A RULING by Switzerland's highest court has opened up the possibility that people with serious mental illnesses could be helped by doctors to take their own lives.
Switzerland already allows doctor-assisted suicide for terminally ill patients under certain circumstances. The Federal Tribunal's decision puts mental illnesses on the same level as physical ones.
The move has been labelled as "dangerous" as it could lead to a rapid rise in the number of people travelling to Switzerland for assisted suicide.
The latest figures show 54 Britons travelled to Zurich's Dignitas Clinic to end their lives in the past four years.
"It must be recognised that an incurable, permanent, serious mental disorder can cause similar suffering as a physical [disorder], making life appear unbearable to the patient in the long term," the ruling said.
"If the death wish is based on an autonomous decision which takes all circumstances into account, then a mentally ill person can be prescribed sodium-pentobarbital and thereby assisted in suicide," it added.
Various organisations exist in Switzerland to help people who want to commit suicide, and helping someone to die is not punishable under Swiss law as long as there is no "selfish motivation" for doing so.
In their ruling the judges made it clear certain conditions would have to be met before a mentally ill person's request for suicide assistance could be considered justified: "A distinction has to be made between a death wish which is an expression of a curable, psychiatric disorder and which requires treatment, and [a death wish] which is based on a person of sound judgment's own well-considered and permanent decision, which must be respected."
The case was brought by a 53-year-old man with serious bipolar affective disorder who asked the tribunal to allow him to acquire a lethal dose of pentobarbital without a doctor's prescription.
The tribunal ruled against his request, confirming the need for a thorough medical assessment of his condition.
Whether any Swiss physician would be prepared to prescribe a lethal dose of pentobarbital to a mentally ill person remains unclear. One internationally renowned expert on medical ethics said such a policy would be both difficult to enforce and dangerous to apply.
"Assisted suicide has always been linked to the challenge of allowing the terminally ill a choice in managing their inevitable death," said Dr Arthur Caplan, chairman of the Department of Medical Ethics at the University of Pennsylvania. "Linking the right to assistance in dying to the quality of someone's life or their suffering is an enormous and, in my view, very dangerous shift in legal and ethical thinking about assisted suicide."
Caplan said the policy could lead to a "very slippery slope", opening the door to anyone who claims to have unbearable psychological or emotional suffering to request help in dying: people with terrible burns, those who are severely disfigured, those who are emotionally bereft at the loss of a child or partner, and even those suffering from career failures.
"This is an incredibly controversial decision," he said. "Is the doctor's mission to eliminate difficult and horrendous human suffering by helping people to die?"
Elsbeth Chowdharay-Best, honorary secretary of Alert, an anti-euthanasia organisation set up to warn people of the dangers of any type of euthanasia legislation and pro-death initiatives, said: "I think this is a horrifying development. It takes one back to the Nazi era, when people with disabilities were considered disposable."
Switzerland is one of a number of countries in Europe that allow assistance to terminally ill people who wish to die.
The Netherlands legalised euthanasia in 2001 and Belgium did in 2002, while Britain and France allow terminally ill people to refuse treatment in favour of death.