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

Examination of Witnesses (Questions 2250 - 2259)


Dr Andreas Brunner and Mr Beat Sommerhalder

  Q2250  Chairman: Thank you very much indeed for having us here and being willing to give us some time to help us in our inquiry into Lord Joffe's Bill which seeks to change the law of England and Wales in relation to end of life and assisted dying. We know that you have considerable experience in this area in Zu­rich and perhaps also more generally and we thought it would be very helpful to have your experience as part of the evidence that we collect. The shorthand writer will take a note of the evidence. We will submit the transcript to you for review before it is published and then it will be appended to our report and become general public property when the report is published. If it is convenient for you what I thought might be good would be for you to give us a shortish introduction on your view on the matters relating to your experience of the area we are concerned with and then my colleagues might wish to ask questions of particular concern to them.

  Dr Brunner: My Ladies, my Lords, welcome to Zu­rich. After the Second World War Sir Winston Churchill was here in Zu­rich and had his famous speech with the even more famous sentence, "Let Europe arise". Perhaps this meeting serves also on another subject to make Europe arise once more because in this case of assisted suicide we would be grateful to have not just our regulation but also some regulation in other countries on this subject. With me today is the Prosecutor from the canton of Aargau, Mr Sommerhalder. Aargau is between Berne and Zu­rich. You have travelled through the canton of Aargau to get here and Mr Sommerhalder is here because the organisation DIGNITAS, which you will visit this afternoon, rented a house in Aargau to make assisted suicide available there also, I think because they had too many problems with us. They are now staying there and I am quite glad of this because you were also at the Government yesterday and you saw Mr Stadelmann. They thought at the Government that assisted suicide questions were more or less the problem of the canton of Zu­rich which has 1.2 million inhabitants rather than the problem of the whole country. Now it has gone also to the canton of Aargau it has moved up a little bit in importance to them. I am sorry I have invited you to this room because we are reconstructing this 18th century building and the other rooms are not perfect at the moment. My English is not very good. Our interpreter is here if necessary and we have to be very clear about what we mean on each word because the terms are quite difficult and there could be some misunderstandings which I hope will not occur. If I say something impolite to you it is not impoliteness, just that I cannot do it better. I read Lord Joffe's very interesting proposal for the Bill and also the statements of Baroness Finlay, which make another point, and those of the church. In our country it is mostly the Roman Catholic Church which is totally against assisted suicide. I think a lot of the proposals in Lord Joffe's Bill would be very important if they were regulated in Switzerland also. If it is convenient to you I thought we would stay about an hour here and then I shall invite you to have a business lunch in the house across the road, which is also a little bit related to our subject in a historical grove, where we can speak together informally further on the subject.

  Q2251  Chairman: That sounds very convenient.

Dr Brunner: I will start by giving you the development of the Swiss law but I do not wish to go over the same things you heard yesterday from Mr Stadelmann.

  Q2252  Chairman: You can take your own line. You will have a way of putting it which will be your own and I am sure we will listen with great interest.

Dr Brunner: In Switzerland we have had a very liberal law since we made our penal law in 1934. Under our Penal Code we have two Articles concerning this subject. One is "homicide on request" and that says that anyone killing a human being at his serious and urgent request shall be sentenced with imprisonment for up to three years. That is important in connection with suicide. When you are at the limit from suicide it might make the difference to have assist in suicide, that is to say that the man is doing the killing, which was asked also in the case of Diane Pretty which everybody knows about. The next one is assisted suicide, Article 115 of our penal law, that is, that anyone, who for a selfish motive shall help someone to commit suicide, shall be sentenced in a penitentiary for up to five years if the suicide has been completed or attempted. Those is the only law prescriptions we have; we have no other prescriptions on suicide in any other law. When the law was made in Switzerland we did not have any suicide organisations. The meaning of assisted suicide was, for example, as a last duty of friendship to help a person to die. In the late 1980s there was the first suicide organisation was established here in Switzerland. That was EXIT, and initially they had a couple of assisted suicides. Now we have five or six organisations and some splinter organisations also. They are people who worked in an organisation but who had perhaps some problem with the organisation and have now set up their own little organisation. Until the year 2000 there were no big problems with that. In the early 1980s we made some processes and we described that as murder and that was not at all, and then that was quiet on the whole problem. Then in about 2000 suicides of people from England started. We had out of the whole of Switzerland in the canton of Zu­rich 26 Swiss people. I can give you those afterwards. DIGNITAS started then with German people. I do not want to go through all the years but the highest figure was in 2003 when EXIT was about the same and DIGNITAS now had a lot of people, 93, only two from Switzerland, the most from foreign countries such as Great Britain. Our police do not make a difference between England and Great Britain; I am sorry.

