Postupak u ovom predmetu je pokrenut predstavkom protiv Konfederacije Švajcarska koju je Sudu podneo švajcarski državljanin g.Ernst G. Haas (podnosilac predstavke), dana 18.7.2007.godine.

Podnosilac je prigovarao po osnovu člana 8 Konvencije, smatrajući da mu pripada da izabere trenutak svoje smrti i način na koji će umreti. Pored Vlade, primedbe je dostavilo i „Dignitas“, švajcarsko privatno udruženje čiji je cilj da svojim članovima obezbedi da mogu živeti i umreti uz poštovanje ljudskog dostojanstva.

Podnosilac je rođen 1953.godine i ima prebivalište u Meltingenu (kanton Soler). On pati od teškog oblika afektivnog bipolarnog duševnog oboljenja od pre dvadesetak godina tokom kojih je učinio dva pokušaja samoubistva i u više navrata boravio na psihijatrijskim klinikama. On je poželeo da se ubije jer smatra da ga njegova bolest sprečava da živi dostojanstveno. Udruženju „Dignitas“ se obratio za pomoć, a više lekara psihijatara je odbilo da mu izda recept za smrtonosnu dozu leka. U junu 2005.godine obratio se različitim državnim organima u cilju dobijanja odobrenja za nabavku potrebne supstance u apoteci, bez lekarskog recepta, a preko udruženja. Pošto su ga Savezno ministarstvo zdravlja, Savezno ministarstvo unutrašnih poslova i Uprava za zdravstvo kantona Cirih odbili, obratio se Saveznom sudu, pozivajući se na član 8 Konvencije. Početkom novembra 2006.godine Savezni sud je odbacio žalbu podnosioca predstavke. Početkom maja 2007.godine podnosilac je uputio pismo velikom broju lekara psihijatara i svakog od njih je pitao da li bi prihvatio da ga primi radi psihijatrijske ekspertize u cilju izdavanja recepta za natrijum pentobarbital.

NAVODNO KRŠENJE ČLANA 8 KONVENCIJE
- Svako ima pravo na poštovanje svog privatnog i porodičnog života, doma i prepiske.
- Javne vlasti se neće mešati u vršenje ovog prava osim ako je to u skladu sa zakonom i neophodno u demokratskom društvu

U svetlu svoje sudske prakse, Sud smatra da pravo nekog lica da odluči u kom trenutku i na koji način njegov život treba da bude okončan, pod uslovom da je to lice u stanju da slobodno formira svoju volju u vezi sa tim, predstavlja jedan od aspekata prava na poštovanje privatnog života u smislu člana 8 Konvencije. S druge strane, podnosilac ne boluje od neizlečive degenerativne boleseti koja bi ga sprečila da sam sebi oduzme život. Sud smatra da treba razmotriti zahtev podnosioca sa stanovišta pozitivne obaveze države da preduzme neophodne mere koje omogućavaju dostojanstveno samoubistvo. Imajući sve okolnosti u vidu Sud smatra da nije bilo povrede člana 8 Konvencije.

Preuzmite presudu u pdf formatu

EVROPSKI SUD ZA LJUDSKA PRAVA

PRVO ODELJENJE

PREDMET HAS (HAAS) protiv ŠVAJCARSKE

(Predstavka br. 31322/07)

PRESUDA

STRAZBUR

20. januar 2011.

U predmetu Has (Haas) protiv Švajcarske, Evropski sud za ljudska prava (prvo odeljenje), postupajući u veću sastavljenom od:

Hristos Rozakis (Christos Rozakis), predsednik,
Nina Vajić,
Anatolij Kovler (Anatoly Kovler),
Hanlar Hadžijev (Khanlar Hajiyev),
Svere Erik Jebens (Sverre Erik Jebens),
Đorđo Malinverni (Giorgio Malinverni),
Žorž Nikolau (George Nicolaou), sudije,
i Seren Nilsen (Søren Nielsen), sekretar odeljenja,

posle većanja na zatvorenoj sednici 14. decembra 2010, izriče sledeću presudu usvojenu tog dana

POSTUPAK

Predmet je formiran na osnovu predstavke (br.31322/07) protiv Švajcarske konfederacije čiji se jedan državljanin, g. Ernst G. Has (Ernst G. Haas) («podnosilac predstavke»), obratio Sudu 18. jula 2007. na osnovu člana 34 Konvencije o zaštiti ljudskih prava i osnovnih sloboda («Konvencija»).
Podnosioca predstavke zastupao je g. P. Šerc (P. Schaerz), advokat iz Ustera (kanton Cirih). Švajcarsku vladu («Vlada») zastupao je njen agent, g. F.Širman (F. Schürmann), načelnik odeljenja za ljudska prava i za Savet Evrope pri Saveznom ministarstvu pravde.
Pozivajući se na član 8 Konvencije, podnosilac predstavke se žali na kršenje prava koje smatra da mu pripada, da izabere trenutak svoje smrti i način na koji će umreti.
Odlukom od 20. maja 2010, Sud je predstavku proglasio prihvatljivom.
Vlada je podnela dodatne primedbe na meritum predmeta (pravilo 59 § 1 Pravilnika Suda). Primedbe je dostavilo i «Dignitas» (član 36 § 2 Konvencije), švajcarsko privatno udruženje čiji je cilj da svojim članovima obezbedi da mogu živeti i umreti uz poštovanje ljudskog dostojanstva.

ČINJENIČNO STANJE

I OKOLNOSTI PREDMETA

Podnosilac predstavke je rođen 1953. i ima prebivalište u Meltingen (kanton Soler/Zoloturn).
Podnosilac pati od teškog oblika afektivnog bipolarnog duševnog oboljenja od pre dvadesetak godina tokom kojih je učinio dva pokušaja samoubistva i u više navrata boravio na psihijatrijskim klinikama. 1. jula 2004 učlanjuje se u Dignitas, udruženje koje UPRAVO nudi pomoć kod samoubistva. Smatrajući da ga njegova bolest, teška za lečenje, sprečava da živi dostojanstveno, podnosilac predstavke je zatražio od udruženja Dignitas da mu pomogne u njegovoj nameri da se ubije. Da bi došao u posed neophodne smrtonosne supstance – 15 grama natrijum pentobarbitala – koja se izdaje samo na lekarski recept, podnosilac predstavke se obratio nekolicini različitih lekara psihijatara, ali uzalud.

A. Koraci koje je podnosilac predstavke preduzeo kod različitih organa

8. juna 2005. podnosilac predstavke se obratio različitim državnim organima u cilju dobijanja odobrenja za nabavku pomenute supstance u apoteci, bez lekarskog recepta, preko udruženja Dignitas.
27. juna 2005, Savezno ministarstvo pravde se proglasilo nenadležnim za njegov zahtev i odbacilo ga je.
20. jula 2005, Savezno ministarstvo zdravlja odbilo je podnosioca predstavke uz obrazloženje da se natrijum pentobarbital u apoteci može dobiti samo na lekarski recept. Osim toga, ono je izrazilo mišljenje da član 8 Konvencije ne nameće državama ugovornicama pozitivnu obavezu da stvaraju uslove koji omogućavaju samoubistvo bez rizika od neuspeha i bezbolno.
3. avgusta 2005, Uprava za zdravstvo kantona Cirih takođe je odbacila zahtev podnosioca predstavke uz obrazloženje da, budući da nema neophodni lekarski recept, zainteresovanom ne može biti odobreno da pomenutu supstancu dobije u nekoj apoteci. Takođe je istakla da se do prava na koje se poziva podnosilac predstavke ne može doći dedukcijom iz člana 8 Konvencije. Tu odluku potvrdio je Upravni sud kantona Cirih 17. novembra 2005.
20. decembra 2005, Savezno ministarstvo unutrašnjih poslova proglasilo je neprihvatljivom žalbu koju je zainteresovani uložio protiv odluke od 20. jula 2005, uz obrazloženje da tu nije reč o hitnom slučaju kad se neka supstanca koja se izdaje samo na lekarski recept može dobiti i bez traženog recepta.
Podnosilac predstavke se obratio Saveznom sudu žalbom na odluke Saveznog ministarstva za unutrašnje poslove i Upravnog suda kantona Cirih. Pozivajući se upravo na član 8 Konvencije, tvrdio je da ta odredba garantuje pravo da se donese odluka o sopstvenoj smrti i da je mešanje države u to pravo moguće samo u uslovima navedenim u stavu 2 člana 8. Po shvatanju podnosioca predstavke, obaveza posedovanja lekarskog recepta kako bi se dobila supstanca neophodna da bi se počinilo samoubistvo i nemogućnost da se nabavi takav lekarski recept, zbog, po njegovom uverenju, pretnji države lekarima oduzimanjem dozvole za rad u slučaju da prepišu tu supstancu duševnim bolesnicima, predstavlja mešanje u njegovo pravo na poštovanje njegovog privatnog života. A ako, po mišljenju podnosioca predstavke, to mešanje i počiva na nekom zakonskom osnovu i teži nekom legitimnom cilju, ono u njegovom slučaju nije srazmerno tom cilju.

B. Presuda Saveznog suda

Presudom od 3. novembra 2006, Savezni sud je spojio oba postupka i odbacio žabu podnosioca predstavke.
Zaključio je, pod jedan, da se prema primenljivim zakonskim odredbama natrijum pentobarbital može dobiti samo na lekarski recept i da podnosilac predstavke nije dobio takav recept. Istakao je, pod dva, da se u konkretnom slučaju ne radi o nekom od izuzetnih slučajeva koji omogućavaju izdavanje nekog leka bez recepta.
U vezi s navodnim kršenjem člana 8 Konvencije, Savezni sud je izrazio sledeći stav:

(prevod)

« 6.1. (...) Pravo na odlučivanje o sopstvenoj sudbini u smislu člana 8 § 1 [Konvencije], uključuje pravo pojedinca da odluči u kom trenutku i na koji način će umreti, bar kad je u stanju da u vezi s tim odlučuje slobodnom voljom i da postupa sledstveno toj odluci (...)

6.2.1. Mora se, međutim, praviti razlika između prava na odluku o sopstvenoj smrti, koje se ovde ne dovodi u pitanje kao takvo, od prava na pomoć države ili trećeg lica pri izvršenju samoubistva. U načelu, takvo pravo se ne može dedukovati ni iz člana 10 stav 2 saveznog Ustava [o slobodi pojedinca] ni iz člana 8 Konvencije; pojedinac koji želi da umre ne poseduje pravo na pomoć pri samoubistvu, bilo stavljanjem na raspolaganje za to neophodnih sredstava ili putem neke aktivne pomoći kad sam nije u stanju da sebi oduzme život (...). Država ima suštinsku obavezu da štiti život. Naravno, takva obaveza se generalno ne nameće protiv izričite volje nekog lica sposobnog da razumno odlučuje. (...) To ipak ne znači pozitivnu obavezu za državu da licu koje želi da umre omogući pristup nekoj opasnoj supstanci izabranoj radi izvršenja samoubistva ili nekim instrumentima namenjenim toj svrsi. Pravo na život garantovano članom 2 Konvencije obavezuje državu u najmanju ruku, u takvim okolnostima, da uspostavi proceduru koja može obezbediti da jedna takva odluka o samoubistvu odgovara slobodnoj volji zainteresovanog lica (...)

6.2.2. Prethodno potvrđuje sudska praksa organa iz Strazbura: član 2 [Konvencije] ne garantuje nikakvo pravo na umiranje, bilo uz pomoć trećeg lica ili uz pomoć države; pravo na život ne podrazumeva nikakvu odgovarajuću negativnu slobodu (presuda Pretty protiv Ujedinjenog Kraljevstva, br. 2346/02, CEDH 2002-III, str. 203, § 40) (...) Član 3 ne obavezuje u načelu državu da garantuje krivičnu nekažnjivost za pomoć pri samoubistvu niti da stvori neki zakonski osnov za neki drugi oblik pomoći pri samoubistvu; država ne sme odobravati dela čiji je cilj prekid života (navedena presuda Pretty, §§ 55 i sledeći). U vezi sa članom 8, Sud je konstatovao – bez ikakve namere da dovodi u pitanje neprikosnovenost života – da kvalitet života, a s njim i pitanje slobodnog odlučivanja lica o sopstvenoj sudbini, igraju određenu ulogu s tačke gledišta te odredbe (navedena presuda Pretty, § 65). Sud je izjavio da «ne može da isključi» da zbog činjenice da je podnosilac predstavke bila onemogućena da izvrši svoju volju da izbegne ono što bi po njenom shvatanju predstavljalo jedan nedostojanstven i mučan kraj života, predstavlja ugrožavanje njenog prava na poštovanje privatnog života u smislu člana 8 § 1 Konvencije (navedena presuda Pretty, 67 ; videti takođe presudu Vrhovnog suda Kanade u predmetu Rodriguez protiv Britanske Kolumbije [Attorney General ; [1993] 3 S.C.R 513], i mišljenje sudije Sopinka kao osnove za mišljenje većine veća) ; to je već bilo najavljeno 1983. u predmetu Reed, u kome je Komisija istakla da postupanje nekog lica kojim drugom licu pomaže da umre ne spada kao takvo u polje primene člana 8, ali da, zauzvrat, zaštita privatnosti lica koje želi da se ubije može ući u taj kontekst (odluka o neprihvatljivosti Reed protiv Ujedinjenog Kraljevstva (odl.), 4. jul 1983, Odluke i izveštaji 33, str. 273, § 13).

