LAUSANNE, Switzerland - A ruling by Switzerland's highest court released Friday has opened up the possibility that people with serious mental illnesses could be helped by doctors to take their own lives.

Switzerland already allows physician-assisted suicide for terminally ill patients under certain circumstances. The Federal Tribunal's decision puts mental illnesses on the same level as physical ones.

"It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term," the ruling said.

"If the death wish is based on an autonomous decision which takes all circumstances into account, then a mentally ill person can be prescribed sodium-pentobarbital and thereby assisted in suicide," it added.

Various organizations exist in Switzerland to help people who want to commit suicide, and assisting someone to die is not punishable under Swiss law as long as there is no "selfish motivation" for doing so.

The judges made clear in their ruling that certain conditions would have to be met before a mentally ill person's request for suicide assistance could be considered justified.

"A distinction has to be made between a death wish which is an expression of a curable, psychiatric disorder and which requires treatment, and (a death wish) which is based on a person of sound judgment's own well-considered and permanent decision, which must be respected," they said.

Case brought by bipolar patient
The case was brought by a 53-year old man with serious bipolar affective disorder who asked the tribunal to allow him to acquire a lethal dose of pentobarbital without a doctor's prescription.

The tribunal ruled against his request, confirming the need for a thorough medical assessment of the patient's condition.

Whether any Swiss physician would be prepared to prescribe a lethal dose of pentobarbital to a mentally ill person remains unclear.

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and a columnist for MSNBC.com, warns, " If this policy were to be put into place in Switzerland or elsewhere it would put physicians in the position of trying to distinguish 'competent' requests from persons with mental illness from 'incompetent' or 'temporarily desperate' persons with mental illness - something psychiatry and psychology are not always adept at doing."

Switzerland's national ethics commission could not be reached for comment late on Friday.

Opening door to suffering
"The ruling opens the door to anyone who says they have unbearable psychological or emotional suffering to request help in dying - people with terrible burns, those who are terribly disfigured, those who are emotionally bereft at the loss of a child or partner or loved and even those suffering from career setbacks and failures," Caplan said.

Switzerland is one of a number of countries in Europe that allow assistance to terminally ill people who wish to die.

Netherlands legalized euthanasia in 2001 and Belgium in 2002, while Britain and France allow terminally ill people to refuse treatment in favor of death.

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