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


Examination of Witnesses (Questions 2360 - 2379)

THURSDAY 3 FEBRUARY 2005

PROFESSOR WOLFGANG HOPFF, DR HANS-R NA­EGELI, MR LUDWIG MINELLI, MRS SORAYA WERNLI, MR SILVAN LULEY and DR PETER REINHARDT

  Q2360  Chairman: And you arrange the doctor for them? How many doctors have you got altogether collaborating with you at the moment, roughly?

  Mr Minelli: Six to eight.

  Q2361  Chairman: They are all in Zu­rich, I suppose, are they?

  Mr Minelli: Not all, no. We have some in Zu­rich, and we have some in the canton of Aargau and in the canton of Lucerne.

  Q2362  Chairman: Is it only in Zu­rich and Aargau that you give assistance?

  Mr Minelli: We have an apartment in Zu­rich. We have a little house in Aargau, and, of course, if we have Swiss members we go to their homes.

  Q2363  Chairman: And that could be anywhere in Switzerland?

  Mr Minelli: Of course.

  Q2364  Chairman: In that case are the doctors who assist you or collaborate with you all over the Federation as well? I had understood they were in Zu­rich but I may be wrong about that.

  Mr Minelli: Sometimes, if the member is able to travel, we ask the member to come to see the doctor but sometimes also I have travelled with the doctor to see a member at his home.

  Q2365  Chairman: The doctor presumably is also paid when he gives the prescription.

  Mr Minelli: We have doctors collaborating without payment. We have doctors who are paid. This is very individual.

  Q2366  Chairman: Are the accounts of your organisation published?

  Mr Minelli: We publish not accounts but information about the finances.

  Q2367  Chairman: That is a subtle difference.

  Mr Minelli: Yes. We publish balances or income and outgoings, but also a lot of information about what we have got as fees from our members and our expenses.

  Q2368  Chairman: Would it be possible for us to get a copy of just one of these? We do not need a whole lot of different years.

  Mr Minelli: This is the report of the year 2003, the latest report which has been printed.

  Chairman: That would be very good if we could have that as part of our record.

  Q2369  Baroness Finlay of Llandaff: Could I ask a little bit about the assessment process? You said that if you can get the medical records of people you will go through them and then a doctor will see the patient. Can you explain what that assessment process is and what the qualifications are of the doctor who is seeing the patient?

  Mr Minelli: Our members first send us a personal request and their medical documents. Then we send a copy of the request and a copy of the documents to one of our physicians and the physician studies this documentation and tells us on the basis of this documentation whether or not he will be able to write a prescription, and only when he gives the green light do we discuss with the member when to come. Then the doctor sees the member, has a discussion with the member and also with relatives, and then makes the definite decision. Every doctor collaborating with us is an experienced doctor, sometimes retired but in any case has broad experience and in most cases is also a specialist in one or other field.

  Q2370  Baroness Finlay of Llandaff: You said that you assess capacity for people's ability to make a decision and I wondered how you assess capacity.

  Mr Minelli: In order to see whether somebody has capacity of decision or not you need not be a doctor. You can ask a simple pattern of questions in order to know whether the person is orientated in time and in locality and whether they can express themselves so that you understand them. We have had recently a publication of the magazine of the Swiss doctors in which there was an article by doctors from the cantonal hospital of Lausanne discussing the capacity of decision of patients and there you may find a pattern of about nine questions which are very simple and which do not need any medical information. Also, the Swiss Academy of Medical Sciences in one of its last regulations says that capacity of decision may be certified by persons who are not doctors.

  Q2371  Baroness Finlay of Llandaff: Do you have any psychiatrists amongst the group of doctors that you refer to?

  Mr Minelli: Not until now but we are looking for some because until now we have been very reluctant to have mentally ill people because there is one procedure in court in the canton of Aargau where this question has been raised. We had last week a hearing at the court and we are expecting the court's decision within the next three or four months and if the decision is favourable then I think we will have more possibilities to help mentally ill people, but because of this case I am looking for a psychiatrist because always when we have mentally ill people we would like to have at least two doctors and at least one psychiatrist telling us that capacity of decision is not in doubt.

  Q2372  Baroness Finlay of Llandaff: I was wondering because there is a high incidence of depression in physical disease which often will respond to treatment but can be difficult to diagnose, and therefore it is not easy to diagnose depression in people who have advanced physical illness.

