Elena Hofacker¹, Louise Forst¹, Matthias Havemann¹, Jens Puschke², Carola Seifart¹

^{1 Institute} for Applied and Clinical Ethics in Healthcare, Faculty of Medicine, Philipps University of Marburg

^{2 Faculty} of Law, Chair of Criminal Law, Criminal Procedure, Criminology and Medical Criminal Law, Philipps University of Marburg

Societal regulations concerning the end of life are always value-laden and reflect fundamental notions of autonomy, responsibility and moral acceptability. Assisted suicide constitutes a paradigmatic case of conflict in this regard: it simultaneously touches upon the individual right to self-determination, professional responsibility in a medical and counselling context, and a society’s collective responsibility for the future in dealing with vulnerability and dying.

In 2020, the Federal Constitutional Court (BVerfG) declared the ban on the commercial promotion of suicide (Section 217 of the German Criminal Code) to be unconstitutional and derived a right to self-determined dying from Article 2(1) in conjunction with Article 1(1) of the Basic Law. This right is not tied to specific stages of life or medical conditions and expressly includes the right to seek assistance from third parties. This ruling marks a far-reaching normative concept that establishes autonomy as a central guiding principle at the end of life.

The extent to which this concept enjoys broad social support appears, at the very least, questionable. The legislative attempts that failed in 2023 point to a persistent ambivalence between legal liberalisation and moral reservations.

Against this background, the lecture draws on empirical findings from a comparative survey of students of medicine, Law and theology conducted 14 years apart. Whilst these findings point to a clear normative shift towards greater individual self-determination, they also show that support for assisted suicide (88 per cent) is not unconditional, but remains highly context-dependent. Of particular relevance here is the question of under what conditions and by which actors assisted suicide is regarded as ethically justifiable.

In particular, the low level of support for assisted suicide among healthy individuals or those not suffering from a terminal illness (21 per cent) points to a discrepancy between the autonomous freedom of choice as conceived by the Federal Constitutional Court and socially shared intuitions regarding moral acceptability. This tension will form the starting point for a normative analysis in the lecture. The centre of attention is on the question of what medical-ethical consequences arise when a constitutionally coherent conception of autonomy systematically clashes with widespread moral intuitions: Is ethics called upon here to play a corrective, mediating or critically distanced role?