Examination of Witnesses (Questions 2380
THURSDAY 3 FEBRUARY 2005
LULEY and DR
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
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
Mr Luley: Absolutely.
Q2384 Chairman: And before they leave
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
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
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
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 meannot
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.