6.2.3. Predmet Pretty (kao ni predmet Rodriguez) nije uporediv s ovim predmetom: sloboda podnosioca predstavke da se ubije, a posledično i nekažnjivost lica koje bi eventualno pružilo pomoć u vršenju samoubistva, pod uslovom da ne postupa iz nekog egoističnog razloga (član 115 Krivičnog zakonika), ne dovode se ovde u pitanje. Sporno je pitanje da li, na osnovu člana 8, država mora da učini nešto kako bi podnosilac predstavke umro bez bolova i bez rizika od neuspeha samoubistva, i shodno tome, da može da dobije natrijum pentobarbital bez lekarskog recepta, odstupanjem od zakona. Na to pitanje treba odgovoriti odrečno: tačno je da Konvencija ne štiti neka teoretska ili prividna prav, već konkretna i delotvorna prava (presuda Artico protiv Italije, 13. maj 1980, serija A, br. 37, § 33) ; ne izgleda, međutim – ako se zna da postoje i druge opcije – da slobodu lica da se ubije, a time i slobodu da odlučuje o kvalitetu sopstvenog života, ograničava prosta činjenica da država ne odobrava izdavanje predmetne supstance, bezuslovno, već država uslovljava izdavanje te supstance lekarskim receptom, u skladu «priznatim pravilima farmaceutskih i medicinskih nauka», i poznavanjem zdravstvenog stanja zainteresovanog lica (član 24, alineja 1, slovo a), u kombinaciji sa članom 26 LPTh [saveznog zakona o lekovima i medicinskim sredstvima], i članom 9, alineja 1, u kombinaciji sa članom 10 Lstup [savezni zakon o psihoaktivnim supstancama]). da bi se na delotvoran način garantovalo pravo na odlučivanje o sopstvenom životu, koje proističe iz člana 8 § 1 Konvencije, nije neophodno odobravati izdavanje bez ograničenja natrijum pentobarbital, iako se ta supstanca smatra pogodnom za izvršenje samoubistva. Sama činjenica da druga rešenja osim natrijum pentobarbitala nose veći rizik od neuspeha i jačih bolova nije dovoljna da bi se opravdalo izdavanje te supstance bez lekarskog recepta u cilju samoubistva. Do takve pozitivne obaveze ne može se doći dedukcijom ni iz člana 10 § 2 Saveznog ustava ni iz člana 8 Konvencije(...)

(...)

6.3.2. Obaveza pokazivanja lekarskog recepta počiva na jasnoj, pristupačnoj i predvidljivoj zakonskoj osnovi, odnosno kad je reč o domaćem pravu, na članovima 24 i 26 LPTh i na članovima 9 i 10 alineja 1 LStup, a kad je reč o međunarodnom pravu, na članu 9 alineja 1 i na Tabeli III Konvencije od 21. februara 1971. o psihotropnim supstancama. Generalno, cilj te obaveze je zaštita zdravlja i bezbednosti stanovništva i, u kontekstu pomoći kod samoubistva, sprečavanje činjenja krivičnih dela i borba protiv rizika od zloupotreba (navedena presuda Pretty, §§ 74 i 75 (...)). Supstancu čije unošenje u organizam vodi u smrt ne mogu jednostavno izdavati apotekari bez ikakvih saznanja o okolnostima slučaja; u interesu pacijenta izdavanje takve supstance mora biti uslovljeno pokazivanjem lekarskog recepta. Lekarski recept pretpostavlja određenu dijagnozu postavljenu po pravilima profesionalne deontologije lekara, odgovarajuću medicinsku indikaciju (Indikationsstellung) i informativni razgovor. Samo lekar može pristupiti ocenjivanju sposobnosti rasuđivanja pacijenta i medicinske dokumentacije i prosuditi da li su bez uspeha iscrpljene sve mogućnosti lečenja (...). Obaveza prepisivanja na recept natrijum pentobarbitola predstavlja garanciju da lekar neće izdati tu supstancu a da se svi uslovi za to nisu stekli jer bi u suprotnom bio izložen krivičnim, građanskim ili disciplinskim sankcijama (...). Njom se pojedinac štit od nepromišljenih i na brzinu donetih odluka (...) i garantuje postojanje medicinskog opravdanja čina (...). Eventualno mešanje u pravo na slobodno upravljanje svojom sudbinom zaštićeno članom 8 Konvencije samo određenu relativnu težinu s obzirom na posledice izdavanja n atrijum pentobarbitala u cilju samoubistva (...). Zauzvrat, zaštita života, zabrana ubistva i njegovo razgraničenje od pomoći pri samoubistvu, koja nije a priori kažnjiva, predstavljaju značajan opšti interes (...). Ako je pomoć pri izvršenju samoubistva medicinskim sredstvima dozvoljena, a to je pitanje o kome, s obzirom na značaj njegove etičke dimenzije, ocenu treba da dâ pre svega zakonodavac (navedena presuda Pretty, § 74 in fine), država ima pravo da predvidi jednu kontrolnu proceduru kojom se garantuje da odluka zainteresovanog zaista odgovara izrazu njegove slobodne i promišljene volje (...) ; u tom smislu, obaveza prepisivanja lekarskog recepta je odgovarajuća i nužna. Budući da podnosilac predstavke tvrdi da takva argumentacija nema u vidu onih 1.300 slučajeva samoubistva i 63.000 slučajeva pokušaja samoubistva godišnje, u kojima država navodno ne poštuje svoju obavezu zaštite, treba istaći da se ti slučajevi ne odnose, kao i u konkretnom slučaju, na pitanje izdavanja bez lekarskog recepta neke supstance u cilju izvršenja samoubistva, pa se stoga ne mogu porediti sa situacijom iz ovog predmeta.

(...)

6.3.4. Propisi u vezi s pružanjem pomoći pri izvršenju samoubistva relativno su liberalni u Švajcarskoj, u tom smislu da su pomoć ili podsticanje sankcionisani samo u slučajevima egoističnih motiva (član 115 Krivičnog zakonika). Zauzvrat, zakonodavac ostaje slobodan, kad odmerava interese koji su u igri – pravo na slobodno odlučivanje o sopstvenoj sudbini onog ko želi da sebi oduzme život, s jedne strane, i zaštita od samoubistava u afektu (Affektsuizid), s druge strane – da zakonitost pomoći pri izvršenju samoubistva i izdavanje neke opasne supstance podredi njihovoj saglasnosti s pravilima profesije i sa stanjem medicinske nauke. Direktive Švajcarske akademije medicinskih nauka od 25. novembra 2004. u vezi sa preuzimanjem brige za pacijentkinje i pacijente pred kraj života, prihvataju da u nekim graničnim slučajevima lekar može da bude suočen s jednim «teško rešivim konfliktom» (tačka 4.1 direktiva). Svakako, pomoć pri samoubistvu ne može se smatrati delom lekarske delatnosti, jer je ona po sebi u suprotnosti s ciljevima medicine; međutim, poštovanje volje pacijenta takođe je od suštinskog značaja za odnos između lekara i pacijenta, tako da se lekar može naći u situaciji da donese odluku po svojoj duši i savesti, odluku koja bi se morala poštovati. Ako lekar izabere pomoć pri izvršenju samoubistva, on time de fakto garantuje: 1) da stanje pacijentove bolesti uistinu nagoveštava kraj života, 2) da je o drugim mogućnostima podrške razgovarao s pacijentom i, eventualno ih sproveo, i 3) da je pacijent sposoban da rasuđuje, da njegova želja deluje kao dobro promišljena, da je nezavisan od spoljnih pritisaka i da se ona smatra trajnom, što mora proveriti neko nezavisno treće lice koje ne mora nužno biti lekar; poslednji čin koji vodi u smrt mora uvek da obavi sam pacijent. Suprotno tvrđenju podnosioca predstavke, lekar u okviru priznatih pravila profesije ima pravo da prepiše natrijum pentobarbital u cilju samoubistva ukoliko su ispunjeni uslovi za njegovo prepisivanje. Kako je to već primetio Savezni sud, danas uočavamo jednu promenu stava u tom smislu da se pomoć pri izvršenju samoubistva smatra dobrovoljnom lekarskom aktivnošću koja se ne može nametnuti ni jednom lekaru, ali koja nije isključena sa stanovišta pravila profesije i nadzora sve dok se poštuje dužnost lekarske predusretljivosti u pogledu pregleda, davanja dijagnoze i izdavanja lekova (presuda 2P.310/2004 od 18. maja 2005, stav 4.3 s referencama), i sve dok se lekar ne prepusti isključivo želji svog pacijenta da umre a da prethodno nije razmotrio motive takve pacijentove odluke u skladu sa primenljivim naučnim kriterijumima (...)

6.3.5. Pitanje prepisivanja i izdavanja natrijum pentobarbitala posebno je osetljivo u slučajevima duševne bolesti:

6.3.5.1. Mora se znati da neko teško duševno oboljenje, neizlečivo i trajno, može upravo kao i somatske bolesti, uzrokovati takvu patnju da s vremenom pacijent najzad više ne smatra svoj život vrednim življenja. Prema najnovijim etičkim, pravnim i medicinskim mišljenjima, ni u takvim slučajevima prepisivanje natrijum pentobarbitala nije nužno kontraindikovano niti se mora isključiti zbog toga što bi predstavljalo kršenje dužnosti lekarske predusretljivosti (...). Međutim, uvek se mora zadržati krajnja uzdržanost: treba, naime, razlučiti želju za smrću kao izraz neke psihičke tegobe koja se može i mora lečiti, od želje za smrću zasnovanu na promišljenoj i trajnoj odluci lica sposobnog da rasuđuje («bilans-samoubistvo»), koju, ako postoji, treba poštovati. Ako je želja za smrću zasnovana na samostalnoj i globalnoj odluci, nije isključeno prepisivanje natrijum pentobarbitala licu koje pati od neke duševne bolesti i, shodno tome, pružiti mu pomoć pri izvršenju samoubistva (...)

6.3.5.2. Pitanje da li su ispunjeni uslovi u nekom konkretnom slučaju ne može se razmatrati a da prethodno nije pribavljeno mišljenje zasnovano na specijalističkom medicinskom znanju – posebno psihijatrijskom – što je u praksi teško; realizacija produbljenog psihijatrijskog veštačenja je stoga neophodna (...), što se može garantovati samo ako je obaveza prepisivanja lekarskog recepta za izdavanje natrijum pentobarbitala i dalje na snazi i ako odgovornost ne leži samo na privatnim organizacijama za pomoć pri samoubistvu. Aktivnosti tih organizacija u više navrata su bile predmet kritika; u jednoj studiji urađenoj u Bazelu, zasnovanoj na proučavanju 43 slučaja samoubistva uz pomoć organizacije «Exit» između 1992. i 1997, s pravom je kritikovano odsustvo uzimanja u obzir psihijatrijskih ili socijalnih činilaca u odluci da se sebi oduzme život (...). Stoga se ne može podržati stav da su izdavanje natrijum pentobarbitala i prenošenje odgovornosti za upotrebu te supstance na neku organizaciju za pružanje pomoći prilikom izvršenja samoubistva jednako u skladu s ratio legis kao i zadržavanje obaveze prepisivanja lekarskog recepta.

6.3.6. U zaključku, treba istaći da – suprotno navodima podnosioca predstavke – ni član 8 Konvencije, ni član 10 § 2 Saveznog ustava (...) ne propisuju obavezu za državu da izdaje natrijum pentobarbital bez lekarskog recepta organizacijama za pomoć pri izvršenju samoubistva ili licima koja žele da sebi oduzmu život. Zahtevanje lekarskog recepta za izdavanje natrijum pentobarbitala ima svoju zakonsku osnovu, ima za cilj zaštitu bezbednosti i zdravlja kao i održavanje reda u javnom interesu, a takođe predstavlja i srazmernu i nužnu meru u demokratskom društvu. U odmeravanju interesa, odnosno, s jedne strane, zaštite života – koji zahteva (u najmanju ruku) da se proveri u svakom slučaju ponaosob da li odluka nekog pojedinca da sebi oduzme život zaista odgovara njegovoj slobodnoj i promišljenoj volji kad izabere samoubistvo uz pomoć drugog lica i neke supstance koja je pod udarom zakonskih propisa o psihoaktivnim supstancama ili o lekovima – a s druge strane, prava na slobodno odlučivanje o sopstvenoj sudbini, država je slobodna, sa ustavnopravnog stanovišta ili sa stanovišta Konvencije, da postavi određene uslove i, u tom kontekstu, da posebno zadrži obavezu prepisivanja za natrijum pentobarbital. (Površna) lekarska dokumentacija koju je (podnosilac predstavke) priložio ne menja ništa u njegovom slučaju; izdavanje neke supstance u cilju samoubistva uz tuđu pomoć nalaže, i u njegovom slučaju, jedan produbljen i detaljan pregled i određenu medicinsku indikaciju, i, kad je reč o ozbiljnosti njegove želje za smrću i o njegovoj sposobnosti rasuđivanja o tome, određeno praćenje od strane lekara specijaliste na određeni rok, koji bi zatim mogao da bude spreman da eventualno izda lekarski recept; ali u okviru ovog slučaja, [podnosilac predstavke] ne može dobiti takav recept zahtevajući da se ukine obaveza prepisivanja recepta; iz tog razloga, njegova objašnjenja u vezi s njegovom sposobnošću rasuđivanja ne čine se relevantnim (navedena presuda Pretty, §§ 74-77) (...)»

