In January 2022, Austria established a legal framework for assisted suicide, making it one of the most recent countries to regulate assisted dying amid intensifying global debate and a growing number of nations either adopting or considering relevant legal frameworks [1-7].

The political debate on self-determined dying and assisted suicide in Austria had been underway for many years, increasing as more European countries introduced legal frameworks. However, apart from a 2015 statement by the Austrian Bioethics Commission advocating reform [8], no significant political steps were taken until the Austrian Constitutional Court’s 2020 ruling, which declared the outright prohibition of assisted suicide to be unconstitutional [9], ultimately leading to the introduction of the Sterbeverfügungsgesetz (Dying Decree Act) on January 1, 2022. The law supplements the Austrian Criminal Code and introduces the concept of the “dying decree” (Sterbeverfügung). A dying decree is a formal written declaration in which an individual who has decided to pursue assisted suicide records their voluntary and autonomous decision to do so. Health care and legal professionals are involved in preparing a dying decree, which permits the substance pentobarbital to be dispensed by a public pharmacy.

The eligibility criteria for obtaining assistance in suicide are shaped by a restrictive legal framework, ultimately limiting access to this option to a small group of individuals. To qualify, individuals must be of legal age and fully capable of making informed decisions. Additionally, the option is only available to individuals who are either Austrian citizens or who have permanent residence in Austria.

Moreover, the law enforces strict conditions with respect to the individual’s state of health: a dying decree may only be issued to people with either an incurable terminal illness or a severe, permanent illness with persistent symptoms that permanently impair their overall quality of life. In both cases, the illness must result in a subjectively unbearable level of suffering that cannot otherwise be alleviated.

Beyond these strict personal requirements, individuals who wish to terminate their lives must navigate significant hurdles during the subsequent procedural steps of preparing a dying decree. The formal process begins with a medical assessment by 2 physicians, one of whom must be certified in the field of palliative medicine. If there is an indication that the individual has a psychological condition that could prompt the desire to end their life, this must additionally be assessed by a psychiatric specialist or clinical psychologist.

After a 12-week waiting period (shortened to 2 weeks if the terminal phase has already been reached), the next step is for a notary or legally qualified employee of a public patient advocacy institution to formally establish or issue the decree. The process is then finalized by providing the individual who wishes to terminate their life via dying decree with a lethal preparation of pentobarbital that can be dispensed by a public pharmacy (Textbox 1).

In terms of the final steps of assisted suicide, the law provides no further procedural guidelines. In Austria, assisted suicide is not institutionalized, nor are physicians or other health care providers obligated to accompany individuals through the last step. The legislator has intentionally left the final steps of assisted suicide largely open-ended. In practice, this lack of guidance has resulted in hurdles for all parties involved.

While the Austrian legal framework is broadly in line with international practices [1-7], the regulatory approach toward the final step of the assisted suicide process is comparatively atypical. In most other jurisdictions—with the exception of Germany (which lacks a specific statutory framework) and Switzerland (where the law does not formally mandate such involvement, although, in practice, a highly structured process ensures professional participation)—medical professionals hold clearly defined responsibilities regarding the application of the lethal preparation [1]. In contrast, the Austrian model leaves the application of the barbiturate unsupervised, lacking a formal requirement for health care professionals to accompany the individual at the time of the assisted suicide.

The unique challenges posed by the Dying Decree Act in Austria have been the subject of theoretical discourse, particularly in the legal [10-13] and ethical [14-16] realms. The law was highly controversial and widely debated, which eventually brought it to the Austrian Constitutional Court for examination. In December 2024, the Constitutional Court confirmed that most provisions of the Dying Decree Act conformed to the Federal Constitution. Two provisions (the need for full renewal of a dying decree after 1 year and the strict ban on information about relevant services) were declared unconstitutional.

However, 3 years after the law’s implementation, by early 2025, there remains a critical lack of empirical research examining the law’s implications for those directly affected. Our study aims to address this gap by analyzing the lived experiences of individuals navigating the Austrian assisted suicide framework and evaluating its legal implementation. This approach is designed to contribute to the existing scholarship in evaluating assisted dying laws [17-21]. In addition to our scholarly objective, we aim to provide insights that may inform policy development and professional practice. To this end, we will disseminate our findings both within academia and beyond.

Our multiperspective evaluation aims to assess the newly enacted Dying Decree Act. By comparing and contrasting the perspectives of relevant key stakeholders, we aim to provide a nuanced understanding of the law’s societal, legal, and ethical implications while also exploring its practical consequences for the health care system and health care professionals. We define key stakeholders as individuals seeking assistance in dying; their family members and other close relatives; and all the professionals specified in the legal framework, notably physicians, notaries, other relevant legal professionals, pharmacists, and psychologists. Thus, our evaluation is grounded in a perspectivist approach, which maintains that any assessment of the law must be built upon the perspectives of those who are centrally affected by it, meaning the key stakeholders, as listed above [22,23]. Our study uses an interdisciplinary approach that incorporates theories, concepts, and methodologies from legal science, ethics, and social science.

