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


Examination of Witnesses (Questions 2280 - 2299)

THURSDAY 3 FEBRUARY 2005

Dr Andreas Brunner and Mr Beat Sommerhalder

  Q2280  Baroness Hayman: In the last five years have there been no certifications for individual doctors outside those organisations?

Dr Brunner: I cannot tell you that. I do not know. I know that we have several persons who died with barbiturate on their own and in one case we could follow the way back to where the barbiturate came from and we found the doctor, an elderly doctor who is quite a difficult man. He comes from the canton of Aargau, but we made it that he cannot make any prescriptions now.

  Q2281  Baroness Hayman: So it was a disciplinary process, that he cannot give prescriptions now?

Dr Brunner: Yes.

  Q2282  Baroness Hayman: Has there been any research on complaints to the disciplinary body for doctors by families about this?

Dr Brunner: Yes.

  Q2283  Baroness Hayman: Because this is how you would expect unreported cases to come to light. If a family member was unhappy about something they would perhaps complain either to the police or to the medical authorities.

Dr Brunner: Yes, that is absolutely true. That makes another point which I want to tell you. We had also quite a lot of problems with family members. There are cases of persons wanting suicide. They speak together in the whole family. It is a family decision. You can also ask if there is some pressure or not. If your old auntie who has got millions is in a mood where she has to pay a lot—I do not know, but you have to mention that also. In most cases a family goes, "Okay", but there are also people who do not advise their families. We have had also British people who did not advise their family. For the family there is a big shock. That is quite a big problem also. How can the family be involved in a process like that or even not be involved, because if you take the family together you can say that is a pressure? I do not know.

  Q2284  Chairman: I am right in thinking that there will be cases—and you do not happen to have the numbers—where a doctor who agrees to give the prescription will report that in the ordinary way as an unnatural death. That would be, as far as one can understand, perfectly lawful and so there would be no complaint from that source in respect of any illegality but there might be other cases where a doctor who does that does not report and that would certainly be a cause for disciplinary action, I would think. Do we know whether there have been reports of that kind to the disciplinary authorities for doctors?

Dr Brunner: That we have also, yes.

  Q2285  Earl of Arran: When a person is very poor and wants to take advantage of assisted suicide does the gathering together of the money come from friends and family or is there any village funding or canton funding for doing this?

Dr Brunner: No, we have no canton funding, no village funding for that. Normally, if the person is living in Switzerland it is not expensive at all.

  Q2286  Earl of Arran: I meant a Swiss national.

Dr Brunner: Then it is not expensive at all. They take 50 or 60 francs, the organisation and the doctor, for the prescriptions. That is not a problem of money there. It could be a problem of money for the foreigners who are coming, if it is from Japan or something like that. If you come from Britain you can do it for a couple of hundred pounds, I think, not on the train but by aeroplane.

  Q2287  Chairman: I know—Ryanair.

Dr Brunner: That is not a problem.

Mr Sommerhalder: We heard that they paid the organisation here about £500 to £1,000 for the costs for documents here. Foreigners pay about £500 or £1,000 maybe.

  Q2288  Baroness Jay of Paddington: No, but the Swiss person does not?

Mr Sommerhalder: No.

  Q2289  Chairman: The Swiss person wanting to have this assistance would pay something less?

Mr Sommerhalder: Fifty francs maybe.

Dr Brunner: I did not hear this number. The organisations have to pay for the burial, the cremation, going back. We have also now a new problem. There was a man who came from Hong Kong last year and he died and he wanted to be buried in Zu­rich. We had to do that also according to our laws. Normally they go back to their own country but they had not got too much money to take him back but they rented here 25 years ago.

  Q2290  Earl of Arran: Does not either EXIT or DIGNITAS have to file annual audited accounts to some central authority? They are a limited company presumably, or a trading company.

Dr Brunner: As I have tried to say, there is no surveillance, they are associations without any state control. I think that should change.

  Q2291  Chairman: That would be a matter for legislation in the canton.

Dr Brunner: Yes, as well as in the country.

  Q2292  Chairman: And that would require the legislative will of the Parliament to be used for that purpose. Would it be possible as part of the administrative arrangement to require some time to elapse between the first request for suicide and it actually happening? Could that be done apart from the criminal law as a matter of regulation, do you think?

Dr Brunner: I will do that, yes. That is for me quite important, that you have the constant deep wish for suicide. That is the most important thing because there are also medical and scientific works from doctors which say that from 100 per cent of elderly ill persons who have a wish to die and explain this wish to die, two months or three months afterwards only 50 per cent stay at this wish. That is not important for the cases, just for the help to die which I said at the beginning makes a difference. There this can be quite short, I think. Perhaps you will speak with EXIT also on that. They say also that there are people who go from time to time really a long way in illness. They have tried everything. They also wanted to do everything, also the family did, and then comes the decision on the day and then they want to go really. The discussion was before but that is really for people only at the end of the final phase, two weeks or something like that.

Baroness Jay of Paddington: I think it would be very helpful when you come to describe in detail what your proposals are if you would be kind enough—I think I am probably being a little stupid about this—to say what it is that you can effect through regulation because you just replied to Lord Mackay that you could regulate on the time frame for decisions and yet you said to Lord Arran and to me that when there were other types of regulation, such as the audited accounts and my more general concern about a regulatory framework, this would all have to be a legislative decision.

Chairman: My concern as well. It would all be legislative.