C. Naknadna obraćanja podnosioca predstavke lekarima

maja 2007. podnosilac predstavke uputio je jedno pismo na adresu nekih 170 psihijatara koji rade, prema informacijama kojima raspolaže Sud, gotovo svi u regionu Bazel. Svakoga od njih je pitao da li bi prihvatio da ga primi radi psihijatrijske ekspertize, i to u cilju izdavanja recepta za natrijum pentobarbital. To pismo je glasilo kako sledi:

(Prevod)

«Gospođo, Gospodine,

U prilogu vam šaljem kopiju jedne presude Saveznog suda u vezi s mojim slučajem. Bio sam zatražio od Saveznog suda direktan pristup natrijum pentobarbitalu da bih mogao, uz pomoć udruženja «Dignitas», da izvršim samoubistvo bez rizika od neuspeha i bezbolno. Savezni sud je, svakako, prihvatio da je pravo da se izabere način i trenutak da se umre jedno od ljudskih prava. Istovremeno je i izjavio da direktan pristup natrijum pentobarbitalu nije moguć, odnosno da je u tu svrhu potreban lekarski recept.

S obzirom da sam ja duševni bolesnik, Savezni sud je osim toga izjavio da je prethodno potrebna jedna produbljena psihijatrijska ekspertiza (s. 75, tačka 6.3.5.2). Pomoću te ekspertize trebalo bi utvrditi da li je moja volja za smrću izraz neke psihičke disfunkcije koja bi se mogla lečiti ili je reč o samostalnoj odluci, promišljenoj i trajnoj, jednog lica sposobnog da rasuđuje (takođe s. 75, tačka 6.3.5.1).

Ovim dopisom vas pitam da li ste spremni da me prihvatite kao pacijenta isključivo u cilju jedne takve ekspertize.

Skrećem vam, osim toga, pažnju na činjenicu da u ovom trenutku i ne postoji baš rizik da se ubijem; bez uzimanja neuroleptika živim od novembra 2006. »

Ni jedan lekar nije odgovorio potvrdno na njegov upit. Neki su ga odbili zbog nedostatka vremena i/ili potrebnih kompetencija, ili pak iz etičkih razloga. Drugi su odbijanje obrazložili tvrđenjem da se bolest podnosioca predstavke može lečiti.

II RELEVANTNO DOMAĆE, UPOREDNO I MEĐUNARODNO PRAVO

Relevantne odredbe švajcarskog Krivičnog zakonika glase kako sledi:

Član 114 – Ubistvo na zahtev žrtve

«Lice koje, rukovodeći se nekim časnim motivom, posebno milosrđem, liši života neko lice na njegov ozbiljan i hitan zahtev, biće kažnjen lišavanjem slobode do najviše tri godine ili novčanom kaznom.

Član 115 – Podsticanje na samoubistvo i pomoć pri izvršenju samoubistva

Lice koje, rukovodeći se nekim egoističnim motivom, podstiče neko lice na samoubistvo ili mu pruži pomoć u cilju izvršavanja samoubistva, ako samoubistvo bude počinjeno ili pokušano, biće kažnjen lišavanjem slobode u trajanju od najviše pet godina ili novčanom kaznom.»

Saveznim zakonom o psihoaktivnim supstancama (Lstup) («zakon o psihoaktivnim supstancama»), od 3. oktobra 1951, regulisani su korišćenje i kontrola psihoaktivnih supstanci. Savezni zakon o lekovima i medicinskim sredstvima (LPTh) («savezni zakon o terapeutskim proizvodima»), od 15. decembra 2000, primenjuje se na psihoaktivne supstance predviđene zakonom o psihoaktivnim supstancama kad se one koriste kao terapeutski proizvod (član 2, alineja 1 B, zakona o terapeutskim proizvodima). Zakon o psihoaktivnim supstancama ostaje međutim primenljiv ako zakon o terapeutskim proizvodima ne predviđa propisivanje ili ako su njegovi propisi manjeg obuhvata (član 2, alineja 1 bis, zakona o psihoaktivnim supstancama).
U smislu člana 1 zakona o psihoaktivnim supstancama i uredbe od 12. decembra 1996. o psihoaktivnim i psihotropnim supstancama švajcarskog Instituta za terapeutske proizvode, natrijum pentobarbital se smatra psihoaktivnom supstancom u smislu zakona o psihoaktivnim supstancama. Osim toga, iz presude Saveznog suda od 3. novembra 2006. proističe da natrijum pentobarbital pripada kategoriji B lekova u smislu zakona o terapeutskim proizvodima.
Osim toga, natrijum pentobarbital naveden je u Tabeli III Konvencije od 21. februara 1971 o psihotropnim supstancama. Prema toj konvenciji ta se supstanca ne može izdavati za korišćenje od strane pojedinaca samo na lekarski recept.
Član 9 zakona o psihoaktivnim supstancama sadrži listu poslenika medicinskih struja koji mogu nabavljati psihoaktivne supstance bez odobrenja. Taj stav glasi:

«Lekari, stomatolozi, veterinari i odgovorna lica koja rukovode javnom apotekom ili bolnicom a koji se svojom profesijom bave na sopstvenu odgovornost, u skladu s nekom odlukom kantonalnih vlasti donetom u skladu sa saveznim zakonom od 19. decembra 1877 u vezi s obavljanjem medicinske, farmaceutske i veterinarske delatnosti u Švajcarskoj konfederaciji, mogu bez odobrenja nabavljati, držati, koristiti i davati psihoaktivne supstance u granicama koje opravdava bavljenje njihovom strukom u skladu s propisima. Ostaju na snazi kantonalne odredbe kojima se reguliše neposredno izdavanje tih supstanci od strane lekara i veterinara (...) »

Prema članu 10, alineja 1 istog zakona, samo su lekari i veterinari ovlašćeni da prepisuju psihoaktivne supstance:

«Lekari i veterinari navedeni u članu 9 ovlašćeni su da prepisuju psihoaktivne supstance.

(...) »

Lekari i veterinari mogu izdavati takve recepte samo u naučno prihvatljivim slučajevima i samo onim pacijentima koje su oni sami pregledali (član 11, alineja 1 istog zakona i član 43, alineja 1 uredbe od 29. maja 1996. o psihoaktivnim supstancama).
Članovi 24 i 26 zakona o terapeutskim proizvodima glase kako sledi:

Član 24 – Izdavanje lekova za koje se zahteva lekarski recept

«Ovlašćeni su da izdaju lekove za koje se zahteva lekarski recept:

a. apotekari, uz lekarski recept i, u izuzetnim opravdanim slučajevima, bez lekarskog recepta;

b. sva ostala lica koja obavljaju neku medicinsku delatnost, u skladu s odredbama o pro-farmaciji [propharmacien: lekar koji je ovlašćen i da izdaje lekove u mestima gde nema apoteke, prim. prev.];

c. svako propisno obučeno stručno lice, uz kontrolu nekog od lica navedenih u alinejama a i b.

(...) »

Član 26 – Načelo prepisivanja i izdavanja

«Prilikom prepisivanja i izdavanja lekova moraju se poštovati priznata pravila farmaceutske i medicinske nauke.

Lek se može prepisati samo ako je poznato zdravstveno stanje konzumenta odnosno pacijenta.»

Poglavlje 8 istog zakona sadrži krivične odredbe koje se odnose na lica koja namerno ugrožavaju zdravlje drugih lica u vezi s nekom od delatnosti na koje se odnosi taj zakon. Član 86 zakona glasi kako sledi:

Član 86 – Krivična dela

«Kazniće se zatvorom ili novčanom kaznom do najviše 200.000 franaka, osim ako je počinilo neki teži prekršaj u smislu Krivičnog zakonika ili zakona od 3. oktobra 1951. o psihoaktivnim supstancama, lice koje namerno ugrozi zdravlje ljudskih bića činjenicom da:

a. zapostavlja svoju dužnost brižljivog obavljanja neke operacije u vezi s terapeutskim proizvodima;

b. proizvodi, stavlja u promet, prepisuje, uvozi ili izvozi lekove ili trguje njima u inostranstvu bez odobrenja ili kršeći druge odredbe ovog zakona;

c. neovlašćeno izdaje terapeutske proizvode;

(...)

f. zapostavlja svoju dužnost da obezbeđuje održavanja medicinskih sredstava;

(...)

Ako je počinilac izvršio delo vršeći svoju profesionalnu delatnost, zatvorska kazna će biti do najviše pet godina, a novčana do najviše 500 000 franaka.

Ako je počinilac delo izvršio iz nehata, zatvorska kazna će biti do najviše šest meseci, ili novčana do najviše 100.000 franaka.»

U svojim presudama 6B_48/2009 i 6B_14/2009 od 11. juna 2009, Savezni sud je potvrdio presudu kojom je jedan psihijatar osuđen četiri i po godine zatvora s obrazloženjem da taj lekar, koji je svom pacijentu pomogao da se ubije, nije uzeo u obzir pacijentovu nesposobnost rasuđivanja.
Istraživanja koja je obavio Sud pokazuju da neke države članice Saveta Evrope predviđaju specifična pravila u vezi s pristupom supstancama koje mogu olakšati izvršenje samoubistva.
U Belgiji, na primer, zakonom od 28. maja 2002. definisana je eutanazija kao delo koje počini treće lice koje namerno liši života neko lice koje to od njega zatraži (član 2 tog zakona). Apotekar koji izda neku «eutanazijsku supstancu» ne čini nikakav prekršaj ako to učini na osnovu lekarskog recepta na kome lekar eksplicitno naznači da supstancu prepisuje u skladu sa zakonom. Propisima se utvrđuju kriterijumi opreza i uslovi koje moraju ispuniti prepisivanje i izdavanje takvih lekova; njima se takođe moraju predvideti neophodne mere kojima se obezbeđuje pristupačnost eutanazijskim supstancama.
U Luksemburgu su zakonom od 16. marta 2009. depenalizovane eutanazija i pomoć pri izvršenju samoubistva. Po tom zakonu, pristup nekom medikamentu koji omogućava samoubistvo zakonski je moguć, za lekara, samo ako je sastavni deo procesa eutanazije ili pomoći pri izvršenju samoubistva.

PRAVO

I. O NAVODNOM KRŠENJU ČLANA 8 KONVENCIJE

Podnosilac predstavke se žali na zahtevane uslove za dobijanje natrijum pentobarbitala, odnosno na lekarski recept koji počiva na produbljenoj psihijatrijskoj ekspertizi. On navodi da se, pošto u njegovom slučaju ti uslovi ne mogu biti ispunjeni, ne poštuje pravo, koje on smatra da mu pripada, da izabere trenutak svoje smrti i način na koji će umreti. Tvrdi da bi u izuzetnoj situaciji kakva je navodno njegova, država morala da garantuje pristup medikamentima neophodnim za samoubistvo. On navodi član 8 Konvencije koji glasi kako sledi:

« 1. Svako ima pravo na poštovanje svog privatnog i porodičnog života, doma i prepiske.

2. Javne vlasti neće se mešati u vršenje ovog prava sem ako to nije u skladu sa zakonom i neophodno u demokratskom društvu u interesu nacionalne bezbednosti, javne bezbednosti ili ekonomske dobrobiti zemlje, radi sprečavanja nereda ili kriminala, zaštite zdravlja ili morala, ili radi zaštite prava i sloboda drugih.»

