Zurich Expands Access to Assisted Suicide in Care Homes and Hospitals

Image: Zurich skyline at blue hour.

On September 27, voters in the canton of Zurich approved a legislative counter-proposal requiring private care homes, hospitals and rehabilitation clinics to tolerate assisted suicide on their premises. The measure won 68.11% of the vote, according to SWI swissinfo.ch. It makes Zurich the first German-speaking Swiss canton to extend this duty across all care homes and to include hospitals and rehabilitation facilities. [1]

The decision is more extensive than a change limited to public nursing homes. It reaches institutions that previously could set their own rules, including private homes without a municipal service mandate. Psychiatric clinics and prisons are excluded. The legal duty is to allow an external assisted-suicide organisation to enter and carry out the process under Swiss law; it does not require an institution to perform the act itself. [1] [2]

That distinction is central. Zurich has not adopted active euthanasia. Under Swiss federal law, assisted suicide means that another person or organisation helps make a lethal substance available, while the person who wishes to die must take it themselves. Direct active euthanasia, in which a third party administers the fatal substance, remains punishable. Article 115 of the Swiss Penal Code punishes assistance motivated by selfish ends, while non-selfish assistance can fall outside criminal liability. [3]

From a limited rule to a canton-wide obligation

The vote builds on a rule that took effect on July 1, 2023. Since then, residents of care homes operated by, or commissioned by, a Zurich municipality have been able to seek assisted suicide in their own facility, at their own expense. Private homes without such a municipal relationship were not required to permit it. [4]

The earlier reform was already a response to uneven access. A 2021 survey cited by the Zurich government found that roughly 75% of the canton’s care homes were already allowing assisted suicide by external organisations. The 2023 law therefore established a common baseline for publicly connected facilities while leaving a gap between them and independent private homes. [4]

The political process that followed was not a simple vote on one proposal. The popular initiative “Self-determination at the end of life also in care homes” sought a broad extension to private homes, hospitals and psychiatric institutions. The cantonal government opposed that initiative as too wide-ranging, but supported a narrower counter-proposal. The counter-proposal extended the duty to private care homes, hospitals and rehabilitation clinics while leaving out psychiatric facilities and ambulatory institutions. The Cantonal Council recommended the counter-proposal to voters, and the initiative was withdrawn. [2] [5]

What the law requires—and what it does not

The new rule concerns access to premises. It does not turn every hospital or care home into an assisted-suicide provider. Institutions do not have to recruit staff to participate, prescribe medication, or endorse the decision. Staff members are not automatically required to be present. The process remains dependent on the person’s legal eligibility, decision-making capacity, medical assessment and compliance with the ordinary duties of care.

This model places a boundary between institutional conscience and a resident’s ability to remain in a familiar setting. A faith-based home may continue to reject assisted suicide as a matter of belief, but it may not prevent an external organisation from entering solely because the home disagrees with the practice. Swissinfo reported that opponents view the law as a conflict between institutional religious freedom and personal self-determination. [2]

The government’s earlier position helps explain the compromise. It argued that hospitals have a curative purpose and may not be comparable to a long-term care home where a resident has made a permanent home. It also warned that people could feel pressure to choose assisted suicide because they feared burdening relatives or the health system. The government expressed particular concern about psychiatric settings, where patients may be acutely vulnerable and where assessing decision-making capacity can be difficult. [5]

Those concerns shaped the exclusions. Psychiatric clinics remain outside the new obligation because their primary duty is stabilisation, treatment and protection from suicide. Prisons are also excluded, although the Zurich government noted that exceptional cases involving a terminally ill prisoner may already be assessed under existing rules. [5]

How hospitals and care homes may adapt

The immediate effect may be organisational rather than numerical. Zurich’s health director, Natalie Rickli, said she did not expect a large volume of cases. Assisted suicide has been rare even in hospitals where it was already permitted. The slightly more than 200 care homes in the canton had also largely developed some form of working arrangement with right-to-die organisations before the vote. [2]

Hospitals will nevertheless need clear procedures. They may have to explain the option without presenting it as a recommendation, identify who receives a request, coordinate with an external organisation, establish privacy arrangements and support relatives and staff. They will also need to separate assisted-suicide requests from emergency suicide-prevention responses, since the legal and clinical duties differ.

Care homes face a related challenge. Residents should be able to make informed choices without being steered toward death, while those who reject assisted suicide should continue to receive palliative and pastoral care. Transparent information before admission may become more important, especially for families comparing institutions with different traditions or internal policies.

