Assisted suicide in Germany: a survey on requests for and current practices of assisted suicide

Following the constitutional court ruling in 2020, which legalized assistance in suicide in Germany under certain conditions, the practice of assisted suicide in Germany has been developing rather dynamically regarding the number of assisted suicides as well as the number of institutions offering suicide assistance. Challenges include a competent assessment of decisional capacity and the choice of adequate drugs. The aim of this study was to provide information about characteristics of people requesting assistance with suicide and those who died by assisted suicide as well as information about the current practice of assisted suicide in Germany. We conducted an anonymous, open online survey with a convenience sample of 672 people who signed up for a webinar on professional standards of suicide assistance in April 2024. Descriptive statistical analysis of absolute and relative frequencies of the responses was performed. The results are provided as total numbers and percentages for either the whole sample (including those missing) or the subgroups analyzed. The free-text answers were coded independently by two researchers by means of qualitative content analysis. A total of 128 of 234 participants who accessed the online survey were included. Key findings are, firstly, a small subgroup receiving a substantial number of requests and assisting suicide in a high number of cases. Secondly, a wide range of professional groups and nonprofessionals were confronted with requests, and thirdly, a great heterogeneity regarding the practice of suicide assistance was observed, i.e. regarding the drugs applied, the process of information and counselling, and the assessment of decisional capacity. Our data indicate a lack of standardization in assisted suicide practice in Germany, which is associated with certain risks such as complications for those seeking suicide assistance due to inappropriate medication, inequalities in access to suicide assistance and legal uncertainty for those providing suicide assistance. Standardizing assisted suicide practice could facilitate quality and legal certainty. Further research based on prospective registries can support transparency and standardization and contribute to an accountable practice of assisted suicide in the future.