A. Stavovi stranaka

1. Podnosilac predstavke

Podnosilac predstavke tvrdi da je žrtva mešanja u vršenje svog prava na poštovanje privatnog života u smislu člana 8 Konvencije. On ne deli stav Vlade po kom on navodno ima na raspolaganju neke druge opcije da bi sebe lišio života. On naime smatra da je uzimanje natrijum pentobarbitala jedini dostojanstven, siguran, brz i bezbolan način samoubistva. Osim toga, činjenica da ni jedan od 170 lekara kojima se obratio, a koji obavljaju svoju delatnost u regionu Bazela, nije bo voljan da mu pomogne, pokazuje, po njemu, nemogućnost ispunjavanja uslova koje je utvrdio Savezni sud. Po njemu je to neosporno suprotno načelu koje je razradio Sud a po kojem se Konvencijom štite konkretna i delotvorna prava. (Artico protiv Italije, 13. maj 1980, § 33, serija A br. 37).
Osim toga, podnosilac predstavke tvrdi da slučajevi samoubistva u kojima je udruženje Dignitas pružilo pomoć datiraju iz perioda od 2001. do 2004. i da ih stoga u konkretnom slučaju ne treba uzimati u obzir. On zatim tvrdi da je pokrenuta istraga protiv nekih lekara u Cirihu koji su prepisali natrijum pentobarbital nekim licima koja su patila od psihičkih tegoba i koja su želela da sebi oduzmu život, uz obrazloženje da ti lekari nisu prethodno obezbedile produbljenu psihijatrijsku ekspertizu. Navodi osim toga, a ga je udruženje Dignitas informisalo da više nije na vezi sa psihijatrima voljnim da obezbede neophodnu ekspertizu. On najzad tvrdi da, u skladu s pravom na samostalno odlučivanje o sopstvenoj sudbini, on nije dužan da se podvrgne novoj terapiji, suprotno stavu Vlade, s obzirom da je jasno i slobodno doneo odluku da sebi oduzme život.
Što se tiče Vladinog argumenta u vezi s rizicima koje nosi jedna preterana liberalizacija u oblasti samoubistva, on ga smatra nedovoljno uverljivim, tvrdeći da su švajcarske vlasti u svakom slučaju gotovo potpuno neaktivne u prevenciju samoubistava i pored 67.000 pokušaja samoubistava godišnje (podnosilac predstavke se poziva na odgovor Saveznog veća od 9. januara 2002. na pitanja koja je bio postavio Andres Gros [Gross], savezni ministar i član Parlamentarne skupštine Saveta Evrope).
Podnosilac predstavke zamera dalje Vladi da ignoriše činjenicu da on već godinama pati od teških mentalnih poremećaja. On brani nesumnjiv karakter svoje namere da sebi oduzme život, koja navodno proističe jasno iz njegovih prethodnih pokušaja samoubistva kao i iz njegovog truda da dobije pravnu potvrdu svoje odluke. Stoga navodno nije neophodno dokazivati ozbiljnost njegove namere ni produbljenom psihijatrijskom ekspertizom, niti nekim dužim psihijatrijskim praćenjem njegovog stanja.
S obzirom na prethodno, zainteresovani tvrdi da se mešanje, na koje se on žali, u vršenje njegovog prava na poštovanje privatnog života, garantovanog članom 8 Konvencije, ne može pravdati ni zaštitom njegovog sopstvenog života niti odbranom interesa vezanih za zdravlje drugih ili javnu bezbednost. On se najzad žali i da je nemogućnost da nađe psihijatra koji bi bio voljan da obezbedi traženu ekspertizu učinila da izgubi iluzije o svom pravu na poštovanje njegovog privatnog života.

2. Vlada

Vlada odbacuje bilo kakvu povredu, u konkretnom slučaju, prava podnosioca predstavke na poštovanje njegovog privatnog života garantovano članom 8 Konvencije. U tom pogledu, Vlada smatra da se ovaj predmet razlikuje od predmeta Pretty protiv Ujedinjenog Kraljevstva (br. 2346/02, CEDH 2002-III), u kome je podnosilac predstavke, nesposobna da deluje sopstvenim sredstvima, bila u nemogućnosti da sprovede svoju nameru da umre na način koji je smatrala dostojanstvenim. Naime, prema Vladi, bolest podnosioca predstavke u ovom predmetu ne sprečava ga da deluje sopstven im sredstvima. Postoje navodno brojna druga rešenja na raspolaganju licima bez fizičkih invaliditeta da izvrše samoubistvo. Osim toga, Vlada smatra, kao i Savezni sud, da pravo na samostalno odlučivanje o sopstvenoj sudbini koje garantuje član 8 Konvencije, ne može podrazumevati i pravo nekog lica da mu se odobri pomoć pri izvršenju samoubistva, bilo tako što bi mu se stavila na raspolaganje sredstva neophodna za to, ili putem neke aktivne pomoći kad lice nije u stanju da samo to učini.
Vlada dodaje da, u svakom slučaju, ako bi Sud ipak morao smatrati da odluka Saveznog suda ugrožava prava garantovana članom 8 § 1 Konvencije, onda bi isto takvo ugrožavanje bilo opravdano u pogledu uslova navedenih u stavu 2 tog člana.
Osim toga, po mišljenju Vlade, osporavani propisi počivaju na dovoljnom pravnom osnovu, što podnosilac predstavke navodno nije osporavao (donji stavovi 19 do 28).
Vlada zatim smatra da ograničenje pristupa natrijum pentobarbitalu služi zaštiti zdravlja i javne bezbednosti i prevenciji krivičnih dela.
Što se tiče nužnosti takvog ograničenja u demokratskom društvu, Vlada ističe da su švajcarski propisi i praksa u pogledu pomoći pri izvršavanju samoubistva otvoreniji nego u većini drugih država Saveta Evrope. Pomoć pri izvršavanju samoubistva u Švajcarskoj navodno nije generalno kažnjiva, već samo u određenim okolnostima (član 115 Krivičnog zakonika – gornji stav 19).
Vlada ističe da je pomoć pri izvršavanju samoubistva lica obolelih od neke duševne bolesti u Švajcarskoj ne samo moguća u pravnom pogledu, već se de fakto i praktikuje. Koliko je njoj poznato, sve krivične presude izrečene protiv lekara zbog prepisivanja natrijum pentobarbitala odnose se na slučajeve kad dijagnoza nije bila brižljivo postavljena ili je bila očigledno pogrešna. Osim toga, prema jednoj studiji urađenoj između 2001. i 2004, o samoubistvima izvršenim uz pomoć udruženja Exit i Dignitas, koji su bili predmet istraživanja Instituta za sudsku medicinu Univerziteta u Cirihu, dvanaest duševno obolelih lica dobilo je pomoć ta dva udruženja tokom navedenog perioda. Ti slučajevi nisu ishodili krivičnim gonjenjem niti drugim merama protiv lekara koji su u toj pomoći uzeli učešće. Pri tom, iz godišnjih izveštaja udruženja Exit navodno proističe da je to udruženje, u dva navrata, 2007. i 2008, pružilo pomoć pri izvršavanju samoubistva jednog duševno obolelog lica (izveštaji Upravnog odbora udruženja za 2007. i 2008. godinu, aneksi 3 i 4). Po Vladi, to pokazuje da su neki lekari bili voljni da pristupe potrebnim pregledima i da prepišu potrebnu količinu natrijum pentobarbitala. Prema saznanjima Vlade, ti slučajevi nisu proizveli pravne posledice. Stoga Vlada tvrdi da bi, da je bo spreman da prihvati modalitete koje je ustanovio Savezni sud a potvrdilo «Švajcarsko društvo za forenzičku psihijatriju (SSPF)», podnosilac predstavke bio u stanju da nađe lekara koji bi, posle praćenja njegovog stanja tokom određenog vremena, mogao da potvrdi eventualno da podnosilac ispunjava uslove za prepisivanje recepta za izdavanje predmetne supstance.
Osim toga, Vlada smatra da koraci koje je podnosilac predstavke preduzeo da bi stupio u kontakt s nekim lekarom izazivaju određene nedoumice. Kao prvo, ističe da je udruženje Dignitas, koje je podnosiocu predstavke pomagalo u toj potrazi, već bilo pružilo pomoć u izvršavanju samoubistva nekoliko duševno obolelih lica. Iz toga Vlada zaključuje da je udruženje moralo poznavati lekari koji su mogli da izađu u susret zahtevu podnosioca predstavke. Drugo, Vlata ističe da je, od 2006, u skladu sa presudom Saveznog suda, kanton Cirih izmenio svoju praksu u smislu da se lekari koji izdaju recept za pentobarbital ne izlažu krivičnom gonjenju. A po mišljenju Vlade, jedno kad je uklonjena prepreka kritikovana u domaćem postupku, umesto da se obrati nekom lekaru iz kantona Cirih, podnosilac predstavke se obratio beležniku za potvrdu o slanju pismenog zahteva na adrese 170 psihijatara koji svi obavljaju svoju delatnost u Bazelu, osim jedne doktorke koja ima praksu u Bernu. Treće, Vlada smatra, pošto joj nisu poznati kriterijumi po kojima je podnosilac predstavke izabrao tih 170 lekara kojima je uputio svoj zahtev, da formulacija tog dopisa nije mogla ohrabriti nekog lekara da na njega odgovori pozitivno, budući da je zainteresovani, odbijanjem unapred bilo kakvu terapiju i zahtevajući samo ekspertizu, unapred isključio ozbiljno istraživanje alternative samoubistvu koje predstavlja etapu pregleda koji mora prethoditi prepisivanju natrijum pentobarbitala.
Pri tom, po mišljenju Vlade, ako propisi u vezi s pomoći pri izvršavanju samoubistva postavljaju državne organe pred teška etička pitanja, on stvaraju još delikatniju situaciju u slučajevima kad takve zahteve postavljaju lica koja nisu obolela od neke smrtonosne bolesti. Po mišljenju Vlade, takva lica izražavaju izbor ne između prednosti blage smrti nad smrću kojoj prethode ili koju prate teške patnje, kao konkretno u predmetu Pretty, već prednosti koju daju smrti nad životom.
Vlada takođe podseća da je, prema članu 2 Konvencije, država dužna ne samo da ne izaziva smrt namerno i nepropisno, već i da preduzima nužne mere radi zaštite života lica iz njene nadležnosti od činjenja drugih lica ili, eventualno, sopstvenih činjenja (Kılavuz protiv Turske, br. 8327/03, § 78, 21 oktobar 2008). Vlada dodaje da su državni organi, čim saznaju za neki rizik od samoubistva nekog lica, dužni da preduzmu sve što se od njih može razumno očekivati da bi se taj rizik predupredio (navedeni slučaj Kılavuz, § 88).
U tom pogledu Vlada iznosi da se, u psihijatriji, volja za samoubistvom smatra simptomom duševne bolesti na koji treba odgovoriti adekvatnom terapijom. Po mišljenju Vlade, treba dakle praviti razliku između volje za samoubistvom kao izrazom bolesti i volje za samoubistvom kao izrazom samostalne, promišljene i trajne odluke. S obzirom na složenost duševnih bolesti i na njihovo neočekivano napredovanje, takva razlika se ne može napraviti bez ozbiljnog pregleda tokom jednog perioda koji omogućava da se proveri stalnost volje za samoubistvom, i bez jedne kompletne ekspertize. Takav pregled zahteva produbljena psihijatrijska znanja i može ga obaviti samo lekar specijalista.
Vlada dalje tvrdi da obaveza pribavljanja lekarskog uverenja podrazumeva izvesne korake od strane zainteresovanog lica. Po mišljenju Vlade, ti koraci se ne čine neostvarivim ako je izbor samoubistva napravljen na osnovu samostalne i trajne odluke. Takva obaveza predstavlja, po mišljenju Vlade, odgovarajuće i nužno sredstvo zaštite života ranjivih lica čija se odluka da sebi oduzmu život može zasnivati na nekoj prolaznoj krizi koja ishodi izmenjenom sposobnošću rasuđivanja. Po mišljenju Vlade, dobro je poznato da mnoga samoubistva nisu bila rezultat stvarne volje za umiranjem već su predstavljala pre jedan poziv za pomoć s ciljem da se okruženju skrene pažnja na neki problem. Tako bi olakšavanje pristupa pomoći pri izvršavanju samoubistva značilo gotovo navođenje takvih lica na korišćenje nekog pouzdanog sredstva da bi sebe lišila života.
Šta više, Vlada ističe i da rešenje prihvaćeno u Švajcarskoj odgovara propisima predviđenim Konvencijom o psihotropnim supstancama i da bi Švajcarska, kad bi morala da isporuči natrijum pentobarbital podnosiocu predstavke bez lekarskog recepta, ili na osnovu lekarskog recepta koji ne zadovoljava medicinske zahteve, time jasno prekršila te propise. Vlada zaključuje da osporavana mera, neophodna za zaštitu života, zdravlja i bezbednosti, zadovoljava uslove iz člana 8 § 2 Konvencije i ne predstavlja njeno kršenje.

