Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Examination of Witnesses (Questions 2160 - 2177)



  Q2160  Chairman: So far as duties of care and so on are concerned, they are not criminal law duties generally speaking. You may have criminal law duties in relation to health and safety at work and that kind of thing. I am not sure whether you have that, but there will be a civil law as well with duties of care. Am I right so far, that there are civil duties of care such as you mentioned the doctor has?

Mr Stadelmann: Yes.

  Q2161  Chairman: In relation to that type of law, for example, if you have someone in prison, is there any duty of care in the Swiss civil law to impose on the person in charge of the prison a duty of care to prevent someone who may be liable because of their imprisonment to contemplate suicide, in other words to protect them against carrying it out? Do you follow me?

Mr Stadelmann: Yes. In the civil law you can, in order to protect a person from herself, put this person in detention. If this person is in prison or in hospital or at liberty, but you or a physician are aware of this risk, in order to protect her from herself, this person can be put in protective care in a hospital or in a medical institution.

  Q2162  Chairman: You explained to me that the criminal law is now federal.

Mr Stadelmann: Yes.

  Q2163  Chairman: Is the civil law of that kind also federal?

Mr Stadelmann: Yes.

  Q2164  Chairman: So it is the same in all the cantons, but again different administrations may exist for the different cantonal authorities?

Mr Frank: Yes.

  Q2165  Baroness Hayman: You said earlier that the health departments of the cantons had no responsibilities for information gathering around the activities of EXIT, that the only reporting responsibilities were to the criminal justice organisations. Have the health departments decided to undertake any investigations in research into the sorts of people who are coming forward and asking for help with assisted suicide? Has there been anything done by an independent government body to look at those things? The other thing I want to ask is that we have talked very much as if the assisted suicide provisions or non-provisions were only used by organisations. Switzerland has many rural areas where presumably access to an organisation is not easy and I wondered whether this was a specialist facility or whether individual GPs were acting in accordance with the Penal Code and assisting where they had no self-serving ends and whether anything had been written about that?

Mr Stadelmann: To answer your first question, the cantonal health authorities have responsibilities. They have the responsibility also to gather information. They do not have a responsibility vis-a-vis of the federal government. They do not have to necessarily gather information at the federal level, but at their field of responsibility in the cantons they have responsibility for investigation, for gathering information about the practice in relation to the sort of people who are coming from other countries.

  Q2166  Baroness Hayman: Do they publish that?

Mr Stadelmann: I do not know if they publish this. This is another problem, publication of information, but they are concerned by this problem. They are concerned by the control of medical activity, physicians are controlled, the pharmacies are controlled, the prescription of lethal substances is controlled at cantonal level. When DIGNITAS opened a new apartment, a new clinic, as you may want to call it that, in another canton, Aargau, which is not far from Zurich, the authorities immediately acted and were concerned about this problem. They were looking at the activity of these physicians who were giving prescriptions for lethal substances and so forth. It is the responsibility of each local government. This is the first question. We have difficulties with the intervention from federal government in these matters which are in the competence of the local government. Your second question concerned the individual doctors rather than the organisations. As we said before, individual doctors are concerned about the criminal law as everybody else is. They also have to report every case of assisted suicide. The guidelines of the Swiss Academy of Medical Sciences establishes the same responsibilities. They have to report in a very precise way. They have to document the whole procedure.

  Q2167  Baroness Hayman: If one wanted to find the figures how would one do that?

Mr Stadelmann: The figures exist, certainly. We had some reports in the press where doctors reported their activity, their involvement with terminally ill people, and the possibilities they have to deal with that. They say, "One of the possibilities, active euthanasia, I cannot give to this person, but I can say to that person, `You may commit suicide if you want'", and a doctor has also the possibility to prescribe the substance, if he is not in violation of any legal provisions concerning the activity of medical persons, hospitals and physicians.

Baroness Hayman: And presumably we would need to go to the health department of the relevant canton to see whether their reports—-

Baroness Jay of Paddington: Every canton.

  Q2168  Baroness Finlay of Llandaff: How is that recorded on the death certificate and is there a standard system of recording across Switzerland or does each canton keep its own register and record with different categories determined by the canton?

Mr Stadelmann: I do not know. It should be cantonal, but I do not know if the death record specifies the kind of death. The civil record does not.

  Q2169  Baroness Finlay of Llandaff: It does not record the cause of death?

Mr Stadelmann: If you mean the civil record, that is federal.

  Q2170  Baroness Finlay of Llandaff: They certify that the person is dead but they do not certify the cause of death?

Mr Stadelmann: No, but if you mean the criminal records or the health authority records, the hospitals, clinics and physicians, there you will certainly find those specifications, but that is again cantonal.

  Q2171  Baroness Finlay of Llandaff: In the UK we record that somebody is dead and then we write what we believe to be the cause of death, the primary cause and possibly the secondary causes of death, contributory factors, and that data is all collected centrally.

Mr Stadelmann: In the civil record, or is it health?

Baroness Finlay of Llandaff: The health department.

Baroness Jay of Paddington: It is because of the National Health Service legislation though, is it not? It has nothing to do with the criminal law.

Baroness Finlay of Llandaff: No, but it is interesting.

Chairman: Death recording in the United Kingdom is part of the registration system. You have to register a death as part of the system which has existed for a long time, long before there was a health service. The cause has to be on the death certificate.

Baroness Jay of Paddington: But the collation centrally is a Department of Health thing, is it not?

Baroness Finlay of Llandaff: It is the ONS, the Office of National Statistics.

Baroness Hayman: Every country, in order to be able to have WHO information, has its centralised figures. We will know how many cancer deaths there are. You will know how many cancer deaths there are in Switzerland somehow and that will have to be on the same basis of the cantons.

  Q2172  Chairman: There is a record of the total number of deaths in Switzerland per annum. It is held by somebody. In Switzerland there will be a record of each death in a certificate that is held centrally.

Ms Favre: Yes.

  Q2173  Chairman: And somebody will be able to tell how many deaths there have been in Switzerland in a particular year.

Ms Favre: Yes.

  Q2174  Chairman: Is that in the federal government?

Ms Favre: Yes.

Mr Stadelmann: There is a Federal Office of Statistics which will collect information from federal authorities as well as from cantonal authorities. In some matters you have information from both and in other cases you have information only from cantonal authorities. That information is collected and published by the Federal Office of Statistics.

  Q2175  Chairman: And that will distinguish between deaths from natural causes and all other deaths?

Mr Stadelmann: Exactly.

  Q2176  Chairman: So we could get that if we wanted to?

Mr Stadelmann: Yes.

  Q2177  Baroness Finlay of Llandaff: The difficulty is, who decides that it is a suicide? Is it the doctor who decides it is a suicide and writes down "suicide" or is it that the doctor says, "This was not natural causes" and it therefore goes to a legal authority which then will hear all the evidence and decide whether it was a suicide or an accidental death or, we have a term, "death by misadventure"?

Mr Stadelmann: This would be a question maybe for the prosecutor who knows exactly how the procedure is going. The doctor certainly fills in a form and declares what he has established and, if there is a different finding afterwards because the criminal prosecution comes to another conclusion, it might be corrected. We have had these nine condemnations in 40 years and that means that mostly the declaration of the doctor will be right.

Chairman: I think we have used our opportunity very fully to ask questions and be helped by you. I would like very much on behalf of the committee to thank all three of you for your help to us. As I say, you will see the transcript in due course and be able to review it and see that it accurately records what you thought you had said. Thank you very much.

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