die Errichtung von Sterbeverfügungen”) came into force in Austria. Since then, (physician-supported) assisted suicide has been permitted in principle for persons who suffer from a serious or terminal illness, provided they are of age and capable of making a decision. With two medical consultations as a prerequisite, a notarial advance directive for assistance in suicide can be drawn up, which entitles the person to procure the lethal medication (sodium pentobarbital) after a defined waiting period. The law does not regulate the further procedure.
After assisted suicide was decriminalised as of 31 December 2021 by the landmark judgment of the Constitutional Court 11 December 2020, the legislator intended to regulate access to assisted suicide in such a way that abuse, coercion, or hasty decisions can be excluded as far as possible. However, administrative hurdles have been set so high that some people who wish to end their own life cannot overcome them – especially if there are no supportive family members or helping friends available.
Organisations are not allowed to provide assisted suicide
There would be an opportunity for assisted suicide organisations to step in to help. However, this possibility is severely restricted by the narrow legal framework. The new law on assisted suicide stipulates, among other things, a strict ban on advertising and a ban on economic benefits. As there are potentially high penalties, organisations such as the ÖGHL (“Österreichische Gesellschaft für ein humanes Lebensende”; Austrian Society for a Humane End of Life) could risk their existence if violating the law.
To obtain legal certainty, the ÖGHL therefore commissioned a legal expert opinion immediately after the National Council’s decision, with the aim of defining the legal scope for future action. The results were discussed internally and led to an adjustment of the association’s statutes. The ÖGHL will neither offer nor mediate any practical assistance until further notice. The services offered by the association are currently limited to counselling and information, help in completing the advance directive for assistance in dying, and referrals to attesting medical doctors. This limitation is regrettable and unsatisfactory, both for the staff of ÖGHL and for the members, who wish for more support. Internally however, the ÖGHL is preparing for a more active role in the future.
Considerable regional differences in the implementation of the law
Overall, access to assisted suicide last year was marked by ignorance, scepticism, and considerable regional differences. Enquiries to the ÖGHL, media reports and personal conversations show that quite a few persons wishing to apply for an assisted suicide, despite all their efforts, have not yet been able to have their urgent wish granted.
One of the reasons for uncertainty and frustration in connection with the new law are the very diverse regional interpretations. In some states (Bundesländer), it is relatively easy to obtain the addresses of attesting doctors and cooperative notaries. In other parts of the country, the professional associations do not share this information, or only with the family doctor / GP. If the latter is not willing to make a corresponding enquiry with them, the patient’s path to an assisted suicide is stopped short at that point.
Lack of information and data
Medical professionals are often sceptical and cautious about assisted suicide. Doctors (as well as pharmacists and lawyers) can refuse any involvement in assisted suicide for reasons of conscience. However, the uncertainty often stems from a lack of information. For this reason, on the initiative of ÖGHL members, several creditable further trainings for doctors have been organised, and these were well attended. Here, too, the medical associations of some states are very supportive, but a major part of them is taking a wait-and-see attitude. Overall, it can be said that the helpful initiatives mostly come from committed individuals rather than from institutions.
Another criticism on the way the law is implemented concerns data transparency. Enquiries from organisations and individual journalists about the number of advance directives for assistance in suicide deposited, and the number of actual assisted suicides, were answered negatively by the Federal Ministry of Social Affairs, Health, Care and Consumer Protection. The Ministry claimed it was against the law to process the data for journalistic purposes. At the end of the year 2022, the Austria Press Agency finally published a concise statistic, according to which a total of 111 advance directives for assistance in suicide were issued in Austria last year; the lethal medication was dispensed in pharmacies 90 times, and actually used about ten times – the latter figure is not precise.
For the purpose of quality control and as a prerequisite for academic research, in the future these figures should not only be collected but also made accessible. Countries such as Belgium or the Netherlands are good examples for transparent data processing.