B. Ocena Suda

Kao što je Sud već bio u prilici da primeti, pojam «privatnog života» je veoma širok, za koji se ne može dati neka iscrpna definicija. On pokriva fizički i moralni integritet lica (X i Y protiv Holandije, 26. mart 1985, § 22, serija A br. 91). On ponekad može obuhvatiti i aspekte fizičkog i društvenog identiteta pojedinca (Mikulić protiv Hrvatske, br. 53176/99, § 53, CEDH 2002-I). Neki elementi, kao, na primer, ime, polni identitet, seksualna orijentacija i seksualni život spadaju u ličnu sferu zaštićenu članom 8 Konvencije (videti, na primer, protiv Francuske, 25. mart 1992, § 63, serija A br. 232-C, Burghartz protiv Švajcarske, 22. februar 1994, § 24, serija A br. 280-B, Dudgeon protiv Ujedinjenog Kraljevstva, 22. oktobar 1981, § 41, serija A br. 45, i Laskey, Jaggard i Brown protiv Ujedinjenog Kraljevstva, 19. februar 1997, § 36, Zbirka presuda i odluka 1997-I). Tom odredbom štite se i pravo na lični razvoj i pravo na uspostavljanje i održavanje odnosa sa drugim ljudskim bićima i sa spoljnim svetom (videti, na primer, već navedeni slučaj Burghartz, mišljenje Komisije, § 47, i Friedl protiv Austrije. 31. januar 1995, serija A br. 305-B, mišljenje Komisije, § 45). U predmetu Pretty (već navođenom, § 67), Sud je smatrao da je izbor podnositeljke predstavke da izbegne nedostojanstven i bolan kraj po njegovom shvatanju spadao u polje primene člana 8 Konvencije.
U svetlu te sudske prakse, Sud smatra da pravo nekog lica da odluči u kom trenutku i na koji način njegov život treba da bude okončan, pod uslovom da je to lice u stanju da slobodno formira svoju volju u vezi s tim i da shodno tome i postupa, predstavlja jedan od aspekata prava na poštovanje privatnog života u smisli člana 8 Konvencije.
Međutim, po mišljenju Suda, ovaj predmet se razlikuje od navedenog predmeta Pretty. Kao i Savezni sud, i Sud smatra da pre svega treba precizirati da se ovaj slučaj ne odnosi na slobodu umiranja niti na eventualnu nekažnjivost lica koje pruži pomoć pri izvršavanju samoubistva. Predmet spora je ovde pitanje da li, u smislu člana 8 Konvencije, država treba da učini da podnosiocu predstavke bude omogućeno da dobije neku smrtonosnu supstancu, natrijum pentobarbital, odstupanjem od zakona, kako bi ovaj mogao da izvrši samoubistvo, bezbolno i bez rizika od neuspeha. Drugim rečima, za razliku od slučaja Pretty, Sud primećuje da podnosilac predstavke tvrdi ne samo da je njegov život težak i bolan, već i da će, ako ne dobije spornu supstancu, i sam čin samoubistva biti lišen dostojanstva. Osim toga, a i dalje za razliku od slučaja Pretty, podnosilac predstavke se ne može zaista smatrati bespomoćnim budući da se ne nalazi u terminalnom stadijumu neke neizlečive degenerativne bolesti koja bi ga sprečila da sam sebi oduzme život (videti, a contrario, navedeni slučaj Pretty, § 9).
Sud smatra da treba razmotriti zahtev podnosioca predstavke za omogućavanje pristupa natrijum pentobarbitalu bez lekarskog recepta sa stanovišta pozitivne obaveze države da preduzima neophodne mere koje omogućavaju dostojanstveno samoubistvo. To pretpostavlja uravnoteženo odmeravanje različitih interesa koji su u igri, u čemu država sa svoje strane ima na raspolaganju određen prostor za procenu (Keegan protiv Irske maj 1994, § 49, serija A br. 290), a koji je promenljiv u zavisnosti od prirode pitanja i od značaja angažovanih interesa. Sa svoje strane Sud je i dalje nadležan da kontroliše in fine usaglašenost odluke domaćeg organa sa zahtevima Konvencije (navedeni slučaj Pretty, § 70).
Sud podseća takođe da e Konvencija mora čitati kao celina (Verein gegen Tierfabriken Schweiz (VgT) protiv Švajcarske (br. 2) [GC], br. 32772/02, § 83, CEDH 2009-....). Stoga je potrebno pozivati se, u okviru razmatranja eventualnog kršenja člana 8, na član 2 Konvencije, koji državnim organima nameće dužnost da štite ranjiva lica čak i protiv postupaka kojim ta lica ugrožavaju sopstveni život (videti, u tom smislu Keenan protiv Ujedinjenog Kraljevstva, br.27229/95, § 91, CEDH 2001-III). Po mišljenju Suda, ta poslednja odredba obavezuje domaće državne organe da spreče lice da sebi oduzme život ako njegova odluka nije donesena slobodno i sa potpunom svešću o tom činu.
Sud osim toga podseća i da se Konvencija i njeni protokoli moraju tumačiti u svetlu današnjih uslova (Tyrer protiv Ujedinjenog Kraljevstva, april 1978, § 31, serija A br. 26, Airey protiv Irske, 9. oktobar 1979, § 26, serija A br. 32, i Vo protiv Francuske [GC], br. 53924/00, § 82, CEDH 2004-VIII). Međutim, istraživanja koja je obavio Sud omogućila su mu da zaključi da smo još daleko od konsenzusa država članica Saveta Evrope u vezi s pravom pojedinca da odluči u kom trenutku i na koji način njegov život treba da se okonča. U Švajcarskoj, prema članu 115 Krivičnog zakonika, podsticanje na samoubistvo i pomoć pri izvršavanju samoubistva kažnjivi su samo ako se počinilac takvog dela rukovodio nekim «egoističnim motivom». Poređenja radi, zemlje Beneluksa su, konkretno, depenalizovale delo pomoći pri samoubistvu, ali samo u vrlo određenim okolnostima. Najzad, neke druge zemlje dopuštaju samo dela «pasivne» pomoći. Mora se konstatovati da velika većina država članica izgleda da pridaju veći značaj zaštiti života lica nego njegovom pravu da ga okonča. Prostor kojim države raspolažu za procenu u toj oblasti je, dakle, značajan.
Što se tiče odmeravanja interesa u igri u ovom predmetu, Sud može razumeti volju podnosioca predstavke da se ubije na siguran, dostojanstven i bezbolan način i bez nepotrebnih patnji, obzirom upravo na veliki broj neuspelih pokušaja samoubistva a koji često ostavljaju teške posledice po ta lica i njihove bližnje. Ipak, Sud je mišljenja da propisi koje su doneli švajcarski organi, konkretno zahtev za lekarskim receptom, a upravo s legitimnim ciljem da se lica zaštite od brzoplete odluke i da se preduprede zloupotrebe, da se izbegne da neki pacijent lišen sposobnosti rasuđivanja dobije smrtonosnu dozu natrijum pentobarbitala (videti, mutatis mutandis, u vezi s pitanjem ograničenja kod prekida trudnoće, Tysiąc protiv Poljske, br. 5410/03, § 116, CEDH 2007-IV).
Takva zakonska regulativa je utoliko nužnija kad je reč o zemlji kakva je Švajcarska, čije zakonodavstvo i praksa dopuštaju relativno lak pristup pomoći kod izvršavanja samoubistva. Kad neka zemlja usvoji jedan tako liberalan pristup, odgovarajuće mere sprovođenja takvog pristupa i mere za predupređivanje zloupotreba se nameću. Uspostavljanje takvih mera takođe ima za cilj da se izbegne da organizacije koje pružaju pomoć pri izvršavanju samoubistva deluju nezakonito i u tajnosti, uz veliki rizik od zloupotreba.
A posebno Sud smatra da se ne mogu potcenjivati rizici od zloupotreba koji su inherentni sistemu koji olakšava pristup pomoći pri izvršavanju samoubistva. Kao i Vlada, i Sud je mišljenja da ograničenje pristupa natrijum pentobarbitalu služi zaštiti zdravlja i javne bezbednosti kao i prevenciji krivičnih dela. On u tom pogledu deli stav Saveznog suda po kome pravo na život, garantovano članom 2 Konvencije obavezuje države da uspostave procedure koje omogućavaju da se proveri da li neka odluka de se sebi oduzme život zaista izražava slobodnu volju zainteresovanog lica. Sud smatra da zahtevanje lekarskog recepta, koji se izdaje na osnovu potpune psihijatrijske ekspertize, predstavlja sredstvo da se zadovolji ta obaveza. To rešenje uostalom odgovara duhu Međunarodne konvencije o psihotropnim supstancama i konvencija koje su usvojile neke države članice Saveta Evrope.
U tom pogledu, Sud primećuje da se mišljenja stranaka značajno razlikuju po pitanju delotvornog pristupa medicinskoj ekspertizi povoljnoj po podnosioca predstavke, a koja bi mu omogućila da dobije natrijum pentobarbital. Sud može razumeti da psihijatri pokazuju izvestan otpor kad se od njih zatraži da prepišu neku smrtonosnu supstancu. U tom pogledu Sud takođe smatra, s obzirom na delikatno pitanje sposobnosti rasuđivanja zainteresovanog lica, da je pretnja krivičnim gonjenjem koja opterećuje lekare spremne da obezbede produbljenu ekspertizu kako bi olakšali samoubistvo – realna pretnja (videti, mutatis mutandis, navedeni slučaj Tysiąc, § 116 ; takođe videti, na primer, presude 6B_48/2009 i 6B_14/2009 Saveznog suda od 11. jun 2009 – gornji stav 28).
Istovremeno Sud prihvata stav Vlade po kome koraci koje je preduzeo podnosilac predstavke da bi stupio u kontakt s lekarom izazivaju određene nedoumice (gornji stav 44). Sud ističe da podnosilac predstavke nije uistinu opovrgao Vladine argumente. Sud primećuje pri tom da je ovaj razaslao onih spomenutih 170 pisama (gornji stav 17) pošto se Savezni sud izjasnio po njegovoj žalbi. Stoga se ti koraci ne mogu a priori uzeti u obzir u ovom predmetu. U svakom slučaju, kao što i Vlada ističe, ta pisma nisu podsticajna za lekare da bi oni na njih odgovorili povoljno po podnosioca predstavke budući da ovaj u tim pismima precizira da ne prihvata nikakvu terapiju, čime isključuje produbljenije razmatranje alternativa samoubistvu. Imajući u vidu informacije koje su mu predočene, Sud nije uveren da je podnosilac predstavke nije bio u mogućnosti da nađe lekara koji bi mu pomogao. Stoga, po viđenju Suda, pravo podnosioca predstavke da izabere trenutak sopstvene smrti i način na koji će umreti nije bilo samo teoretsko i prividno (kriterijum razrađen u navedenoj presudi Artico, § 33).
A obzirom na prethodno, a imajući u vidu prostor za sopstvenu procenu koji je na raspolaganju domaćim organima, Sud smatra da, čak i pod pretpostavkom da države imaju pozitivnu obavezu da usvoje mere kojima se olakšava izvršavanje samoubistva na dostojanstven način, švajcarski organi nisu u konkretnom slučaju ignorisali tu obavezu. Iz čega proističe da nije bilo kršenja člana 8 Konvencije.

IZ TIH RAZLOGA SUD JEDNOGLASNO

Izriče da nije bilo kršenja člana 8 Konvencije;

Sačinjeno na francuskom, a zatim saopšteno u pismenom obliku 20. januara 2011, primenom pravila 77 §§ 2 i 3 Pravilnika Suda.

Seren Nilsen Hristos Rozakis

Sekretar Predsednik

___________________________________
Prevod presude preuzet sa https://hudoc.echr.coe.int/

Ovaj prevod je nastao uz podršku Fonda za ljudska prava Saveta Evrope

FIRST SECTION

CASE OF HAAS v. SWITZERLAND

(Application no. 31322/07)

JUDGMENT

STRASBOURG

20 January 2011

FINAL

20/06/2011

This judgment has become final under Article 44 § 2 of the Convention.

In the case of Haas v. Switzerland, The European Court of Human Rights (First Section), sitting as a Chamber composed of:

Christos Rozakis, President,
Nina Vajić,
Anatoly Kovler,
Khanlar Hajiyev,
Sverre Erik Jebens,
Giorgio Malinverni,
George Nicolaou, judges,
and Søren Nielsen, Section Registrar,

Delivers the following judgment, which was adopted on that date:

PROCEDURE

1. The case originated in an application (no. 31322/07) against the Swiss Confederation lodged with the Court under Article 34 of the Convention for the Protection of Human Rights and Fundamental Freedoms (“the Convention”) by a Swiss national, Mr Ernst G. Haas (“the applicant”), on 18 July 2007.

2. The applicant was represented by Mr P.A. Schaerz, a lawyer practising in Uster (Canton of Zürich). The Swiss Government (“the Government”) were represented by their Agent, Mr F. Schürmann, Head of the Human Rights and Council of Europe Section at the Federal Office of Justice.

3. Relying on Article 8 of the Convention, the applicant complained that his right to decide how and when to end his life had been breached.

4. By a decision of 20 May 2010, the Court declared the application admissible.

5. The Government filed further observations on the merits (Rule 59 § 1 of the Rules of Court). In addition, third-party comments were received from Dignitas (Article 36 § 2 of the Convention), a Swiss private-law association whose aim is to ensure that its members are able to live and to die with dignity.

THE FACTS

I. THE CIRCUMSTANCES OF THE CASE

6. The applicant was born in 1953 and lives in Meltingen (Canton of Solothurn).

7. The applicant has been suffering from a serious bipolar affective disorder for about twenty years. During this period he has twice attempted suicide and has stayed in psychiatric hospitals on several occasions. On 1 July 2004 he became a member of Dignitas, an association which offers, among other services, assisted suicide. Taking the view that his illness, for which treatment is difficult, made it impossible for him to live with dignity, the applicant asked Dignitas to assist him in ending his life. He approached several psychiatrists to obtain the necessary lethal substance, namely 15 grams of sodium pentobarbital, which is available only on prescription, but was unsuccessful.

A. The applicant’s requests to the authorities

8. On 8 June 2005 the applicant contacted various official bodies seeking permission to obtain sodium pentobarbital from a pharmacy without a prescription, through the intermediary of Dignitas.

9. The Federal Office of Justice found that it did not have jurisdiction to grant his request and rejected it on 27 June 2005.

10. On 20 July 2005 the Federal Department of Public Health dismissed the applicant’s claim on the ground that sodium pentobarbital could only be obtained on prescription from a pharmacy. It also expressed its opinion that Article 8 of the Convention did not impose on the States Parties a positive obligation to create the conditions for committing suicide without the risk of failure and without pain.

