Assisted suicide as conducted by a "Right-to-Die"-society in Switzerland: a descriptive analysis of 43 consecutive cases.

BACKGROUND AND METHODS: The Swiss "Right-to-Die"-society EXIT enables assisted suicide by providing terminally ill members with a lethal dosage of barbiturates on request. This practice is tolerated by Swiss legislation. EXIT insists on its assumption that people with serious illness and suffering have the competency to take such a decision. The case of two patients who committed suicide a short time after their release from a psychiatric clinic raised some doubts about the practice of EXIT. The files of all 43 cases of suicide assisted by EXIT between 1992 and 1997 in the region of Basle kept in the Institute of Forensic Medicine were examined for accuracy of the medical data. This sample was compared for age, gender-ratio and prior psychiatric treatment with 425 ordinary suicides in the same region. An attempt was made to assess whether only terminally ill and people with intolerable suffering had been assisted with suicide and what efforts EXIT had made to rule out psychiatric illnesses or poor social conditions as the reason for the wish to die. RESULTS: A medical report of the treating doctor(s) was in the files in only five cases. The "EXIT" cases where older than the "ordinary"-sample. Among those over 65 years old there were almost twice as many women as men. 16 of the 24 women older than 65 years were widowed. There were 20 cases of cancer; but in eleven cases medical files revealed no apparent medical condition to explain a death-wish. Five of the patients declared a social loss or fear of such loss as the reason for their wish to die. Six persons had formerly been in psychiatric care, though this was not mentioned in the files. CONCLUSIONS: Due to the scarcity of information in the files as regards previous palliative care, the high proportion of old women and the high percentage of people not suffering from a terminal illness compared to the literature we conclude that psychiatric or social factors are not an obstacle for EXIT to assist with suicide.

[Stigma, stigma management, destigmatization]. / Stigma, Stigmabewältigung, Entstigmatisierung.

WHO and WPA recently inaugurated worldwide "anti-stigma-campaigns". On this background the exploration discrimination of against the mentally ill of the term stigma and its meaning is useful. Stigma dates from ancient Greece and was meant to be a visible sign of disgrace. Today stigma and stigma management are sociological terms described by the American sociologist Ervin Goffman (1963) in is essay "Stigma--notes on the management to spoiled identity". Changes and hazards of attempts of destigmatization are explored.

[Assisted suicide and psychiatric disorders]. / Beihilfe zum Suizid bei psychisch Kranken.

In the region of Basel in Switzerland 43 assisted suicides were registered between 1992 and 1997, eight percent of all suicides in the region. Assisted suicide was administered by the help-to-die society Exit. There was a psychiatric history in six of the suicides. Four of them suffered of serious physical illness as well. The analyses of these six suicides focuses on the conditions of assisted suicide in people with mental illness and the ethical problems arising.

[Neuroleptics in the newspaper. A mass media analysis]. / Neuroleptika in der Zeitung. Eine Medienanalyse.

OBJECTIVE: Neuroleptic drugs have a dubious public reputation. Many people consider them obnoxious, even in schizophrenia. METHOD: 10 annual editions of six German language opinion leading newspapers are analysed. RESULTS: Only in one of 35 articles neuroleptics are judged positive, in 27 negative. They are seen close to violence and restriction, as punishment or even as torture, as paralyzing or even as "torturetherapy". Informations in the articles are scarce. Most of the articles cover the fields of medicine or psychiatry or of forensics. CONCLUSION: Apart from the negative attitude the extremely low number of articles on neuroleptics is the most outstanding result of our study.

[Tranquilizers in the newspaper. An media analysis]. / Tranquilizer in der Zeitung. Eine Medienanalyse.

OBJECTIVE: For the public the image of psychopharmacological drugs is identical with that of minor tranquilizers. The way of describing and portraying these drugs in the media therefore is of general interest. METHOD: Ten annual volumes of six German language opinion leading daily and weekly papers which exist on CD-Rom in full text editions are screened for the key word "minor tranquilizer". The articles identified are analyzed formally quantatively and qualitatively. RESULTS: The ten annual volumes analyzed contained 45 articles in which tranquilizers were mentioned (4.5 per annual volume). The key words were found in all sections of the papers, most often, however, in the cultural section, followed by the science section. Regarding the themes medicine and law were in the first position (one third), but society, arts and culture and politics contained even more articles dealing with the key word minor tranquilizer. For fifth of the articles only mentioned the key word. Only once minor tranquilizers are the main topic of the article. Tranquilizers are valued negatively ten times as often as they are valued positively. In two fifth of the articles the term is employed as a metaphor. Even in this context minor tranquilizers are valued negatively (10:1). CONCLUSIONS: Three fourth of the articles, employing the term in the non metaphorical way, deal with abuse and dependency. The public image of minor tranquilizers in the media is mainly characterized by their potency to cause dependency.

