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


Examination of Witnesses (Questions 2380 - 2397)

THURSDAY 3 FEBRUARY 2005

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

  Q2380  Chairman: So far as I am concerned at least it will be sufficient to have it in English. That would be very useful because obviously, as you are asked questions, some other aspects of the written documentation will become apparent and it will be useful to have that.

  Mr Luley: Most of the physicians who look at the requests of members of DIGNITAS also ask, "What about the consent of the husband or the wife? What about the children?". They usually ask before they make their decision. For example, Dr Reinhardt, looking at the requests, always says, "What about family? What about friends? How does the family see the situation?". Most of us want to know in advance.

  Q2381  Chairman: Supposing that the member said, "I do not wish the family to know anything about it".

  Mr Luley: We have to respect that because at the end of the day it is a personal decision. In the German documentation, which is more up to date, it is already printed that the family members should be involved in the whole discussion.

  Q2382  Chairman: Perhaps we do need the German copy if the basic text has changed.

  Mr Luley: In the English documentation, and I will leave everything with you, there is mention that family members should accompany members to Switzerland once they wish to come for an accompaniment. Also, all the phone calls and ongoing communication that we have with members are in our office. We have e-mails, letters, telephone calls.

  Q2383  Chairman: Once the member puts in an application to have help then you have this correspondence with them?

  Mr Luley: Absolutely.

  Q2384  Chairman: And before they leave home?

  Mr Luley: Absolutely. Everything has to be set up and prepared in advance. All these matters are discussed before they come here.

  Q2385  Baroness Jay of Paddington: You mentioned, Mr Minelli, that you try to encourage people to come more than once, maybe to come for a preliminary visit. Do you have any idea how many do that?

  Mr Minelli: I have no statistics for that.

  Q2386  Lord Joffe: Dr Reinhardt, your colleague mentioned that you do some of these examinations of patients. Could you tell us how you go about it and how long an examination would take on average?

  Dr Reinhardt: I cannot give you a clear period of time. It depends normally on the records we have from the doctors. Normally we have 10 or 20 documents. The situation is so clear that you speak for 20 or 30 minutes. Sometimes it is an hour. It depends so much on the situation of the illness and the family situation so that I cannot give you an average time.

  Q2387  Lord Joffe: The range is from half an hour to an hour or more?

  Dr Reinhardt: Yes, about that.

  Q2388  Chairman: What is it you are looking for? What is the examination directed to?

  Dr Reinhardt: I cannot understand you.

  Professor Hopff: It would be a general examination and he will get all the information from the university hospital or where the patient comes from or from the first doctor who had the treatment under control and he will see all the diagnoses. He will just prove whether this diagnosis is correct. He will be the so-called second opinion so that any crime is excluded. That is why we ask for a second opinion from another doctor.

  Q2389  Chairman: On whether or not the patient is suffering from some physical condition that makes it appropriate that he should be helped? Is that right?

  Professor Hopff: Yes. May I give you a life example? I have felt healthy all my life and last August I passed the pilot's examination of our Swiss aerial office and it is very careful. They examine you hard. My doctor said, "You are very healthy and if you continue, you are now 75, you will keep your pilot's licence up to 80". At the beginning of last December I still felt very healthy but the first week of December my right salivary gland began to swell and after some days I had a pulmonary embolism and we cured this and then we looked for the secondary one and this was a very fast-growing cancer so we started chemotherapy and just last Saturday I came out of hospital. Now for me it is the same. I gave all the diagnoses to DIGNITAS from the hospital that it is a very malignant, fast-growing cancer but still we have to go to a second doctor and he can decide whether an accompanied death will be possible. I can tell you from my experience when I was a long time ago Vice President of EXIT that we very often saw, when people had the so-called green light that they would be accompanied if the pain was unbearable, that, as Mr Minelli has said, about 50 per cent of our patients could relax and some days later when we said, "We will be there; we will help you; we will accompany you", the husband called and said, "My wife peacefully died last night". This was in about 50 per cent of cases, and I can tell you how glad I am that I have the guarantee that when the situation is unbearable I can come here and Ludwig Minelli has been to my place and discussed this problem with my wife, with my son and with my daughter. They said, "We will be very sorry but anyway you do not have to suffer. If you decide to die we will agree". That is a life example.

  Q2390  Chairman: I understand. Thank you very much indeed.