11. On 3 August 2005 the Health Department of the Canton of Zürich also dismissed the applicant’s request, finding that, in the absence of the necessary medical prescription, he could not be authorised to obtain the substance in question from a pharmacy. It too noted that such a right could not be inferred from Article 8 of the Convention. That decision was upheld by the Administrative Court of the Canton of Zürich on 17 November 2005.

12. On 20 December 2005 the Federal Department of the Interior declared inadmissible an appeal lodged by the applicant against the decision of 20 July 2005, on the ground that this was not an emergency in which a substance usually subject to medical prescription could be delivered without one. It noted that only a doctor could issue the relevant prescription.

13. The applicant lodged appeals with the Federal Court against the decisions of the Federal Department of the Interior and the Administrative Court of the Canton of Zürich. Relying in particular on Article 8 of the Convention, he alleged that this provision guaranteed the right to choose to die and that State interference with this right was acceptable only in the conditions set out in the second paragraph of Article 8. In the applicant’s opinion, the obligation to submit a medical prescription in order to obtain the substance necessary for suicide, and the impossibility of procuring such a prescription – which, in his view, was attributable to the threat that hung over doctors of having their licence withdrawn by the authorities should they prescribe the substance in question to mentally ill persons – amounted to interference with his right to respect for his private life. He argued that while this interference was admittedly in accordance with the law and pursued a legitimate aim, it was not, in his case, proportionate.

B. The judgment of the Federal Court

14. By a judgment of 3 November 2006, the Federal Court joined the two sets of proceedings and dismissed the applicant’s appeals.

15. It noted, firstly, that, pursuant to the applicable legal provisions, sodium pentobarbital could only be obtained on medical prescription and that the applicant had not obtained such a prescription. It further noted that this was not an exceptional case in which a medical product could be issued without a prescription.

16. As to the alleged violation of Article 8 of the Convention, the Federal Court found as follows:

[Translation]

“6.1. ... The right to self-determination within the meaning of Article 8 § 1 [of the Convention] includes the right of an individual to decide at what point and in what manner he or she will die, at least where he or she is capable of freely reaching a decision in that respect and of acting accordingly ...

6.2.1. The right to choose to die, which is not as such in issue here, must however be distinguished from the right to assistance with suicide from the State or a third party. In principle, such a right cannot be inferred either from Article 10, paragraph 2, of the Federal Constitution [enshrining individual freedom] or from Article 8 of the Convention; an individual who wishes to die does not have a right to be assisted in committing suicide, whether by the provision of the necessary means or through active assistance where he or she is not capable of ending his or her own life ... The State has a fundamental obligation to protect life. Admittedly, such protection is not generally extended against the will of a person who is capable of forming his or her own views ... Nonetheless, it does not follow that the State has a positive obligation to ensure that a person who wishes to die has access to a dangerous substance, selected for the purpose of suicide, or to tools intended to be used for that purpose. In such circumstances, the right to life guaranteed by Article 2 of the Convention obliges the State, at the very least, to put in place a procedure to ensure that a decision to commit suicide does indeed correspond to the free will of the individual in question ...

6.2.2. The foregoing is confirmed by the case-law of the Strasbourg institutions: Article 2 [of the Convention] guarantees no right to die, whether with the assistance of a third party or of the State; the right to life has no corresponding negative freedom (judgment in Pretty v. the United Kingdom, no. 2346/02, § 40, ECHR 2002‑III) ... Article 3 does not in principle oblige the State to guarantee criminal impunity for assisting a person to commit suicide or to create a legal basis for another form of assistance with that act; the State must not sanction actions intended to terminate life (Pretty, cited above, §§ 55 et seq.). With regard to Article 8, the Court found that – without in any way negating the principle of sanctity of life – the quality of life and, in consequence, the question of the individual’s autonomy play a role under this provision (judgment in Pretty, cited above, § 65). The Court stated that it ‘[was not prepared] to exclude’ that the fact that the applicant was precluded from exercising her choice to avoid what she consider[ed would] be an undignified and distressing end to her life constituted an interference with her right to respect for private life within the meaning of Article 8 § 1 of the Convention (Pretty, cited above, § 67; see also the judgment of the Supreme Court of Canada in the case of Rodriguez v. British Columbia [Attorney General; [1993] 3 S.C.R. 513], and Judge Sopinka’s opinion as the basis of the majority’s findings); this had already been presaged in the 1983 Reed case, where the Commission had emphasised that the activity of a person aiding and abetting suicide did not, as such, fall within the sphere of Article 8, but that, on the contrary, the protection of the private life of the person seeking to die could be at stake (inadmissibility decision in Reed v. the United Kingdom, no. 7630/76, Commission decision of 4 July 1983, Decisions and Reports 33, p. 273, § 13).

6.2.3. The case of Pretty (like that of Rodriguez) is not comparable to the instant case: the applicant’s freedom to commit suicide, and consequently the impunity of an individual who might provide assistance to that end, providing he or she is not acting from selfish motives (Article 115 of the Criminal Code), are not in issue here. The matter in dispute is whether, on the basis of Article 8, the State must take steps to ensure that the applicant is able to end his life without pain and without risk of failure, and that, in consequence, he is able to obtain sodium pentobarbital without a medical prescription, in derogation from the legislation. This question must be answered in the negative: admittedly, the Convention guarantees not rights that are theoretical or illusory but rights that are practical and effective (judgment in Artico v. Italy, 13 May 1980, § 33, Series A no. 37); it does not appear, however, – given that other options exist – that the freedom to commit suicide and, accordingly, the freedom to choose one’s own quality of life are restricted by the mere fact that the State does not authorise the unconditional issue of the substance in question, but makes it dependent on the presentation of a medical prescription, issued on the basis of the ‘recognised rules of pharmaceutical and medical science’ and knowledge of the health of the individual concerned (section 24(1)(a) taken in conjunction with section 26 of the LPTh [Federal Medicines and Medical Devices Act], and section 9(1), taken in conjunction with section 10, of the Lstup [Federal Drugs Act]). In order to guarantee effectively the freedom to choose to end one’s own life, derived from Article 8 § 1 of the Convention, it is not necessary to authorise unrestricted availability of sodium pentobarbital, even if this substance is supposedly highly suitable for the act of committing suicide. The mere fact that solutions other than sodium pentobarbital entail higher risks of failure and greater pain is not sufficient to justify the provision, without prescription, of this substance for the purpose of suicide. Such a positive obligation cannot be inferred either from Article 10 § 2 of the Federal Constitution or from Article 8 of the Convention ...

...

6.3.2. The obligation to submit a medical prescription has a clear, accessible and foreseeable legal basis, namely, in respect of domestic law, sections 24 and 26 of the Federal Medicines and Medical Devices Act and sections 9 and 10(1) [sic] of the Federal Drugs Act, and, with regard to international law, Article 9 § 1 and Schedule III of the [United Nations] Convention on Psychotropic Substances of 21 February 1971. Generally speaking, this obligation is intended to protect the health and safety of the population and, in the context of assisted suicide, to prevent the commission of criminal offences and combat the risks of abuse (Pretty judgment, cited above, §§ 74 and 75 ...). A substance which, when ingested, leads to death, cannot simply be dispensed by a pharmacist without any knowledge of the circumstances of the case; in the patient’s interests, provision of such a substance must be subject to the presentation of a medical prescription. A medical prescription presupposes a diagnosis drawn up on the basis of a doctor’s professional code of ethics, a medical indication (Indikationsstellung) and an information-seeking interview. Only a doctor can assess a patient’s capacity for discernment and his or her medical records, and determine whether all treatment options have been exhausted to no avail ... The obligation to obtain a prescription for sodium pentobarbital is a guarantee that doctors will not issue this substance without all the necessary conditions being fulfilled, since otherwise they would leave themselves open to criminal, civil or disciplinary sanctions ... It protects individuals from hasty and unconsidered decisions ... and guarantees the existence of a medical justification for the action. ... A potential interference with the right to self-determination protected by Article 8 of the Convention has only a relative bearing in view of the consequences attached to issuing sodium pentobarbital for the purpose of suicide. ... In contrast, the protection of life, the prohibition of murder and the latter’s delimitation with regard to assisted suicide, which is not a priori subject to penalties, represent a significant public interest. ... While assisted suicide by medical means is authorised, a matter that, given the importance of the ethical issue at stake, must in the first instance be assessed by the legislature (see the above-cited Pretty judgment, § 74 in fine), the State is entitled to put in place a procedure for review, thus guaranteeing that the decision of the individual concerned does indeed correspond to his or her free and considered will ...; to that end, the obligation to obtain a medical prescription is appropriate and necessary. In so far as the applicant alleges that this argument does not take into consideration the 1,300 cases of suicide and the 63,000 cases of attempted suicide per year, in which the State allegedly fails to comply with its duty of protection, it must be emphasised that those cases do not, as the instant case does, concern the question of dispensing, without prescription, a substance for the purpose of suicide and are thus not comparable to the present situation.

...

6.3.4. The regulations on assisted suicide are relatively liberal in Switzerland, in so far as assistance or incitement is punishable only in the event of selfish motives (Article 115 of the Criminal Code). In contrast, the legislature remains free, in weighing up the interests at stake – the right to self-determination of persons wishing to kill themselves on the one hand, and protection against impulsive suicides (Affektsuizid) on the other – to make the legality of assisted suicide and the provision of a dangerous product subject to compliance with professional rules and the state of medical science. The Guidelines on End of Life Care issued by the Swiss Academy of Medical Sciences on 25 November 2004 acknowledge that, in borderline cases, a doctor may be faced with an ‘intractable conflict’ (point 4.1 of the Guidelines). Clearly, assisted suicide cannot be considered as part of a doctor’s activities, since it is self-evident that such an action goes against the aim of medicine; however, respect for the patient’s wishes is also fundamental to the relationship between the doctor and patient, so that the doctor may be led to take a decision in all conscience, a decision that ought to be respected. If the doctor opts for assisted suicide, he is guarantor of the fact that: (1) the patient’s illness makes it likely that death is close; (2) other options for support have been discussed and, where appropriate, put into place; and (3) the patient is capable of discernment, his or her wish appears to be carefully considered, is not the result of external pressure and is to be regarded as final, which must be verified by an independent third party who need not necessarily be a doctor; the final act which leads to death must always be carried out by the patient himself. Contrary to the applicant’s assertions, a doctor is entitled, in the context of the recognised professional rules, to prescribe sodium pentobarbital for the purpose of suicide, provided that the conditions for doing so are fulfilled. As the Federal Court has already observed, a change in attitude is to be perceived in modern society, in the sense that assisted suicide is increasingly considered as a voluntary medical activity which cannot be imposed on any doctor, but which is not excluded by the rules of professional conduct and supervision, provided that the duty of medical care is respected in examining patients, diagnosing them and dispensing the product (judgment 2P.310/2004 of 18 May 2005, paragraph 4.3, with references), and provided that doctors do not allow themselves to be guided solely by their patient’s wish to die and fail to examine the reasons for such a decision in accordance with the applicable scientific criteria ...

6.3.5. The question of prescribing and dispensing sodium pentobarbital is particularly problematic in cases of mental illness:

6.3.5.1. It must not be forgotten that a serious, incurable and chronic mental illness may, in the same way as a somatic illness, cause suffering such that, over time, the patient concludes that his or her life is no longer worth living. The most recent ethical, legal and medical opinions indicate that in such cases also the prescription of sodium pentobarbital is not necessarily precluded or to be excluded on the ground that it would represent a breach of the doctor’s duty of care ... However, the greatest restraint must be exercised: it is necessary to distinguish between a desire to die as the expression of a psychological disorder which can and must be treated, and a wish to die that is based on the considered and sustained decision of a person capable of discernment (‘pre-suicide assessment’), which must be respected as applicable. Where the wish to die is based on an autonomous and all-embracing decision, it is not prohibited to prescribe sodium pentobarbital to a person suffering from a psychiatric illness and, consequently, to assist him or her in committing suicide ...

6.3.5.2. The question of whether the conditions have been met in a given case cannot be examined without recourse to specialised medical – and particularly psychiatric – knowledge, which is difficult in practice; a thorough psychiatric examination thus becomes necessary ..., which can only be guaranteed if the obligation to submit a prescription in order to obtain sodium pentobarbital is maintained, and if responsibility does not lie solely with private organisations for assisted suicide. The activities of such organisations have been criticised on several occasions; a study carried out in Basle, analysing 43 cases of assisted suicide by the organisation Exit between 1992 and 1997, rightly criticised the failure to take into account psychiatric or social factors in the decision to end one’s life ... Accordingly, one cannot argue that issuing sodium pentobarbital and delegating responsibility for its use to an organisation for assisted suicide is equally compatible with the purpose of the legislation as maintaining the obligation to obtain a medical prescription.