The research questions are as follows:

The study sets out to examine the Austrian legal framework for assisted suicide applying generally recognized methods of legal interpretation [24,25]. This analysis will be complemented by a comprehensive legal literature review of academic law journals, databases, and library resources. The review will focus on legal texts and their scholarly interpretation and dissemination, excluding empirical studies. Our aim lies in generating a structured understanding of the legal framework governing assisted suicide in Austria. Extracted material will be organized thematically according to key legal topics (eg, eligibility, procedural safeguards, and institutional responsibilities) to provide a structured narrative of the legal landscape. Searches will be conducted using relevant keywords related to the applicable statutory provisions.

Beyond the Austrian context, the study will also explore alternative regulatory approaches. This includes an analysis of other national and European Union (EU) provisions, guidelines, rulings, and proposed solutions. Particular attention will be paid to the case law of the European Court of Human Rights and further relevant EU documents as a means of illustrating the European framework in which the discourse on assisted suicide is embedded. In addition to EU regulations, the study will include a comparative legal analysis of how other nations regulate assisted suicide. By comparing these approaches with the Austrian framework, the study aims to provide both an overview of international best practice models and an insight into the Austrian legislators’ legal reasoning. The objective is twofold: (1) to understand the reasoning behind the Austrian legislators’ choices and (2) to apply a comparative perspective that provides the scientific community with new insights.

The legal analysis will be conducted by the authors in collaboration with legal experts from the Forum on End-of-Life Autonomy (Forum Autonomie am Lebensende). This forum is an expert panel that was established in 2022 and is headed by the Department for Ethics and Law in Medicine of the University of Vienna (Institut für Ethik und Recht in der Medizin). The forum members meet on a regular basis to discuss the practical implementation of the legal framework surrounding assisted suicide. It comprises experts from various fields with practical insights into the law and its application. By involving the forum, the study ensures that legal questions will be addressed and answered from multiple perspectives and areas of expertise.

The primary objective of this section of the study is to evaluate the moral implications and ethical challenges of the Dying Decree Act from a philosophical and applied ethical perspective. This is achieved by analyzing the line of argumentation used in the process of legalizing assisted suicide and its manifestation in the legal framework in Austria. We will then consider whether the Dying Decree Act can adequately address ethical concerns at the level of the individual, the health care system, and society as a whole.

Thus, we base our ethical reflections on a multiperspective, systemic approach. At the micro level, we focus on patient–health care professional interactions. Our applied ethics are guided by the 4 bioethical principles [26] as well as interprofessional health care ethics, referencing nursing and medical ethics as professional ethics. At the meso level, we focus on interactions between decision-makers and teams in health care settings, applying organizational ethics theories [27] from a systemic perspective. These highlight the urgent need for team and organizational development to implement the Dying Decree Act. At the macro level, it is important to clarify the various moral arguments influencing social discourse and reflect on managing tensions and conflicts in the Austrian health care system. This necessitates the active involvement of health care professionals, policymakers, and patients, ensuring that diverse perspectives are represented. It also demands careful attention to and respect for pluralism within a solidarity-based health care system. Therefore, the ethical analysis will consider practical consequences at the level of patients, health care professionals, and the health care system as a whole.

Building on this framework, we will select philosophical and ethical approaches equipped to identify and reflect on potential moral concerns associated with assisted suicide. Our aim is to show how these concerns and objections are more or less meaningful according to whether they target individuals, organizations, or society. Second, we will highlight those arguments and objections that arise during the legalization process and are specifically considered in the Dying Decree Act to discuss their consequences and implications for individuals, organizations, and society. We will focus primarily on the Austrian Constitutional Court texts as well as the legal text of the Dying Decree Act itself. Third, our ethical reflection is integrated into both the quantitative and qualitative research components.

This study is designed to comply with the Declaration of Helsinki. The University of Vienna Ethics Committee approved the initial research proposal on November 27, 2023 (01071). An addendum was submitted in September 2024, to which ethical consent was granted on November 4, 2024.

All participants were asked to provide informed consent prior to taking part. For the online survey, participants provided informed consent by clicking a confirmation button prior to proceeding to the questionnaire. Before being asked to provide their consent, participants were presented with detailed information about the study, including its purpose, the voluntary nature of participation, and data protection measures. The survey was conducted anonymously. Providing contact details for potential participation in a follow-up interview was optional, and they were collected separately from the survey responses.