  Q2293  Baroness Jay of Paddington: But when you said that you can do that yourself I thought—-

Dr Brunner: Not myself, no. Sorry.

  Q2294  Baroness Jay of Paddington: That means I have misunderstood.

Dr Brunner: I can in the canton and I can put that in our—-

  Q2295  Baroness Jay of Paddington: All right, but the audited regulation has to be federal, does it?

Dr Brunner: Yes. I can put it in a statement what should in my opinion be in such a regulation of the country. First, that is the obligatory authorisation and monitoring of the organisations which are working in the canton of Zu­rich. They have, as I said, to disclose each point of funds. Also we have here problems of barbiturate control and they have to show us which internal control of the association they are doing with their organisation structure. You will see EXIT this afternoon. They are quite a big organisation. They have their own ethic commission. They have their own control commission. They are really an organisation which tries also in an ethical way to make sure that everything is okay. On the other side DIGNITAS—do not tell him that I said that, although he knows that I am saying that—is a one-man show with a couple of pupils who are around him. That is quite difficult because then we have to look at different meanings, different points of view, internal controls. The second point is assistance to suicide. There has been a clear selection of that. I think it should be obligatory to go to a good institute for psychological tests on what you have so that you are clear that those people are really good people and not on the way to having a mission to kill people. They have to be regulated, with education and also further education on the supervision of this assistance to suicide. With EXIT it is very high, sure. It came clear, not more than five or ten cases a year. It is also for me important to have no business connections. What I said on selection, education, further education, supervision and treated cases has to go under assistance to suicide but also to the doctors who are in the organisations. They also have to make a full, conscious decision, not under their own proposal, to help people to die though their prescriptions. Then we have to put up some standards for the cases. In the section of help to die, the two-week cases, I say that you have the prescription not of the doctor of the organisation but of your own doctor or hospital doctor that this person is terminally ill and wants certainly to die. You have to have a medical certificate for your constant wish to die and on the capacity of understanding and how the barbiturate has been taken. These prescriptions cannot be older than one month. There are also prescriptions we have now which are two or three years old and people have not seen them any more; we have to regulate that. On the second point, help to suicide, you have to have really good medical witnesses over the illness and how it happened. Then I think we should put down also (and we will) that all other options, such as palliative medicine, this person did not want or had it or it did not help, and then you have to have two medical diagnoses to say that the wish is well considered and constant and long. That is very important and here we should discuss the political discussions. Those have to be normally between two and three or six months, so longer than 14 days, much longer. That is only for people who can live longer than a couple of weeks. We are here in the category of help to suicide. Then we have to make also clear standards for the mentally ill person, psychiatrically ill persons, if the organisations are allowed and under what conditions with an obligation to co-operate with the official persons because some of the organisations do not want to co-operate at all. That is not good. Then we have regulations on costs to pay because normally assisted suicide for the canton of Zu­rich costs altogether about 2,000-3,000 euros. That has also to have some sanctions for the doctors, for the organisations, for everyone. We will try but I do not think we will get that in these regulations, that is the point. I think when we have those rules at least there will be better control. That is all I tell you now. That is all we can do in the canton, this regulation, and at the same level not changing the criminal law, but it is not a good solution to have it in a canton. We have to do that all over the country.

  Q2296  Chairman: The Federation could do it?

Dr Brunner: Yes.

  Q2297  Chairman: But, failing the Federation, the cantons could do it?

Dr Brunner: There will be a little bit more pressure and they will do it. It takes two more years, I think. We have, for instance, federal regulations for marriage, making connections between people, standards also. We rule everything in our countries and one of the most important points, also with liberal law, is the final decision. We do not have any rules because we are discussing and discussing and we do not find any rules but we practise in the dark quite a lot. That we have to see also.

  Q2298  Bishop of St Albans: I want to move to a more general point. When I was a parish priest I had the sad duty to take numbers of funerals of people who had committed suicide, not assisted suicide, just suicide. The impact upon those families was, of course, in many cases absolutely dreadful. It left the family feeling broken and in a terrible state and that did not seem ever to go away. Is there any evidence in your canton of the long term impact of legally assisted suicide upon the family and upon the wider community?

Dr Brunner: There is not, as I told you before, but I think that you have to speak about that also with the organisations. For me that is not the point we follow. For me it is very important that it can be that a person says, "No, I do not want anything to be said to the family", for different reasons, but to say what you mentioned now, just in those words, also to this person who does not want to take the family in, I think is very important.

Mr Sommerhalder: In most cases the family is involved in assisted suicide. They build the will together.

Bishop of St Albans: I can only report a broadcast I heard on the BBC about two weeks ago about an American man who had been in a case of assisted suicide which he was absolutely fine about, he thought, and then just found it absolutely devastating and could not cope afterwards at all with the loss of his mother. That could be for all sorts of reasons and I do not want to do a straightforward cause and effect, but the impression gained from that programme, which was not about assisted suicide; it was a biographical programme about a writer, was that the impact on him had been absolutely terrible. I do not know whether there is any evidence and, as you say, it is outside your particular brief.

  Q2299  Baroness Finlay of Llandaff: I wonder if I could return for a moment to some aspects of regulation. Has this 115 part of your law been used for anything other than this assisted suicide with barbiturates? Is there another incidence of suicide where you invoke that part of your federal law?

Dr Brunner: Yes, it can. We have got some different cases also out of these organisations. I told you at the beginning but today most of them we have got on this case.


 
previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2005