6.3.6. To conclude, it is appropriate to note that – contrary to the applicant’s allegations – neither Article 8 of the Convention nor Article 10 § 2 of the Federal Constitution ... impose an obligation on the State to issue, without medical prescription, sodium pentobarbital to organisations for assisted suicide or to persons who wish to end their lives. The requirement of a medical prescription for sodium pentobarbital has a legal basis, is intended to protect public safety and health and to maintain order in the public interest, and is also a proportionate and necessary measure in a democratic society. In weighing up the interests at stake, namely the protection of life – which requires (as a minimum) verification, on a case-by-case basis, of whether individuals’ decisions to end their lives genuinely correspond to their free and considered will where they opt for assisted suicide using a product subject to legislation on drugs or medicinal products –, and the individual’s right to self-determination, the State remains free – from the standpoint of constitutional law or of the Convention – to lay down certain conditions and, in this context, to maintain, inter alia, the obligation to obtain a prescription for sodium pentobarbital. The (summary) medical documents submitted [by the applicant] alter nothing in his case; the delivery of a substance for the purpose of assisted suicide necessitates, in his case too, a thorough and considered examination and a medical indication, and, with regard to the genuineness of his wish to die and capacity for discernment in this connection, monitoring over a certain period by a medical specialist who would subsequently be able, as appropriate, to issue a medical prescription; in contrast, in the context of the present case [the applicant] cannot receive such a prescription by requesting that the obligation to present a prescription be lifted; for this reason, the explanations with regard to his capacity for discernment do not appear relevant (Pretty judgment, cited above, §§ 74-77) ...”

C. The applicant’s subsequent requests to doctors

17. On 2 May 2007 the applicant sent a letter to 170 psychiatrists, almost all of whom, according to the information available to the Court, practise in the Basle region. He asked each of them whether they would agree to see him for the purpose of carrying out a psychiatric examination and with a view to issuing a prescription for sodium pentobarbital. The letter was worded as follows:

[Translation]

“Dear Sir/Madam,

Please find attached a copy of a Federal Court judgment in my case. I had asked the Federal Court to be granted direct access to sodium pentobarbital so that, with the help of Dignitas, I could commit assisted suicide without risk of failure and without pain. Admittedly, the Federal Court has accepted that the right to choose the time and manner of one’s death is a human right. At the same time, it has held that direct access to sodium pentobarbital is impossible, since a medical prescription is necessary in order to obtain the said product.

Given that I suffer from mental illness, the Federal Court also stated that a preliminary in-depth psychiatric examination was also necessary (p. 75, paragraph 6.3.5.2.). This should determine whether my wish to die is the expression of a psychological disorder that is open to treatment or whether it results from an autonomous, considered and sustained decision by a person who is capable of discernment (see also p. 75, paragraph 6.3.5.1.).

I hereby ask whether you would be willing to accept me as a patient, for the sole purpose of conducting such an assessment.

In addition, I draw your attention to the fact that I am unlikely to commit suicide at present; I have not taken neuroleptics since November 2006.”

18. None of the doctors responded positively to his request. Some refused on the ground of lack of time and/or the necessary competence, or for ethical reasons. Others argued that the applicant’s illness could be treated.

II. RELEVANT DOMESTIC, COMPARATIVE AND INTERNATIONAL LAW

19. The relevant provisions of the Swiss Criminal Code are worded as follows:

Article 114 – Homicide at the victim’s request

“Any person who for commendable motives, and in particular out of compassion, causes the death of a person at that person’s own genuine and insistent request shall be liable to a custodial sentence not exceeding three years or to a monetary penalty.”

Article 115 – Inciting and assisting suicide

“Any person who for selfish motives incites or assists another to commit or attempt to commit suicide shall, if that other person thereafter commits or attempts to commit suicide, be liable to a custodial sentence not exceeding five years or to a monetary penalty.”

20. The Federal Drugs Act (Lstup) (“the Drugs Act”) of 3 October 1951 regulates the use and supervision of drugs. The Federal Medicines and Medical Devices Act (LPTh) (“the Therapeutic Products Act”) of 15 December 2000 applies to drugs covered by the Drugs Act where they are used as therapeutic products (section 2(1)(b) of the Therapeutic Products Act). The Drugs Act remains applicable, however, if the Therapeutic Products Act does not regulate a specific matter or if its regulation is less extensive (section 2(1 bis) of the Drugs Act).

21. Under section 1 of the Drugs Act and the Order on Drugs and Psychotropic Substances of 12 December 1996 issued by the Swiss Institute for Therapeutic Products, sodium pentobarbital is considered to be a drug within the meaning of the Drugs Act. Moreover, it appears from the Federal Court’s judgment of 3 November 2006 that sodium pentobarbital is categorised as a “category B” medicinal product within the meaning of the Therapeutic Products Act.

22. In addition, sodium pentobarbital is listed in Schedule III of the United Nations Convention on Psychotropic Substances of 21 February 1971. Under that Convention, it may be issued for individual use only on the basis of a medical prescription.

23. Section 9 of the Drugs Act lists the members of the medical profession who may obtain drugs without authorisation. Section 9(1) is worded as follows:

“Doctors, dentists, veterinary surgeons and those managing a public or hospital pharmacy who practise as self-employed professionals by virtue of a decision of the cantonal authorities adopted pursuant to the Federal Law of 19 December 1877 on the practice of the professions of doctor, pharmacist and veterinary surgeon in the Swiss Confederation, may obtain, hold, use and issue drugs without authorisation, within the limits justified by the practice, in conformity with the requirements, of their profession. This shall be without prejudice to the cantonal provisions regulating direct dispensing by doctors and veterinary surgeons ...”

24. Pursuant to section 10(1) of the same Act, only doctors and veterinary surgeons are authorised to prescribe drugs:

“The doctors and veterinary surgeons who fall under the scope of section 9 shall be authorised to prescribe drugs.

...”

25. Doctors and veterinary surgeons may write such prescriptions only in so far as this is medically acceptable and only for patients whom they have examined personally (section 11(1) of the same Act, and Article 43 § 1 of the Order on Drugs of 29 May 1996).

26. Sections 24 and 26 of the Therapeutic Products Act are worded as follows:

Section 24 – Issuing of medicinal products subject to a prescription

“The following persons shall be authorised to issue medicinal products that are subject to a prescription:

(a) pharmacists, on a medical prescription, and, where justified in exceptional cases, without a medical prescription;

(b) any other person exercising a medical profession, in accordance with the provisions on dispensing physicians;

(c) any duly trained professional, under the supervision of a person who comes under the scope of paragraphs (a) and (b).

...”

Section 26 – Principle of prescription and issue

“The recognised rules of pharmaceutical and medical science shall be respected in the prescription and issuing of medicines.

A medicinal product may be prescribed only where the state of health of the consumer or patient is known.”

27. Chapter 8 of the same Act contains criminal-law provisions targeting persons who intentionally endanger the health of another person in relation to an activity covered by the Act. Section 86 of the Act provides:

Section 86 – Offences

“Anyone who intentionally endangers human life shall be liable to imprisonment or a fine of up to 200,000 francs, unless he or she has committed a more serious offence within the meaning of the Criminal Code or of the Drugs Act of 3 October 1951, if he or she:

(a) neglects the duty of care when carrying out an operation related to therapeutic products;

(b) manufactures, places on the market, prescribes, imports or exports medicinal products or trades in them abroad without authorisation or in infringement of other provisions of this Act;

...

(f) neglects his or her obligation to ensure the upkeep of medical devices;

...

Where the perpetrator is acting in a professional capacity, the term of imprisonment shall be for up to five years and the fine shall be up to 500,000 francs.

Where the perpetrator acts through negligence, the term of imprisonment shall be up to six months or the fine up to 100,000 francs.”

28. In its judgments 6B_48/2009 and 6B_14/2009 of 11 June 2009, the Federal Court upheld the conviction and sentencing to four and a half years’ imprisonment of a psychiatrist on the ground that the latter, who had assisted his patient to commit suicide, had incorrectly assessed the patient’s capacity for discernment.

29. The research conducted by the Court indicates that certain member States of the Council of Europe have specific regulations covering access to substances liable to facilitate suicide.

30. In Belgium, for example, the Law of 28 May 2002 defines euthanasia as an act carried out by a third party which intentionally ends an individual’s life at the latter’s request (section 2 of the Law). A pharmacist who issues a “lethal substance” does not commit an offence where this is done on the basis of a prescription in which the doctor explicitly states that he or she is acting in accordance with the law. The implementing regulations establish the criteria of prudence and the conditions which must be met for the prescription and issue of such medicines; the necessary measures must also be taken to ensure the availability of the lethal substances.

31. In Luxembourg, the Law of 16 March 2009 decriminalised euthanasia and assisted suicide. Under that Law, access to a medicine enabling suicide is legally possible for a doctor only if he or she plays an integral part in the process of euthanasia or assisted suicide.

THE LAW

I. ALLEGED VIOLATION OF ARTICLE 8 OF THE CONVENTION

32. The applicant complained about the conditions required to obtain sodium pentobarbital, namely a medical prescription based on a thorough psychiatric assessment. He alleged that, since those conditions could not be met in his case, the right to which he considered himself entitled, namely that of choosing the time and manner of his death, was not respected. He submitted that, in an exceptional situation such as his, access to the necessary medical products for suicide ought to be guaranteed by the State. He relied on Article 8 of the Convention, which provides:

“1. Everyone has the right to respect for his private and family life, his home and his correspondence.

2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.”

A. The parties’ submissions

1. The applicant

33. The applicant alleged that he was the victim of interference with the exercise of his right to respect for his private life within the meaning of Article 8 of the Convention. He did not share the Government’s view that other options for ending his life were available to him. He considered that the ingestion of sodium pentobarbital was the only dignified, certain, rapid and pain-free method of committing suicide. Moreover, the fact that none of the 170 psychiatrists practising in the Basle region contacted by him had been willing to help him was, in his opinion, proof that it was impossible to satisfy the conditions laid down by the Federal Court. He submitted that this was unquestionably contrary to the principle, established by the Court, that the Convention protected rights that were practical and effective (he referred to Artico v. Italy, 13 May 1980, § 33, Series A no. 37).

34. The applicant further alleged that the cases of suicide referred to in which Dignitas had provided assistance dated back to 2001 to 2004 and that, in consequence, they were not to be taken into account in his case. In addition, an investigation had been opened in respect of doctors in Zürich who had prescribed sodium pentobarbital to persons suffering from psychiatric problems wishing to commit suicide, on the ground that there had been no in-depth psychiatric assessment. He also submitted that he had been informed by Dignitas that the association was no longer in contact with psychiatrists who were willing to carry out the necessary expert assessment. Lastly, he argued that, by virtue of the right to self-determination, he was not required to undertake further therapy, contrary to the Government’s affirmations, in so far as he had clearly and freely taken his decision to end his life.

35. As to the Government’s argument concerning the inherent risks of excessive liberalisation in the area of suicide, he considered this unconvincing, alleging that the Swiss authorities were in any event all but inactive in the area of suicide prevention, despite the fact that there were almost 67,000 attempted suicides per year (in this connection, the applicant referred to the Federal Council’s reply of 9 January 2002 to questions posed by Andreas Gross, national councillor and member of the Parliamentary Assembly of the Council of Europe).

36. The applicant further submitted that the Government had ignored the fact that he had been suffering from serious psychiatric problems for many years. His intention to end his life was unambiguous, as was clearly shown by his previous suicide attempts and his efforts to obtain legal approval for his decision. It was not therefore necessary for him to prove that he was serious in his intent, through either an in-depth psychiatric assessment or psychiatric assistance over a prolonged period.

37. In view of the above, the applicant alleged that the impugned interference with his right to respect for his private life as guaranteed by Article 8 § 1 of the Convention was not justified, either by the protection of his own life or on the grounds of public health or safety. Finally, he complained that the impossibility of finding a psychiatrist willing to provide an expert report had rendered illusory his right to respect for his private life.

2. The Government

38. The Government denied any infringement in the instant case of the applicant’s right to respect for his private life as guaranteed by Article 8 § 1 of the Convention. In this regard, they considered that this case differed from the Pretty v. the United Kingdom case (no. 2346/02, ECHR 2002‑III), in which the applicant, incapable of acting autonomously, was prevented from putting into practice her choice to die in a manner that she considered dignified. According to the Government, the illness suffered by the applicant in the instant case did not prevent him from acting autonomously. There were numerous other solutions available to able-bodied persons wishing to commit suicide. Furthermore, like the Federal Court, the Government considered that the right to self-determination which was enshrined in Article 8 § 1 could not include the right of an individual to assisted suicide, whether by making available the necessary means or through active assistance where the person was not able to act autonomously.

39. The Government added that, in any event, should the Court nonetheless consider that the Federal Court’s decision infringed the rights guaranteed by Article 8 § 1 of the Convention, such an infringement would be justified in the light of the criteria set out in paragraph 2 of that Article.

40. Moreover, in the Government’s opinion, the impugned regulations had a sufficient basis in law, a fact that the applicant had not contested (see paragraphs 19-28 above).

41. The Government further alleged that the restriction on access to sodium pentobarbital served to protect public health and safety and to prevent crime.

42. As to the necessity of such a restriction in a democratic society, the Government indicated that the Swiss regulations and practice in the area of assisted suicide were more permissive than in the majority of the other Council of Europe member States. Assisted suicide was not liable to punishment in general, but only in certain circumstances (they referred to Article 115 of the Criminal Code; see paragraph 19 above).