Swiss federal authorities describe palliative care as medical, psychological, social and pastoral support for patients and families. Good palliative care can improve quality of life and may reduce a person’s wish to die, but it does not automatically remove every request for assisted suicide. [3] A responsible system therefore needs both options: strong relief of suffering and a carefully regulated response when an eligible person continues to make a settled, autonomous request.

A Swiss debate with wider consequences

Zurich’s decision may encourage similar campaigns in other cantons. Swissinfo reported that organisations such as EXIT and Dignitas helped initiate the Zurich legislative effort, and that the vote could give them a basis for seeking comparable rules elsewhere. [2]

The decision also raises a question about the role of private institutions in publicly regulated care. A resident may have chosen a home for its religious identity, but that resident may later reach a deeply personal decision about the end of life. The new policy resolves the conflict in favour of access to the premises, while preserving the institution’s right not to participate directly.

That resolution will not end the ethical argument. Supporters see it as protection against unequal access based on postcode, ownership or religious affiliation. Critics worry that a legal duty to tolerate assisted suicide weakens the freedom of institutions and could normalise a choice that vulnerable people may experience as an expectation. Both concerns deserve attention in implementation, especially through independent counselling, careful capacity assessments, clear consent procedures and protection from family, financial or institutional pressure.

Switzerland’s federal framework also leaves unresolved questions. Swissinfo noted that assisted suicide can be legally possible for a person without a terminal illness if the wish to die is autonomous, the person has decision-making capacity and the person acts independently. Direct euthanasia remains prohibited. [2] Future debates may address dementia, advance directives and the point at which a person can no longer personally carry out the final act.

Closing Thoughts

Zurich’s new rule is best understood as a change in the relationship between residents and the institutions that care for them. It does not erase religious convictions, replace palliative care or make assisted suicide routine. It does mean that a private care home, hospital or rehabilitation clinic generally cannot use its own premises as a barrier when a legally eligible person makes an autonomous request.

The quality of the reform will depend less on the vote’s headline than on the safeguards built around it: honest information, time for reflection, independent assessment, access to symptom relief, protection from pressure and respect for staff who do not wish to participate. If those conditions are taken seriously, access and compassion do not have to be opposing goals.

What does this look like in practice?

A resident in a private care home who makes a persistent request would not simply receive a lethal substance from the home. The request would pass through the applicable medical and organisational safeguards. An external assisted-suicide organisation could be contacted, the person’s capacity and voluntary decision would be assessed, and the institution would arrange access to a suitable private space. The resident would remain responsible for taking the substance themselves. Staff could continue to provide ordinary care without becoming participants in the act.

In a hospital, the process would require additional coordination because patients may be admitted for treatment rather than long-term residence. The hospital would need to clarify who can receive the request, how the treating team communicates with an external organisation and how palliative options are offered. The law creates access to the setting; it does not remove the need for clinical judgement or legal compliance.

What is the relevance of this?

The Zurich vote shifts the main question from “May this institution refuse?” to “How can access be provided without coercion?” That change affects residents, families, clinicians, chaplains, care workers and private providers.

For residents, it reduces the risk that moving into a private home or hospital will force them to leave a familiar environment at the end of life. For institutions, it requires policies that respect both conscience and resident autonomy. For policymakers, it provides a test of whether access can be widened while maintaining suicide prevention, palliative care and reliable safeguards for people who may be vulnerable.

The result is therefore not a blanket endorsement of assisted suicide. It is a decision about the place where a legally permitted act may occur and about whose interest should prevail when personal autonomy conflicts with an institution’s refusal. Zurich has chosen access, while leaving the act itself outside the direct role of most healthcare staff.

References

[1] Zurich will extend assisted suicide to private care homes and hospitals

[2] Self-determination over religious freedom: Zurich sends strong signal on assisted dying

[3] The various forms of euthanasia and their position in law

[4] Assisted suicide in care facilities becomes anchored in law

[5] Zurich government supports assisted suicide in all care homes but rejects broader initiative

Reference video

• SRF: Zurich vote on assisted suicide in care homes and hospitals — Swiss public broadcaster explainer on the proposed legal change and vote.

• Zurich Cantonal Council: session video on the assisted-suicide initiative and counter-proposal — official parliamentary recording from March 30, 2026.

• SRF Forum: Must all Zurich care homes and hospitals allow assisted suicide? — televised discussion of the policy before the vote.

If this topic feels personal or urgent, Switzerland’s confidential support line Die Dargebotene Hand can be reached at 143; children and young adults can call 147. [3]