2012 Annual SOARS Lecture

To Live with Dignity, To Die with Dignity

Silvan Luley
Dignitas Switzerland

DIGNITAS is a non-profit-organization founded on May 17, 1998 in Forch, near Zurich, by Ludwig Minelli, a human rights lawyer. The main points of Sylvan Luley’s extensive talk, which broadly relate to the concept of old age rational suicide, were the following:

“We all want to live. However, we don’t just want to barely live. We have personal views which determine whether our life still holds some value for us.

“The healthy cannot judge over someone who is suffering what that individual’s life is worth, whether or not it’s worth carrying on.

“It is Dignitas’ first and most important task to look for solutions which lead towards re-installing quality of life so that the person in question can carry on living. At the same time, if solutions towards life are not possible, the option of a dignified death must also be looked at.

“Today, Dignitas, with its sister association Dignitas-Germany in Hanover, which was founded on September 26, 2005, has some 6,500 members in 70 different countries around the world. As of today, 899 of our members live in England, Wales and Scotland. We have an office in Forch and we have a house in Pfaffikon-Zurich where accompanied suicides for members from abroad may take place. There are 20 people working for Dignitas, most of them part-time, comprising board members, an office team and a team of companions who visit patients and assist with accompanied suicides.

“Most important, Dignitas does not restrict its services to Swiss residents. The Good Samaritan did not request to see a passport before he helped the injured man on the road. Dignitas ignores borders as far as possible.

“The core goal of Dignitas is to disappear, to vanish, to close down…..However, as long as most countries’ governments and legal systems disgracefully disrespect their citizens’ basic human right to a dignified end in life and force them either to turn to risky suicide attempts or to travel abroad instead, Dignitas will serve as an ’emergency exit’.

“People are not the property of the state. They are the bearers of human dignity, and this is characterized most strongly when a person decides his or her own fate…..The freedom to shape one’s life includes the freedom to shape the end of one’s life. However, departing on such a ‘long journey’ entails responsibility. All individuals are part of society. Therefore, one should not set out on this journey without careful preparation, nor without having said appropriate goodbye to loved ones.

“On January 9, 2002, the Swiss government explained that according to scientific research, for each committed suicide there are as many as twenty to fifty attempted suicides…..Dignitas’ experience, derived from 14 years of taking care of people who wish to end their life for all sorts of reasons, is that society should focus on the prevention of suicide attempts…..One-third of our daily counselling work by telephone is with non-members. Additionally, we have a free-of-charge internet forum with some 2,500 registered members, set up like a self-help group, cared for by a professional mediator…..First and foremost, we are a suicide-attempt-prevention organization and therefore a help-to-live organization.

“Over its 14 years of existence, Dignitas has led or been involved in dozens of legal cases…..(in particular) this led, on January 20, 2011, to the European Court of Human Rights’ decision in the case of Haas vs. Switzerland – ‘In the light of this jurisdiction, the Court finds that the right of an individual how and when to end his life, provided that said individual was in a position to make up his own mind in that respect and to take the appropriate action, was one aspect of the right to respect for private life under Article 8 of the Convention’. Many opponents of the ‘freedom of choice in last issues’ will claim that there is no right to die. They are wrong; certainly within the jurisdiction of the European Convention on Human Rights.

“Another line of our legal work is engaging in legislative proceedings. As to the UK, we had a visit from the House of Lords Select Committee on Assisted Dying for the Terminally Ill Bill, led by Lord Joffe, in 2005. There was also the investigation of the (Falconer) Commission on Assisted Dying…..they also visited Dignitas…..In Scotland, Member of Parliament Margo MacDonald drafted the Assisted Suicide (Scotland) Bill. To all these projects, Dignitas submitted in-depth responses addressing facts, figures and legal aspects.

“In the case of medically-diagnosed severe or terminal illnesses, unbearable pain or unendurable disabilities, Dignitas can arrange the option of an accompanied suicide upon the request of an individual member. There are many prerequisites linked to the arrangement of such an assisted suicide: the person has to be a member of Dignitas…the person must be mentally competent…the person has to be able to carry out the final action which brings about death by him or herself…the person must send a written request to Dignitas (with) comprehensive historical and up-to-date medical reports showing diagnosis, treatments tried, medication, development of the illness, etc…a Swiss physician (independent of Dignitas) assesses the request and hopefully grants a ‘provisional green light’ (without this doctor’s consent, there will not be an accompanied suicide)…the person has to have at least two face-to-face consultations with the Swiss physician who initially provided the ‘provisional green light’…the person has to be able to stay several nights in Switzerland…(and) the person has to provide several official documents such as a birth certificate, etc…..it all takes time. Therefore, one has to allow for about 3 to 4 months for the whole procedure.