  Professor Hopff: But now I am very grateful that I have found a very collaborative oncologist and he knows my opinions. Therefore, we went a little deeper and he said, "You are the pharmacologist. You tell me just before dying", and so he could get me again at the last moment.

  Q2391  Baroness Hayman: Could I just explore a little more what the second opinion is for? It is obviously there to verify the physical disease but you were talking earlier about the importance of competence and of knowing that someone is not, for example, suffering from a severe clinical depression which would stop them being competent. Could I understand a little more who assesses for competence? Having just heard you speak it would not be necessary for you, I completely understand you there, but for some patients obviously it is a matter of concern for the organisation and from what you were describing of the initial interview for the doctor is that screening for competence and mental illness as well as verifying medical records?

  Professor Hopff: The second opinion more or less is for us never to get in trouble with the police authorities. When you have a different doctor and he says the same, the authorities will be quiet.

  Q2392  Baroness Hayman: But if a patient came from England, for example, where there is not the legal provision for this, it might well be that the medical records showed the extent of the cancer but would not say, "And this patient has spoken to me and expressed the desire to end their life and they are competent to express that desire", because that conversation might not have taken place in England, so it is not verifying the second opinion. You would have to start from the beginning with that issue.

  Professor Hopff: Yes, it is very difficult to answer your question because first of all it is an elementary human right of the patient and the doctors give the signal, "It is true what the patient says and we can accompany him".

  Mr Minelli: We have no other way to get pentobarbital of sodium than with a prescription from the doctor. I would prefer another system. I would prefer that a doctor makes a certificate telling us that the patient has been instructed about possible alternatives, that he has not accepted alternatives, that he is sound of mind, and that with this certificate I can go to the canton pharmacist in order to get a decision that I can go to the pharmacy to get pentobarbital of sodium. If we had this system the doctor would not have the problem of writing a little prescription which is normally against what doctors have learned.

  Q2393  Baroness Finlay of Llandaff: Can I ask Mrs Wernli what the accompanying person does while they are there?

  Mrs Wernli: First of all, our collaborator who is present during the accompaniment will check all the documents, the personal request and so on. The next step is a short conversation between the collaborator and the physician who has written the prescription. Quite often it is between Mrs Wernli herself, the physician and the person being accompanied, the three together. They review the request once again. The people requesting accompaniments will have sent all the documents beforehand, so we have their personal request and letter in which they describe everything. We have the physician's report, so in that respect the interview between the physician and the person wanting the accompaniment will have taken place already, so we know what the situation is and who wants the accompaniment. If we all have the same opinion and if the doctor says, "Yes, this person has this possibility; I have written a prescription", and the collaborator and everyone else agrees upon it, then the collaborator talks to the member and the relatives present. Everybody is different. Some people would like to sit down and have a conversation with the person present during the accompaniment. Others are in a lot of pain. They do not want to wait. They want to go ahead. We talk to them, whether they want to have candlelight, classical music. Whatever their wishes are we try to accommodate them and, most importantly, the people who come are always being told at all times that they may leave and go home. They do not have to take the medicine. They can leave whenever they want. Even in the last minute they can say, "I do not think this is the right way for me", and walk away. There is another very important thing too, that if the person from DIGNITAS who is there during the accompaniment feels there is something wrong (it is the thing about empathy that Mr Minelli mentioned), "I do not think this person really wants to go or maybe he is pressured by his relatives", or whatever, they may say, "No, I am not doing this accompaniment; I am sorry".

  Q2394  Chairman: But then ultimately it happens.

  Mrs Wernli: It has happened, yes. If somebody comes up here and says, "I wish to go", put yourself into the situation that you are the person helping this very ill person to have the accompaniment. If you personally feel within you that there is something wrong here, that this person does not really want to go, would it not be your moral and ethical responsibility to say, "No, I cannot help you with this accompaniment"?

  Q2395  Chairman: But it is the accompanying person, the helper, that ultimately hands over the prescription for the patient to take?

  Mr Luley: No, he does not hand over the prescription.

  Q2396  Chairman: He hands over the medicine, I mean.

  Mr Luley: Yes.

  Q2397  Chairman: That is what I mean—not the paper but the actual material.

  Mr Luley: Yes indeed. He puts it within reach of the person who wants to go.

  Chairman: Our time has passed rather quickly. We have to move on. Thank you very much indeed.





 
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