Prerequisites for Assisted Suicide

Requirements for Assisted Suicide Accompaniment in Germany

Support in Assisted Suicide Accompaniment – Precaution, Preparation, and Guidance

The question of a self-determined end of life is among the most complex and sensitive issues within our society. It touches the very core of fundamental human existential questions and presents both individuals and the community with profound ethical, medical, legal, and personal challenges. At its center lies the confrontation with human autonomy over one’s own life and the scope of the constitutionally protected right to self-determination. This issue is of particular societal relevance because it highlights the tension between the protection of life as a constitutional value on the one hand and respect for the individual’s freedom to end their own life on the other.

In its landmark ruling of 26 February 2020 (Case No. 2 BvR 2347/15 et al.), the Federal Constitutional Court of Germany declared that the right to a self-determined death is an integral component of the general right of personality, derived from Article 2(1) in conjunction with Article 1(1) of the German Basic Law (Grundgesetz – GG). This right encompasses not only the freedom to end one’s own life, but also expressly the entitlement to seek assistance from third parties. Consequently, the former criminal provision under Section 217 of the German Criminal Code (StGB), which penalized the “commercial promotion of suicide,” was deemed unconstitutional and nullified.

The Court emphasized that every individual is free to determine the time, manner, and circumstances of their own death according to their personal values. It further clarified that there is neither a legal duty to continue living nor may the State deny access to assisted suicide based on paternalistic considerations. While the State has a legitimate interest in protecting life, it may not do so in a way that effectively abolishes or disproportionately restricts individual self-determination. Human dignity requires the acceptance of individual decisions, even when they diverge from societal majority views.

Nevertheless, this does not mean that assisted suicide accompaniment is permissible without limits. It remains bound by specific legal and factual conditions to ensure that the decision is genuinely free, autonomous, and serious. Certain minimum requirements must therefore be observed to establish the legal permissibility of assisted suicide accompaniment. These include, in particular, the individual’s capacity for insight and judgment, their legal competence, the exclusion of external pressures, thorough medical counseling on alternatives (such as palliative and hospice care), and comprehensive documentation of the decision-making process. Only by adhering to these safeguards can assisted suicide accompaniment proceed lawfully while preventing abuse.

1. Free Will and Seriousness of the Decision

The decision to commit suicide must be made autonomously, free from external pressure, and with careful consideration.
There must be neither a situation of coercion nor any manipulation by third parties.
This includes the individual’s capacity for judgment: the person must be able to recognize and assess the implications of their decision.

The Federal Constitutional Court emphasized that the State may not make a substantive assessment of the motives. The reasons may include illness, suffering, loss of quality of life, but also personal existential convictions.

2. Adulthood and Legal Capacity

A valid decision on assisted suicide may only be taken by individuals who are of legal age and possess full legal capacity.
Minors, as well as individuals who lack the capacity for discernment due to mental illness, are excluded from legally permissible assisted suicide accompaniment.

3. Medical Accompaniment and Duty to Provide Counseling

While medical accompaniment is not a legal requirement, it is considered in practice to be the safest and legally appropriate means of documenting both the seriousness and the free, autonomous nature of the decision.
“Under current law, following the annulment of Section 217 of the German Criminal Code by the Federal Constitutional Court, physicians may lawfully participate in assisted suicide, provided the aforementioned conditions are fulfilled.
Consultations are intended to present alternatives (such as palliative medical care or hospice services) while ensuring that the individual’s autonomy remains unaffected.

4. Documentation and Legal Safeguards4

To avoid potential criminal or civil liability, thorough documentation of the decision-making process is indispensable. Such documentation comprises medical attestations of discernment and judgment, written statements of the individual, and, if necessary, expert opinions or second medical assessments.
A clear and explicit written declaration by the individual wishing to end their life serves to protect both the acting parties (such as physicians) and the relatives from potential future legal proceedings.

5. Access to Lethal Medicinal Products

The practical execution is, at present, subject to inconsistent legal regulation.
The dispensing of life-ending medication falls under the provisions of the German Narcotics Act (BtMG). Thus far, the Federal Institute for Drugs and Medical Devices (BfArM) has consistently denied applications for such authorizations.
Certain administrative courts (for instance, the Administrative Court of Cologne, judgment of 2 November 2022 – 7 K 3162/20) have ruled that, under strict conditions, individuals may have a legal entitlement to access the relevant medication.
Nonetheless, the legal framework in this regard remains unsettled, leading in practice to affected individuals frequently resorting to medical prescriptions that operate within a legal grey zone.

6. No Criminal Liability for Assisted Suicide Accompaniment

Following the decision of the Federal Constitutional Court, assistance in suicide is not subject to criminal liability in Germany, as long as the individual concerned has made the decision freely and with autonomous responsibility.
In contrast, killing on request (§ 216 of the German Criminal Code – StGB) continues to constitute a criminal offence, namely where death is directly caused by the active intervention of another person. The crucial distinction lies in the fact that, in assisted suicide, it is the individual themselves who performs the life-ending act.

Assisted suicide accompaniment is legally permissible in Germany under strict but clearly defined conditions. The decisive factor is the individual’s self-determined, free, and well-considered decision. Medical accompaniment, documentation, and counseling provide additional legal certainty.

The legal situation remains disputed in certain aspects—particularly regarding access to medication—and is subject to ongoing judicial development. Nevertheless, since the 2020 decision of the Federal Constitutional Court, the right to a self-determined death has been constitutionally protected, and every individual is entitled to make this decision for themselves.