  Q2253  Chairman: You are not unique in that particular respect!

Dr Brunner: Last year the numbers were a little bit deeper because we have now the canton of Aargau where they are also going, and in Aargau last year there were about 20 assisted suicides. Of British people we have seven. In EXIT most of the assisted suicides are for Swiss people. That is very important. They have from time to time one from Germany, for example, but this person had acquired in his life a close relationship to Switzerland or has his children here or something like that. DIGNITAS went up from five (in 1999 there were zero) to 93, so we have in total about 100 in Switzerland. This year has started with a lot of assisted suicides. The normal way of proceeding in assisted suicides in our country is that the person who wants to have suicide will be a member of one of these organisations. In the past it was important that the organisations only gave help to dying persons. I make a difference between helping a person to die and helping a person to suicide. Helping to die refers to people who are incurably ill and very near the end of life. That process would start quickly. Helping to suicide refers to all other persons. That means the killing or homicide or help to suicide of a person in whom this state of being near to death is not yet reached. That means that with treatment their lives can go on for months or even years, perhaps even more than ten years. The third section in this category is the killing of people who are old, who are afraid to be mentally ill or who have the first beginnings of mental illness; they would receive help from the organisation. That is all allowed in Switzerland. It is not necessary that it is the first category, that is, the helping to die. It is also free for persons who live longer but the doctor has got to have a reason for that because people in our country are taking a barbiturate and then they have to go a doctor who gives a prescription. Also, concerning Lord Joffe's Bill, it is important to see that you have very few doctors who want to give those prescriptions. Normally they are doctors who have ended their professional career who are doing that. For young doctors it is quite difficult because the understanding for doctors is to help people to stay alive. That is quite a big problem and every organisation has a couple of these doctors. You see one or two today, to help them, a doctor of confidence of the organisation. That is quite difficult. For me the doctor should be quite neutral. There have to be two doctors, not just the doctor of the organisation. They speak with this doctor. Then they get the prescription. Afterwards they are going to homes for elderly people in Zu­rich. That is allowed; it is two years ago but there were only six persons. There was no problem. Or mostly they are foreigners in one of the apartments of the organisation. You will hear about the process this afternoon, that they are coming in, they are speaking once more and then after a couple of times they are drinking that barbiturate and finally, when they are dead, the people have to inform the police because it is not a normal death. We have that as a control and the police come with the forensic physician and the public prosecutor. That is not a normal penal procedure. We are coming only afterwards and that makes quite a lot of problems. They show us a couple of documents, like the suicide declaration, the medical diagnosis and all that. We want also now to have from the medical that they have capacity of judgement. That is very important. They make also a processing record of that. Now perhaps what we have most problems with are the people who are paralysed who have to have some infusion or stomach catheter. That is concerning the Article on homicide on request because it is very important in our country that the human being committing suicide is doing the last act himself or herself. Normally they drink the cup or with the infusion and they have to be capable of turning around here and doing a little bit of other things, which is quite difficult because they are really ill people sometimes. Another really difficult case is mentally ill persons, normally mentally ill or more than starting with Alzheimer's disease. There are three positions of Alzheimer's disease. Now we are making a process for when Alzheimer's disease is too advanced so that the person is no longer conscious of what he is doing. That is quite a difficult section. On the other side we have to see also that there can be mentally diseased persons who can be from time to time for a period in a good condition, and then we say lastly that it can be possible that this person can be assisted to suicide. Another problem is double suicides. We get from time to time double suicides, say, a couple who have lived 50 years together or a sister and brother. Here you have big problems because if I am in a couple or in a relationship and I ask him, "Shall we go to the cinema today?", and he says, "Oh, no, I prefer to go to the opera", and I say, "Come on, let us go to the cinema", it is a discussion and one person has more influence than the other. I was once in my profession doing a little bit of politics also and we had a letter from a couple who announced that they were going to have assisted death a few days later. When they wrote that I thought, "I have to visit them". I visited them. It was a couple in their eighties. He had cancer of the prostate and I saw that the lady had spent 50 years doing what her husband wanted. When her husband said, "Come on, darling, let's go", she said, "Yes". I tried to tell her that I knew a couple of widows who were quite happy afterwards. There is a restart of life for someone like that. I only want to show that the double suicides are a big problem. Then we have problems with foreigners. The normal way is that they come from other countries. They have some written contact with the organisations and they arrive one day by plane or by car or train in Zu­rich or Aargau and the same day or the day afterwards they are committing suicide with assistance. For me it seems they had pressure first from the journey to come here, and also they came on several occasions with television teams or writers or whatever, but also, if they come alone when they are in this room they feel a pressure to go. That is quite a problem. For me that means that the explicit wish to die has to continue over some time. If I may make this remark, those 14 days you have in your proposal, Lord Joffe, is a very short time and it would be good to think that over once more perhaps, because it is very important to say that apart from mental problems people have dips in their lives. One day you want your life, the next day not. My mother is 85. She is in good condition but there are periods when she says, "I want to die. My husband is dead. I do not have anything to do". Two days afterwards she has a great concert and she is happy". In old people it is like that. You have got phases. You are in a dip, you are low, and then you go up and life is beautiful. We have that also and it is very important that we do not get persons to suicide who are in a phase like that in my opinion. Perhaps now you can ask some questions and then I will show you what I think we have to do as law in the canton of Zu­rich because I have prepared the law a little bit to have some regulations and if Switzerland does not do this we will prepare in the canton of Zu­rich such a law, we will make such a law to put some pressure on the country. It is stupid when we make a law. We need to make a law in all Switzerland but to put some political pressure on we will make a law.