  Mr Minelli: We know that and if somebody is asking us to prepare an assisted suicide but there is no terminally ill situation we are very slow and we wait until the member calls us again. We never call the member, "Would you now make your decision?". We tell them we are looking to see whether we are able to find a physician. Sometimes the physician tells us the medical documents are not sufficient; we need more information, and sometimes when we have the impression that there is a depression which could be related to the illness we even phone the member and tell them, "You could try this, you could try that". We try always to help them towards life. Sometimes we see that by this method the intention to put an end to their lives goes away. I had a 77-year old man. He visited me about three years ago and he told me, "I have no illness at all but I think it is time to go. I would like to end my life. I have been separated from my wife, not in court but in reality, and I think it is time for me to go". Then I told him, "I do not think that I will find a Swiss physician to write a prescription for you in this situation because doctors have difficulty writing a prescription for a person who is not ill, but I suggest that you could write to the cantonal physician, the authority who controls the physicians, and ask him whether he would grant such a decision so that you can get pentobarbital". The cantonal physician answered immediately, "I will not give this permission and if you would like to have a decision in order to be attacked at court you must ask it specially and that will cause costs". Then he asked for this special decision and the cantonal physician did not reply any more. I heard nothing of our member for two years. After two years I got a message from him that he has a new address and that he is again together with his wife and then I wrote a letter to him in order to ask, "Should we ask now the cantonal physician to render his decision?", and he told me, "I do not need it any longer". He had been in a dilemma and with this possibility I opened the way out of the dilemma. I had in mind that it could have been a depression of old age and perhaps it has been.

  Q2373  Baroness Finlay of Llandaff: When you talk to people do you ask them whether they have informed all of their family and their close friends and whether they have thought through the implications of their action for other people in the family?

  Mr Minelli: We have even printed in our documentation, "You should speak with your family, with your friends, as soon as possible in order to give them the possibility to get acquainted with the idea of assisted suicide". For instance, I have a member, a German professor, living both in California and in Germany. He is now 96 years old. Four years ago he told me, "I will come to Zu­rich and have my assisted suicide and then you can inform my wife". I told him, "Listen: that is not our way of doing it. It is not fair on your wife and it is not fair on DIGNITAS because if we proceed this way your wife could be very angry and this anger would have just one object—DIGNITAS, so I think you should be fair with your wife and fair with us". After that he informed his wife and also his daughter. Later on he made the journey to Switzerland together with his daughter. He has been here and seen the physician. The physician has written a prescription and then he left for Germany and now he is again in California and two weeks ago he wrote a letter that his cancer of the prostate has become worse and that he intends to come within two or three months. We are always telling our members, "You should speak with your relatives, with your family, with your friends because it is important not only that they know it, not only that they have the opportunity to get acquainted with the idea, but also in order to come with you to Zu­rich. Do not come alone to Zu­rich. If relatives are coming with you, if possible bring at least two persons so that after your death a single person does not have to go back alone to their country".

  Q2374  Earl of Arran: I am sure you are well aware that in the future it is possible that certain restrictions and regulations might be imposed upon organisations such as yours. To what extent do you worry about this?

  Mr Minelli: Not at all. I do not worry about it.

  Q2375  Earl of Arran: They give you no anxiety?

  Mr Minelli: No, because we had the other problem of the public prosecutor, Dr Brunner. He wanted to make a cantonal law and after that I published my article about the European Convention on Human Rights with assisted suicide. After that we reopened our house in the canton of Aargau. He has no more the intention of making this law. He is now thinking that perhaps a federal law could be made but the Director of Justice in Berne, Mr Koller, has said publicly that if you want to make a law you should first know a lot of things and they do not know anything. Swiss authorities have never visited us and therefore we are very grateful that you make this visit to us. Perhaps this is the problem of the prophet in his own land.

  Chairman: That is an appropriate moment to ask the Bishop if he has any questions.

  Q2376  Bishop of St Albans: I would like to go back to try to understand the organisation itself because you began by saying there are no power struggles and it seemed from your description that the reason there are no power struggles is that there appears to be absolute power between you and your colleague. Is that the case? Who could, for example, say to you, "Sorry, Mr Minelli, but it is time for you to step down as the leader of this organisation"?

  Mr Minelli: If Mr Wernli has the impression that I am doing something the wrong way he will tell me and then we will discuss it.

  Q2377  Bishop of St Albans: But nobody has the authority to say to you, "Actually, it is time for you to hand the chair over to somebody else"?

  Mr Minelli: No. I have been told very early in my life by a German author who has written about human rights and about justice, "Whenever you are setting up a philanthropic organisation you must exclude power struggles because I have lived in Germany and in an organisation for human rights one member of the board sued the others in court and they have no longer been able to do any real work to help people in the field of human rights". This lesson I learned.

  Q2378  Chairman: So you did that. You carried that doctrine into practice in having yourself and your colleague, the two of you? You consider that outlaws any form of power struggle? Would you be able to give us, because I think it would be useful to have it, your documentation suggesting to the member that they should consult their relatives and if possible bring at least two with them if they came to Zu­rich?

  Mr Minelli: This is not printed. This we tell them over the phone.

  Q2379  Chairman: But the print says to consult their relatives?

  Mr Minelli: We will give you our documentation, the German and the English and, if you would like it also, the French.


 
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