“Only if all the requirements are fulfilled can a Swiss physician write the prescription which allows Dignitas to procure the necessary medication for the accompanied suicide. It’s a lethal overdose of a fast-acting barbiturate which is dissolved in ordinary drinking water. After taking it, the patient falls asleep within a few minutes and drifts into a deep coma which passes peacefully and painlessly into death. Naturally, each permitted use of a fatally effective medication requires a Swiss doctor’s prescription, for only by this means can the drug be legally obtained.

“Our experience shows that only very few people who enrol as a member take advantage of the option of assistance with suicide after all.

“On October 25, 2002, the first UK resident made use of the option of a self-determined end in life at Dignitas, accompanied by his son and daughter; he was from Wales, had been born in 1925 and was suffering from an invasive adenocarcinoma of the oesophagus with metastases.

“There are three groups of suffering, of medical situations, which can generally be identified as eligible for an accompaniment at Dignitas, based on the present legal and factual situation in Switzerland –

(a) There are those who are suffering from a terminal condition, like the man from Wales.

(b) There are people who are suffering due to a severe disability, such as, for example, young rugby-player Daniel James who was almost entirely paralysed after an accident.

(c) And there are elderly people whose life has become too arduous as the result of a multitude of ailments related to old age: a typical example of this was the conductor Sir Edward Downes: at the age of 84, he suffered from heart and blood pressure problems, arthritis in the back and the knees, prostrate problems, and was almost entirely deaf and blind.

“From 2002 until October 2012, 217 Britons – 130 women and 87 men – chose to end their days at Dignitas. (In total, Dignitas has assisted in the deaths of 1,471 individuals from around the world: 866 being female and 605 being male)

“Nowadays, people are living longer, much longer. Of the many reasons for this development, one is the progress in medical science which leads to a significant prolonging of life expectancy…..Obviously, this progress is a blessing for the majority of people. However, it can also lead to a situation in which death as a natural result of illness can be postponed to a point much further in the future than some patients would want to bear an ailment. More and more people wish to add life to their years – not years to their life.

“In the light of this development, limited access to accompanied self-deliverance to certain people, such as those in the group (a) that I mentioned before, cannot be justified. The current projects for legislation on assisted dying in the UK, focusing on the terminally ill, are a step in the right direction. At the same time, they discriminate against people like Tony Nicklinson, and also against those few of the approximately 1.3 million over-85 years old in the UK who, due to their ailments, might rationally wish to end their long life in a self-determined, peaceful manner.

“Most of the difficulties that Dignitas deals with have their origin in the fact that we have always been convinced that the right to die is in fact the very last human right, and thus there should not be any discrimination just because of the place of residence of a person.

“On May 15, 2011, the voters of the Canton of Zurich strongly rejected two initiatives (by 84.5% to 15.5%, and by 78.4% to 21.6%) by religious political parties aimed at prohibiting access to assisted dying. The next political statement followed on June 29th of the same year, when the Swiss Federal Government decided to refrain from legislating on assisted suicide, meaning that the existing law was sufficient. The Standerat – our small parliamentary chamber – followed this opinion unanimously on December 21, 2011, and the Nationalrat – the large parliamentary chamber – confirmed this on September 26, 2012 by 163 against 11 votes.

“Incompetent and biased media – ‘The world’s foremost euthanasia clinic’…’800 Britons on waiting list for Swiss suicide clinic’ – these words are not only found in UK tabloids but also in Swiss newspapers…..a large part of the media uses any opportunity to create hype…..Whilst we could dismiss false information as typical tabloid rubbish or the bad day of a journalist incapable of reading the facts published on Dignitas’ website, the misleading words in fact cause a lot of suffering for which the media ignorantly denies responsibility.

“We – groups like Dignitas, FATE, SOARS and many more – are actually the real pro-life people because our work is about options and choices, about respect for humans.”

During the general discussion that followed Silvan Luley’s lecture, there was universal agreement that we, in the UK, are very fortunate to have the possibility of travelling to Switzerland when we become terminally ill, severely disabled, or for an old age rational suicide – for many of us, membership in a Swiss organization like Dignitas is essentially a good insurance policy.