43. The Government specified that assisted suicide for individuals suffering from a psychiatric illness was not only legally possible in Switzerland but also occurred in practice. To their knowledge, the criminal convictions of doctors for prescribing sodium pentobarbital all concerned cases where the diagnosis had not been carefully established or was manifestly erroneous. Moreover, according to a study conducted between 2001 and 2004 on suicides assisted by the associations Exit and Dignitas, carried out by the Institute of Forensic Medicine at the University of Zürich, twelve persons suffering from a psychiatric illness had been assisted by those two associations during that period. None of the doctors involved in those cases was prosecuted, and nor were any other measures taken against them. Further, it was apparent from Exit’s annual reports that this association had twice, in 2007 and 2008, accompanied the suicide of a person suffering from a psychiatric illness (the association’s Management Committee Reports for 2007 and 2008, Annexes 3 and 4). In the Government’s view, this showed that doctors were willing to carry out the necessary assessments and prescribe the required quantity of sodium pentobarbital. To the Government’s knowledge, these cases had not had legal consequences. Accordingly, the Government submitted that, if he was prepared to accept the conditions laid down by the Federal Court and confirmed by the Swiss Society for Forensic Psychiatry, the applicant could find a doctor who, after accompanying him over a certain period, would be able to attest, if appropriate, whether he fulfilled the conditions for prescription of the substance in question.

44. The Government also considered that the steps taken by the applicant to contact a doctor raised several questions. Firstly, they noted that Dignitas, which had assisted the applicant in this action, had already assisted with the suicides of several other persons suffering from mental illness. They concluded that the association must be aware of doctors who could assume responsibility for the applicant’s request. Secondly, they noted that, since 2006, in line with the Federal Court’s judgment, the Canton of Zürich had changed its practice so that doctors who drew up a prescription for sodium pentobarbital no longer faced criminal prosecution. According to the Government, once the impugned obstacle in the domestic law had been lifted, rather than seeking to contact a doctor in the Canton of Zürich, the applicant had sent a written request, certified by a notary, to 170 psychiatrists, all of whom practised in the Basle region, with the exception of one doctor who practised in Berne. Thirdly, the Government, not knowing the criteria used by the applicant in selecting the 170 addressees of his request, considered that the wording of the letter was not such as to encourage a doctor to respond positively, in that the applicant, by dismissing in advance any therapeutic treatment and requesting solely an expert assessment, ruled out any serious examination of an alternative to suicide, a step that was part of the assessment that must precede the prescription of sodium pentobarbital.

45. In addition, according to the Government, while the regulations on assisted suicide confronted the State authorities with difficult ethical questions, they created an even more delicate situation in the case of persons wishing to commit suicide who were not suffering from a terminal illness. In their view, such persons were not choosing to prefer an easy death to a death preceded or accompanied by severe suffering, as in the Pretty case (cited above) in particular, but rather choosing to prefer death to life.

46. The Government also pointed out that, under Article 2 of the Convention, the State is enjoined not only to refrain from the intentional and unlawful taking of life, but also to take appropriate steps to safeguard the lives of those within its jurisdiction from acts by others or, where appropriate, from themselves (they referred to Kılavuz v. Turkey, no. 8327/03, § 78, 21 October 2008). They added that, where the authorities were aware of the risk of suicide by an individual, it was incumbent on them to do everything that could reasonably be expected of them to prevent the suicide (ibid., § 88).

47. In this connection, the Government submitted that, in psychiatry, the wish to commit suicide was seen as a symptom of mental illness, to which the appropriate response was suitable therapy. In their view, it was therefore necessary to draw a distinction between the wish to commit suicide as an expression of illness and the wish to commit suicide as an autonomous, considered and sustained decision. Given the complexity of mental illnesses and their uneven development, such a distinction could not be made without a thorough assessment over a time period that would make it possible to verify the consistency of the wish to commit suicide. Such an examination would necessitate in-depth psychiatric knowledge and could only be conducted by a specialist.

48. The Government further submitted that the obligation to submit a medical certificate implied certain actions by the applicant. In their view, however, these did not seem insurmountable if his choice to commit suicide resulted from an autonomous and sustained decision. Such an obligation amounted to an appropriate and necessary means for protecting the life of vulnerable persons whose decision to commit suicide could be based on a temporary crisis that altered their capacity for discernment. It was well known that many suicides were not a response to a genuine wish to die, but were instead more of a cry for help, intended to draw the attention of those around them to a problem. Thus, to facilitate access to assisted suicide would almost amount to pushing such individuals to use an infallible method of ending their lives.

49. The Government also argued that the solution adopted in Switzerland corresponded to the regulations provided for in the United Nations Convention on Psychotropic Substances, and that if Switzerland were required to provide sodium pentobarbital to the applicant without a medical prescription or on the basis of a prescription that did not satisfy the medical requirements, it would be in clear violation of those regulations. They concluded that the impugned measure, necessary for the protection of life, health and safety, fulfilled the conditions of Article 8 § 2 of the Convention and did not entail a violation of that provision.

B. The Court’s assessment

50. As the Court has had previous occasion to remark, the concept of “private life” is a broad term not susceptible to exhaustive definition. It covers the physical and psychological integrity of a person (see X and Y v. the Netherlands, 26 March 1985, § 22, Series A no. 91). It can sometimes embrace aspects of an individual’s physical and social identity (see Mikulić v. Croatia, no. 53176/99, § 53, ECHR 2002-I). Elements such as, for example, name, gender identification, and sexual orientation and sexual life fall within the personal sphere protected by Article 8 of the Convention (see, for example, B. v. France, 25 March 1992, § 63, Series A no. 232-C; Burghartz v. Switzerland, 22 February 1994, § 24, Series A no. 280-B; Dudgeon v. the United Kingdom, 22 October 1981, § 41, Series A no. 45; and Laskey, Jaggard and Brown v. the United Kingdom, 19 February 1997, § 36, Reports of Judgments and Decisions 1997‑I). Article 8 also protects a right to personal development, and the right to establish and develop relationships with other human beings and the outside world (see, for example, Burghartz, cited above, opinion of the Commission, p. 37, § 47, and Friedl v. Austria, 31 January 1995, Series A no. 305-B, opinion of the Commission, § 45). In the Pretty case (cited above, § 67), the Court held that the applicant’s choice to avoid what she considered an undignified and distressing end to her life fell within the scope of Article 8 of the Convention.

51. In the light of this case-law, the Court considers that an individual’s right to decide by what means and at what point his or her life will end, provided he or she is capable of freely reaching a decision on this question and acting in consequence, is one of the aspects of the right to respect for private life within the meaning of Article 8 of the Convention.

52. In the Court’s opinion, however, the instant case is to be distinguished from the above-cited Pretty case. Like the Federal Court, it considers that it is appropriate to state at the outset that the instant case does not concern the freedom to die and possible immunity for a person providing assistance with a suicide. The subject of dispute in this case is whether, under Article 8 of the Convention, the State must ensure that the applicant can obtain a lethal substance, sodium pentobarbital, without a medical prescription, by way of derogation from the legislation, in order to commit suicide painlessly and without risk of failure. In other words, unlike the Pretty case, the Court observes that the applicant alleges not only that his life is difficult and painful, but also that, if he does not obtain the substance in question, the act of suicide itself would be stripped of dignity. In addition, and again in contrast to the Pretty case, the applicant cannot in fact be considered infirm, in that he is not at the terminal stage of an incurable degenerative disease which would prevent him from taking his own life (see, conversely, Pretty, cited above, § 9).

53. The Court considers that it is appropriate to examine the applicant’s request to obtain access to sodium pentobarbital without a medical prescription from the perspective of a positive obligation on the State to take the necessary measures to permit a dignified suicide. This presupposes a weighing of the different interests at stake, an exercise in which the State is recognised as enjoying a certain margin of appreciation (see Keegan v. Ireland, 26 May 1994, § 49, Series A no. 290), which varies in accordance with the nature of the issues and the importance of the interests at stake. For its part, the Court has jurisdiction to review in fine whether the domestic decision complies with the requirements of the Convention (see Pretty, cited above, § 70).

54. The Court also reiterates that the Convention must be read as a whole (see Verein gegen Tierfabriken Schweiz (VgT) v. Switzerland (no. 2) [GC], no. 32772/02, § 83, ECHR 2009). In consequence, it is appropriate to refer, in the context of examining a possible violation of Article 8, to Article 2 of the Convention, which creates for the authorities a duty to protect vulnerable persons, even against actions by which they endanger their own lives (see, on this point, Keenan v. the United Kingdom, no. 27229/95, § 91, ECHR 2001‑III). For the Court, this latter Article obliges the national authorities to prevent an individual from taking his or her own life if the decision has not been taken freely and with full understanding of what is involved.

55. The Court also reiterates that the Convention and the Protocols thereto must be interpreted in the light of present-day conditions (see Tyrer v. the United Kingdom, 25 April 1978, § 31, Series A no. 26; Airey v. Ireland, 9 October 1979, § 26, Series A no. 32; and Vo v. France [GC], no. 53924/00, § 82, ECHR 2004‑VIII). However, the research conducted by the Court enables it to conclude that the member States of the Council of Europe are far from having reached a consensus with regard to an individual’s right to decide how and when his or her life should end. In Switzerland, pursuant to Article 115 of the Criminal Code, inciting and assisting suicide are punishable only where the perpetrator of such acts is driven to commit them by “selfish motives”. By way of comparison, the Benelux countries in particular have decriminalised the act of assisting suicide, but only in very specific circumstances. Lastly, certain other countries accept only acts of “passive” assistance. It should be noted that the vast majority of member States seem to attach more weight to the protection of the individual’s life than to his or her right to terminate it. It follows that the States enjoy a considerable margin of appreciation in this area.

56. With regard to the balancing of the competing interests in this case, the Court is sympathetic to the applicant’s wish to commit suicide in a safe and dignified manner and without unnecessary pain and suffering, particularly given the high number of suicide attempts that are unsuccessful and which frequently have serious consequences for the individuals concerned and for their families. However, it is of the opinion that the regulations put in place by the Swiss authorities, namely the requirement to obtain a medical prescription, pursue, inter alia, the legitimate aims of protecting everybody from hasty decisions and preventing abuse, and, in particular, ensuring that a patient lacking discernment does not obtain a lethal dose of sodium pentobarbital (see, mutatis mutandis, with regard to restrictions on abortion, Tysiąc v. Poland, no. 5410/03, § 116, ECHR 2007‑I).

57. Such regulations are all the more necessary in respect of a country such as Switzerland, where the legislation and practice allow for relatively easy access to assisted suicide. Where a country adopts a liberal approach in this manner, appropriate implementing measures for such an approach and preventive measures are necessary. The introduction of such measures is also intended to prevent organisations which provide assistance with suicide from acting unlawfully and in secret, with significant risks of abuse.

58. In particular, the Court considers that the risks of abuse inherent in a system that facilitates access to assisted suicide should not be underestimated. Like the Government, it is of the opinion that the restriction on access to sodium pentobarbital is designed to protect public health and safety and to prevent crime. In this respect, it shares the view of the Federal Court that the right to life guaranteed by Article 2 of the Convention obliges States to establish a procedure capable of ensuring that a decision to end one’s life does indeed correspond to the free will of the individual concerned. It considers that the requirement for a medical prescription, issued on the basis of a full psychiatric assessment, is a means enabling this obligation to be met. Moreover, this solution corresponds to the spirit of the United Nations Convention on Psychotropic Substances and the conventions adopted by certain member States of the Council of Europe.

59. In this connection, the Court observes that the parties’ views diverge considerably on the issue of effective access to a medical assessment that would be favourable to the applicant and enable him to obtain sodium pentobarbital. The Court can envisage that psychiatrists would display some reluctance when confronted with a request for a prescription of a lethal substance. It also considers, in view of the delicate question of the applicant’s capacity for discernment, that the threat of criminal proceedings hanging over doctors willing to provide an in-depth report in order to facilitate suicide is real (see, mutatis mutandis, Tysiąc, cited above, § 116; see also, for example, the Federal Court’s judgments 6B_48/2009 and 6B_14/2009 of 11 June 2009, at paragraph 28 above).

60. At the same time, the Court accepts the Government’s argument that the steps taken by the applicant to contact a doctor raise a number of questions (see paragraph 44 above). It notes that the Government’s arguments have not been entirely refuted by the applicant. It also notes that he sent the 170 letters in question (see paragraph 17 above) after the Federal Court had ruled on his appeal. Accordingly, these steps cannot a priori be taken into account in the present case. In any event, as the Government emphasised, the letters do not seem likely to encourage the doctors to reply favourably, given that the applicant stated that he was opposed to any form of therapy, thus excluding a more comprehensive attempt to find possible alternatives to suicide. In the light of the information submitted to it, the Court is not convinced that it was impossible for the applicant to find a specialist who would have been prepared to assist him. Consequently, in the Court’s opinion, the applicant’s right to choose the time and manner of his death was not merely theoretical or illusory (criterion laid down in Artico, cited above, § 33).

61. Having regard to the foregoing and to the margin of appreciation enjoyed by the national authorities in such a case, the Court considers that, even assuming that the States have a positive obligation to adopt measures to facilitate the act of suicide with dignity, the Swiss authorities have not failed to comply with this obligation in the instant case.

It follows that there has been no violation of Article 8 of the Convention.

FOR THESE REASONS, THE COURT UNANIMOUSLY

Holds that there has been no violation of Article 8 of the Convention.

Done in French, and notified in writing on 20 January 2011, pursuant to Rule 77 §§ 2 and 3 of the Rules of Court.

Søren Nielsen Christos Rozakis
Registrar President

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