For the interview study, all participants are asked to provide written informed consent using the official consent form issued by the Ethics Committee of the University of Vienna. Participation is voluntary, and participants may withdraw from the study at any time without providing a reason. Due to the sensitive nature of the topic, interview participants who are either individuals seeking assistance in dying or family members or relatives will also be informed that professional counseling services are available and may be accessed through the study team if desired.

No financial compensation or incentives were offered for participation.

Furthermore, all applicable data protection regulations, including the EU’s General Data Protection Regulation, have been strictly adhered to, and concise rules on data security have been formulated (eg, all data will be deleted when the research is concluded and results are published). All interviews will be transcribed by a professional transcriber who is subject to strict confidentiality requirements. All identifying details (eg, names and places) will be removed after transcription. Transcripts will be coded using unique identification numbers in accordance with pseudonymization procedures, and identifying information will be stored separately in a password-protected file within the secure university data system until completion of the project.

Our study aims to provide a comprehensive understanding of the lived experiences and practical challenges encountered by all stakeholders involved in assisted suicide under Austria’s newly established legal framework. By examining these perspectives, the study seeks to address critical gaps in empirical research and inform future policy and practice. Previous scholarship has highlighted that end-of-life regulation cannot be adequately understood through isolated legal or ethical analysis alone but requires a holistic approach [43]. In line with this identified need, our study uses an interdisciplinary approach to evaluate Austria’s new framework on assisted suicide, bringing stakeholders’ perspectives and lived experiences to the forefront. The study components, which incorporate multiple stakeholder perspectives, will aim to advance academic discourse by examining the experiences of (1) individuals seeking assistance in dying, (2) their family members and other relatives, and (3) involved professionals. Thus, this study generates empirical insights into how the legal framework shapes clinical roles, responsibilities, and accessibility. Ultimately, the study aims to bridge the gap between theoretical discussions on assisted suicide and the practical realities faced by those involved by offering evidence-based recommendations that are relevant not only to Austria but also to international debates on assisted dying legislation.

With our project, we aim to contribute to the international landscape of research on assisted dying regulation. It is essential to recognize that cultural and legal differences necessitate caution when transferring findings across countries. It is crucial to consider the lived experiences of all involved parties within their specific national context. An example illustrating this need is the variation in physicians’ attitudes and practices regarding assisted dying across countries [44-46].

In other countries, studies have already adopted multiperspective and interdisciplinary approaches to gain a comprehensive understanding of national practices and their impact on all involved stakeholders [18,43]. In Austria, research on assisted suicide has largely been limited to specific stakeholder groups [47-50], leaving a gap in understanding the interconnected nature of these groups’ various experiences. Our study is the first holistic approach evaluating the Austrian legal framework.

We anticipate that the framework’s lack of guidance regarding the final steps—where health care providers are neither required nor formally instructed to accompany individuals—creates practical uncertainties across multiple stakeholder groups. This may shape the experiences of individuals seeking assisted dying, their relatives, and health care professionals by influencing access, redistributing responsibilities, and creating uncertainty regarding professional roles. Health care institutions, including hospitals and nursing homes, may also encounter procedural ambiguities due to the informal handling of assisted suicide.

Additional anticipated findings include physicians’ reasoning regarding participation in the assessment process and eligibility determination, the (emotional) impact of assisted dying on relatives, and practical or financial barriers influencing equitable access to assisted suicide.

The study sets out to provide a robust and practical study design capable of providing a thorough evaluation of the newly enacted law on assisted suicide from a multiperspective standpoint. Its large-scale approach is enabled by an interdisciplinary research team and a clear emphasis on including all stakeholder groups affected by the legal framework. This inclusive perspective—combined with a mixed methods approach suitable for collecting both qualitative and quantitative data—positions the study as the most extensive research design on this topic in Austria. As such, it is able to make a significant contribution to the research in this highly relevant field.

We are aware that our evaluation will face several challenges that may turn into limitations of our study. First, the recent enactment of the law may lead to a lack of routine in its practical implementation, which could cause the relevance of some identified issues to shift over time. Second, given the highly sensitive and personal nature of assisted dying, recruiting study participants—particularly individuals seeking assisted suicide and their family members—may prove challenging. Third, we need to take care of avoiding response bias. Study participants may be hesitant to fully disclose their experiences or opinions due to fear of judgment or perceived legal and professional repercussions. We aim to mitigate this by using state-of-the-art interviewing techniques and ensuring strict confidentiality throughout the research process.

The results of this study will be disseminated to a broad audience through a variety of publications and international and national conferences. To maximize accessibility and facilitate unrestricted knowledge exchange, the results will be submitted to journals that support open-access publication. Additionally, the study has been preregistered through the OSF repository [35]. For the general public, the findings will be presented in plain, accessible language on the designated website. Finally, study results will be presented at roundtable discussions and expert panels organized by the Department of Ethics and Law in Medicine to ensure public engagement and knowledge exchange until the final research findings can be presented at the institute’s closing conference.