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

Examination of Witnesses (Questions 2300 - 2319)


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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