By Derek Humphry
Known historically for its independence and individualism, Switzerland is now setting the pace for the practice of assisted suicide on a wider scale even than the Netherlands.
Today there are no less than four ‘right-to-die’ organizations in a country with a population of seven million. Two of them offer help with hastened death to both terminally ill and chronically ill, be they resident or foreigner. One group will even visit a dying patient in another country if there is no alternative.
Switzerland has not had a law forbidding assisted suicide since the criminal code was revised in 1937. The relevant law para.155 -- is interpreted to mean that anybody - doctor, nurse, family or friend - can assist a suicide of a physically sick person provided it is done for altruistic reasons. If assistance is given out of evil motives, or financial gain, then it is a crime -- but there are no known cases of prosecution. The law says nothing about visitors.
Estimates in recent years have put the amount of hastened deaths at between one and 200 a year. No official statistics kept because it is not an offense.
But such is the growing worldwide interest in assisted suicide that what was ten years ago a quiet, compassionate, national practice in Switzerland has recently spilled over into an international context. Because most nations (except the Netherlands and one American state, Oregon) will not legalize assisted suicide, desperate persons who believe in the freedom to die at a time of their choosing are looking to Switzerland.
(Clarification of terms: assisted suicide is not euthanasia. Assisted suicide means helping the patient find the lethal drugs, giving advice and moral support, but leaving the patient to decide whether to ingest the potion. Some call it ‘assisted suicide up to the final, self-release stage.’ Euthanasia is a doctor giving a lethal injection by request. Only the Netherlands permits both procedures, under strict guidelines.)
Neither the Netherlands nor Oregon will accept non-residents for help in dying -- the Dutch require that the physician has known the patient for several years, while Oregon law has a ‘residents only’ provision.
The more flexible law in Switzerland, together with four proactive organizations, means that interest has mounted from persons with intolerable physical health problems in surrounding countries which will not change their prohibition. Austria, Germany, France and Spain are affected.
My inquiries into the situation indicate this position currently:
EXIT - German speaking. With 50,000 members, this powerful Zurich group is the most active in helping Swiss citizens to die in appropriate cases. It does not help foreigners. The pentobarbital is obtained from the patient’s doctor, but the EXIT helper usually makes all the arrangements, even to handing over the lethal cocktail, but leaving just before death. EXIT always informs the local police of what happened, they check it out, and the death is officially recorded as suicide.
This organization gets just over 300 calls a year from people wanting help to die, with 120 actually getting assistance in an average year. Swiss professional medical groups as a policy discourage doctors engaging in assisted suicide, but some do when circumstances justify it, particularly when an intravenous injection is required.
Persons with mental health problems are not helped. Any doctor who writes a lethal prescription – almost always ten grams of pentobarbital -- for no acceptable reason is unlikely to be prosecuted but will lose his or her medical license.
EXIT-International is a breakaway from the Zurich organization. It is a small but wide-ranging group run by an elderly doctor of philosophy, the Rev. Rolf Sigg. Small though it is, the group is apparently well funded and willing to travel throughout Europe to help people die, though for the time being only German-speaking persons are assisted because of language problems. He claims to have helped in his lifetime more than 300 people die so far -- double Dr. Jack Kevorkian's total. (Kevorkian is serving life imprisonment for murder in what was, ethically, a justified voluntary euthanasia.)
Dr. Sigg has been particularly active in Germany where the strange situation exists that while assisted suicide has not been a crime for hundreds of years, hardly any doctors will practice it because of the depth of shame in the country over the Nazi so-called Euthanasia T-4 program’ during World War Two. Almost 100,000 Germans who were physically or mentally handicapped were systematically murdered in a frenzy of Aryan race-cleansing.
Law enforcement authorities in Germany have several times pressed charges against Dr. Sigg for bringing pentobarbital into the country, secured convictions, but on appeal they were dismissed. Appeal judges warned him not to continue importing narcotics but at the same time praised his humanitarianism. The appeal court also re-affirmed that assisted suicide is not a crime in Germany.
Lacking narcotics, Dr. Sigg nowadays mostly uses the plastic bag technique if he cannot persuade the patient’s own doctor to prescribe barbiturates. He is opposed to doctors carrying out any form of euthanasia, believing that the task is more suited to specially trained operatives.
DIGNITAS was formed three years ago with a motto of "To Live With Dignity - To Die With Dignity." It is headed by attorney Ludwig A. Minelli in Forch, Switzerland, and has helped about 30 people to die so far. It has a cautious and law-abiding approach.
Minelli says in an email to me: "DIGNITAS does help also foreigners [who come to this country]. They must first be members for an annual fee of 25 Swiss francs. No other fees are charged. The member must themselves get a prescription from a Swiss physician for the lethal dose of pentobarbital after examination of physical symptoms and case documentation. The case must fit Swiss law."
DIGNITAS issues its brochures in German, French, Italian, and soon English.
In a nation where at least three separate languages are spoken, the most reserved about assisted dying are the French-speakers. (But all groups like the name Exit’ causing no small confusion to outsiders.) The small but persistent group EXIT A.D.M.D. Suisse romande, based in Geneva, distributes advice but does not actively help people to die.
The fact that EXIT-International travels around Germany helping people to die, and that DIGNITAS will accept foreigners who qualify, has given the 21-year-old Augburg-based group, Deutsche Gesellschaft fur Humanes Sterben (DGHS), a great deal to think about. Some of its members are pressing for it to be more supportive of dying members, such as Caring Friends does for Hemlock members in the USA.
Dr. Kurt Schobert, the group’s secretary, told my by letter: "There is massive frustration in our society and the Western world who want law-reform but they do not get it."
Schobert feels that, while there is no direct prohibition ofassisted suicide, parts of the German penal code (323c) could be used to prosecute people because they failed to help the person live. There have been prosecutions in Germany of people who failed to call an ambulance speedily enough to resussicate a victim who had expressed a wish not to live anyway.
Says Schobert: "The best we can do is to collect and distribute information about how we are able to help people within the law, and thus give people the power to do it themselves."
The fact that voluntary euthanasia and assisted suicide will become fully legal in the Netherlands in 2002 has sparked off virulent opposition from Roman Catholic, Orthodox and Protestant churches in Europe and Russia. These powerful churches are organizing to try to stop any similar legislation in their own countries.
According to polls, 75 percent of Germans support law reform on assisted suicide, while 60 percent say the church has no right to intervene in questions of dying.
Published: August 2, 2001
Derek Humphry, author of Final Exit’, is president of the Euthanasia Research & Guidance Organization (ERGO)
See Related Archive Document: The Practice of Assisted Suicide in Switzerland (1996-97) - A Report by Dr. Meinrad Schaer.