  Q2254  Chairman: That is quite an interesting and important point to explore. I think I am right in saying that the criminal law is now federal Swiss law?

Dr Brunner: Yes.

  Q2255  Chairman: And the Articles you referred to are from the Swiss Penal Code which rules in Aargau and in Zu­rich and everywhere else?

Dr Brunner: Yes.

  Q2256  Chairman: What I am not clear about from what you have just been saying is this. You can have pressure from Zu­rich or from Aargau or from other cantons on the Federation to change the criminal law for the Federation but if you cannot persuade the Federation to act are you still able in the canton of Zu­rich itself to promote a criminal law which will govern what takes place in Zu­rich?

Dr Brunner: Yes. I understand your question quite well. I do not want to change the criminal law. We cannot do that. The criminal law has to be changed by the Confederation but we can have a law of authorisation and monitoring of those organisations. That is not criminal law.

  Q2257  Chairman: That is administrative law, would you say?

Dr Brunner: Yes.

  Q2258  Chairman: You can make administrative law arrangements and there are administrative law tribunals, are there not, in Switzerland distinct from the criminal court?

Dr Brunner: That is right.

  Q2259  Chairman: And these tribunals could, for example, administer a registration or regulation system for a given organisation like EXIT or DIGNITAS?

Dr Brunner: Yes. Every canton could do that also.

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