Examination of Witnesses (Questions 2300
- 2319)
THURSDAY 3 FEBRUARY 2005
Dr Andreas Brunner and Mr Beat Sommerhalder
Q2300 Baroness Finlay of Llandaff:
So they are always in the context of somebody being ill and having
their death brought forward as a suicide?
Dr Brunner: Yes,
but we have to make a difference, perhaps not so clearly. For
criminal law it is no problem but for the doctor it is a problem
to make the prescription if the person is not really very ill.
That is the second control.
Q2301 Baroness Finlay of Llandaff:
How long is the prescription valid for if a doctor writes a prescription?
Dr Brunner: Now
it is for ever, or you take—I am not so sure but I think
the validation of prescriptions is one year, but if you take the
barbiturate and you take it at home you can have it for a long
time. I think there we have to look also that there is control
and that is why we do it.
Q2302 Baroness Finlay of Llandaff:
That was my next question, whether you have control of barbiturate
prescriptions.
Dr Brunner: Not
any more, nothing.
Q2303 Baroness Finlay of Llandaff:
So they would be like antibiotic prescriptions?
Dr Brunner: Yes.
Q2304 Baroness Finlay of Llandaff:
You did say during your presentation that there were problems
with reporting after the event and you outlined some. In your
proposals have you thought of putting in a system of pre-event
reporting so that at the time the request is made there would
be some reporting so you could monitor the whole process?
Dr Brunner: No,
and we are clearly against this way to get it. I will tell you
why. You will never find out if you put the state before that
point. You will have too many questions which are open, too many
meanings which are open. That is not good if you take the state
before the organisation. I will take an example I know quite well.
In the little infant hospital they have the neonatal cases and
they made in the big hospital in Zurich an arrangement so
that it is quite difficult to make the decision to turn off the
things in the really big cases.
Q2305 Baroness Finlay of Llandaff:
Switching off the ventilator?
Dr Brunner: Yes,
and in the hospital they talked together, the chief, everyone,
that is five persons, had to say yes, including the parents. If
one person does not, they do not do it. I think that is a way
but if you take the state to this you will never find a solution
for that.
Q2306 Lord Joffe: I was very interested
in your proposals in the legislation that you thought you might
like to bring in. I would like to touch on a couple of the points
you made. You talked about a maximum of four or five. Was it per
organisation or per doctor?
Dr Brunner: Per
person, not to assist more than about five assisted suicides per
year.
Q2307 Lord Joffe: So it was not an
organisation?
Dr Brunner: No,
it was not an organisation.
Q2308 Chairman: One person?
Dr Brunner: One
person.
Q2309 Chairman: To guard against
the idea of a person having a mission to kill people?
Dr Brunner: That
is it.
Q2310 Lord Joffe: I think you distinguished
between two groups of people who are interested, at the one end,
in getting assistance to die where they are in the process of
dying, and the other was long term. I think you said something
about more or less two weeks would cover the first case but it
seems very low to me.
Dr Brunner: No.
If I said that, it is only for an example. A couple of weeks I
say. I want to make the difference. A couple of weeks, also one
or two months. It is quite difficult to make here a clear measure
but I want to have the distinction between those ways when the
natural death is really very near and those when we do not speak
for a couple of months or years. I say one or two weeks. It can
be a little bit more and the other is months and years.
Q2311 Lord Joffe: I see. You mentioned
about the ethical code and about it being against the doctor's
code of ethics. That does not refer to assisted dying in the case
of terminally ill patients?
Dr Brunner: Yes,
it can also have that because most of the doctors also in our
country go with the patients still to the end and there is no
abbreviation of the end.
Q2312 Lord Joffe: Perhaps I am misunderstanding
something. In the new guidelines which the Swiss Academy of Medical
Sciences have produced it refers to terminally ill patients and
that if a doctor's conscience influences him to make a decision
to assist a patient to die that is appropriate.
Dr Brunner: Yes,
but they do not make the division that I make between those two
groups of cases.
Q2313 Lord Joffe: So you are referring
to the second group?
Dr Brunner: I am
referring to the first group also and then to the second group.
Q2314 Lord Joffe: Oh, I see. Again,
perhaps I am not making myself clear. Bearing in mind that the
Swiss Academy of Medical Sciences make this recommendation that
a doctor who feels from a conscience point of view that it is
correct to assist a patient to die, they specifically cover that
in their recommendations, that seems to me to be in accordance
with the code.
Dr Brunner: Now
I understand what you mean. That is okay but it is very low and
I know many doctors will say, "That is not for me".
Before it was not ethical at any point and now only in the terminal
illness they say in the ethic rules it could be in certain circumstances
and I think that is quite a big path for the doctors.
Q2315 Lord Joffe: Finally, you have
read the Bill that we have prepared. It only relates to terminally
patients and I wondered if that Bill with safeguards included
in it covered the concerns that you have expressed and you want
to incorporate in any future legislation.
Dr Brunner: Perhaps
it would be good to make the difference between these two groups
as I told you before. Then you have to make the decision: do you
take only the first group to make your regulation or do you take
also the second group which can also be very helpful, I think?
The big problem is that your way is not going on the way of organisations,
more on the medical way. I also mentioned that it would be quite
difficult. I do not know the problem in Britain but you have to
speak with a lot of doctors. If you find also good doctors to
do this work there will be in Great Britain, I think, a big change
and it could be quite difficult. That is my opinion. It is very
clear. I can speak afterwards on two or three points if you want
because our time is now running out. We can discuss it further
over lunch.
Q2316 Earl of Arran: Can I just ask
very quickly, how long might it be before your regulations become
law?
Dr Brunner: That
depends. Now in the Confederation Mr Stadelmann told them that
they have made a report on that and they will speak with the Minister
of Justice and then he will decide if he wants to make a bill
for the country for that.
Baroness Jay of Paddington:
That is about two years.
Q2317 Earl of Arran: It is quite
a long time.
Dr Brunner: You
wait two years but the decision is now made in the next two months
and if they do not say, "We made it now quickly", we
will start in the canton of Zurich.
Q2318 Earl of Arran: Does it have
to be approved by others before it can become effective? Does
it have to meet with anyone else's approval or voting or a referendum?
Dr Brunner: That
is possible, yes. The way it goes now is from the cantonal government
to the cantonal parliament and if it is approved at the cantonal
parliament then it is okay, but it is possible that there will
be a referendum. We have a lot of referenda. We are voting people.
Q2319 Chairman: There is a good turnout
as well. I just want to make clear the passage in the medical
ethical guidelines of the Academy. It says in 4.1 under the heading
of "Assisted suicide", "In this borderline situation
a very difficult conflict of interest can arise for the doctor.
On the one hand assisted suicide is not part of a doctor's task,
because this contradicts the aims of medicine. On the other hand,
consideration of the patient's wishes is fundamental for the doctor-patient
relationship". Then it provides for a conscientious decision
on the part of the doctor which must be respected. I think that
is really what you were referring to, that on the one hand it
is not part of a doctor's task but on the other hand a doctor
may do it whereas in fact I think I picked you up as saying that
generally speaking in this country, at least in this canton, and
probably also in Aargau as well, it is more through the organisations
rather than through individual doctors that this assisted suicide
occurs.
Dr Brunner: Yes.
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