[Suicide in the psychiatric clinic: weekend leave as risk factor. A qualitative analysis]. / Der Suizid in der psychiatrischen Klinik: Wochenendurlaub als Risikofaktor. Eine qualitative Analyse.

OBJECTIVE: The study focuses on biographic and social aspects including illness behaviour of psychiatric in-patients who committed suicide in weekend leave. METHOD: The authors undertake a retrospective qualitative analysis of 14 cases of inpatient suicide. RESULTS: 11 of 14 patients had been confronted during their weekend leaves with a milieu full of emotional conflicts with their spouses, parents or children. These conflicts had been of considerable subjective significance for the patients, who often experienced feelings of guilt and failure in their relations. CONCLUSION: Weekend leave of psychiatric inpatients is to be considered as a risk factor for suicide, a risk that must be taken into account before sending a patient home for the weekend.

[Are suicides in the psychiatric hospital actually more frequent now?]. / Sind Suizide im psychiatrischen Krankenhaus wirklich häufiger geworden?

Annual suicide rates in a North German psychiatric hospital between 1975 and 1997 are reported. There is no overall increase. After a peak in the early eighties there was a moderate but steady decrease of the suicide rate whereas the average of the absolute suicide rate remained stable for almost a quarter of a century.

[Commitment of mentally ill. Legal procedures and risk in implementation]. / Fürsorgerische Freiheitsentziehung. Ordentliches Verfahren und Gefahr im Verzug.

According to a Survey in Seven Swiss Cantons the Rates of Involuntary Hospitalization Varies Widely (21 to 590 per 100,000). Possible Implications are Discussed.

[General seclusion practice in a psychiatric clinic. A follow-up study]. / Zur Isolierungspraxis in einer psychiatrischen Klinik. Eine Nachuntersuchung.

The frequency of seclusions per admission was not reduced. Patients in seclusion were mainly male schizophrenics, as three years before. The main difference was a drastic reduction of time of seclusion in two thirds of patients.

[Electroconvulsive therapy and defibrillation in the paper. An analysis of the media]. / Die Elektrokrampftherapie und die Defibrillation in der Zeitung. Eine Medienanalyse.

In our study on Psychiatry, Mass Media and Public Opinion we made a content analysis of newspaper reports on ECT and electric defibrillation. We traced only few special articles on the subject in the 1994 and 1995 CD-Rom versions of the "Der Spiegel", The "Frankfurter Allgemeine Zeitung" (FAZ), the "Neue Zürcher Zeitung" (NZZ) and the "Berliner Tageszeitung" (taz), although the word "Elektroschock" was employed 118 times. Even in high standard newspapers the style of language becomes special when they deal with ECT. The articles are strongly biased and lack informations. In contrast to Defibrillation ECT is not generally accepted. Referring to ECT horror pictures of past psychiatry are cited. The language used is biased and discriminative. Referring to Defibrillation technical details are described and the language is neutral. The social representation of ECT is completely negative.

[Schizophrenia in the "New Zurich Newspaper". A media analysis]. / Schizophrenie in der "Neuen Zürcher Zeitung". Eine Medienanalyse.

Social representations of mental illness and psychiatry are largely influenced by mass media. This study explores the use of the term "schizophrenia" in the Swiss newspaper NZZ in 1994 and 1995, the text of which is available on CD-ROM. In 31% of the cases the term is used figuratively, i.e. as a metaphor. When used as a name of an illness, it reflects contradictory connotations: schizophrenics as mentally ill offenders or criminal in the local columns, schizophrenics featuring as creative writers or artists in the cultural columns. Information on schizophrenia as disease is rare. If it does occur, reporting is rather sociopsychiatric than neurobiological.

[Electroconvulsive therapy, electroshock and shock therapy in the newspaper]. / Elektrokrampftherapie, Elektroschock und Schocktherapie in der Zeitung.

Newspapers reports on ECT are extremely biased. A quantitative analysis of four German and Swiss papers demonstrates impressingly the change of meaning of synonymous terms like "Elektroschock" and "Schocktherapie" which refer to torture and brutal reforms of Eastern European communist economies.