The ASEP project is intended to help further develop necessary laws and guidelines.
When nursing staff or healthcare providers are confronted with a request to end a patient’s life, there is often a great deal of uncertainty. Image source: Adobe Stock
Assisted suicide is morally and ethically controversial. It is primarily discussed in public when a high-profile case comes to light—as was most recently the case with the famous twins Alice and Ellen Kessler. Although assisted suicide is permitted in Germany, it is scarcely regulated by law. Until now, there has been little scientifically validated data on the current practice of assisted suicide. In recent years, various research teams have set out to shed light on the matter. Among them is a team from the Institute of General Medicine and Palliative Medicine at Hannover Medical School (MHH). In the project “Assisted Suicide in Germany—Research on Practice (ASEP),” PD Dr. Sven Schwabe and his colleagues aim to learn more about the practical procedures, the people involved, the challenges, and how it fits into the healthcare system.
Court ruling created a new legal situation
“Killing on request” is prohibited in Germany, but assisted suicide is permitted. The legal situation regarding assisted suicide is outlined in a February 2020 ruling: “The right to a self-determined life includes the freedom to take one’s own life,” the Federal Constitutional Court ruled at the time. This freedom also encompasses the freedom “to seek help from third parties for this purpose and to accept such help, insofar as it is offered.” A prerequisite is always that the person wishing to die has made their decision of their own free will and independently ingests the substance used for suicide. With regard to those providing assistance, the following applies: “No one can be compelled to provide assisted suicide.” Whether someone wishes to provide assistance is a question that each person must decide for themselves. Since May 2021, there has been no longer any professional prohibition against physicians assisting in suicide. However, assisted suicide is not part of a physician’s professional duties.
Significant social implications
In its February 2020 ruling, the Federal Constitutional Court granted lawmakers the authority to re-regulate assisted suicide. Two legislative initiatives on this issue failed in the Bundestag in 2023. “We currently have one of the most liberal legal frameworks for assisted suicide in the world here in Germany, but we know very little about the practice of assisted suicide,” explains sociologist PD Dr. Sven Schwabe, director of the ASEP research project. Yet the topic holds great societal significance. Although assisted suicides account for only a very small proportion of the total number of suicides, their number is rising steadily. In 2020, the three major euthanasia organizations operating in Germany recorded a total of 109 assisted suicides; by 2025, that number had already risen to more than 1,000. In addition, there is likely a significant number of unreported cases. “Assisted suicides have not been officially recorded to date, which is why there are no reliable case figures,” notes PD Dr. Schwabe. Furthermore, there is very little data available on the complex process of assisted suicide, which begins with the initial consultation with individuals intent on taking their own lives and extends all the way to criminal investigations.
Study describes the current situation
PD Dr. Schwabe and his team now aim to fill this data gap with the ASEP research project. “ASEP is a descriptive qualitative study. Through interviews with experts, practitioners, and family members, we aim to gain scientific insights into what the actual practice of assisted suicide looks like in Germany,” explains sociologist Anna Preitenwieser. Three questions are central to the study: How do medical and non-medical practitioners and family members experience current practices? What practical, organizational, ethical, and legal challenges exist? How is assisted suicide in Germany linked to the healthcare system?
Objectifying an emotional debate
The research project “Assisted Suicide in Germany—An Examination of Current Practices” began in April 2025. It is divided into three phases. The first phase—expert interviews with representatives of relevant professional associations and institutions, as well as with knowledgeable individuals—has already been completed. The second project phase is currently underway, during which individuals who have already been involved in the practical provision of assisted suicide are being interviewed. These include, for example, physicians, nurses, funeral directors, and family members. “The group of participants is very diverse,” says PD Dr. Schwabe. In the third phase of the project, the study’s findings will be discussed with representatives from politics, academia, and professional associations. “ASEP will help raise awareness of current practices in assisted suicide in Germany and bring a more objective perspective to the debate on assisted suicide, which is sometimes highly emotional,” says PD Dr. Schwabe. At the same time, the data can serve as a basis for legal regulations on assisted suicide. The entire project is overseen by a scientific advisory board. The German Research Foundation (DFG) is funding ASEP with approximately 400,000 euros.
Guidelines on assisted suicide published
Healthcare professionals are regularly confronted in clinical practice with requests to die and, increasingly, with specific requests for assisted suicide. These requests are often accompanied by uncertainty. In recent months, three medical guidelines have been published:
a) on addressing requests for assisted suicide in primary care practice,
b) on suicidality in general,
c) on how to handle requests for assisted suicide.
The guidelines are explicitly aimed at healthcare professionals, provide practical tips, and can help build confidence when dealing with the topic of assisted suicide. In addition, a registry for recording assisted suicides in Germany (RegAS) was launched in the fall of 2026. All individuals who have been involved in an assisted suicide are invited to share their experiences here.
You can find the original publication here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0311880
Text: Tina Götting