Assisted suicide clinic in Switzerland becomes more controversial, may prompt changes in Swiss law

From the Wall Street Journal:

ZURICH — Daniel Gall, a French actor, was skeptical when his sister and her husband told him two years ago that they wanted to commit suicide. Genevieve Gall-Peninou was 81 and said she could no longer bear the Alzheimer's Disease she had suffered for several years. Yves Peninou, 86, didn't want to live without her.

"No doctor would ever help you," he told the couple. "Neither one of you is ill enough!"

But soon after, the Peninous, both doctors, contacted Dignitas, a Zurich-based organization that helps people end their lives. A Dignitas doctor in Zurich reviewed the Peninous' case and agreed to write a prescription for sodium pentobarbital, the lethal drug typically used for assisted suicides in Switzerland. They paid Dignitas its fee of 10,000 Swiss francs. ($10,500).

When Mr. Gall accompanied the couple to Switzerland in January 2008 for the final act, his doubts intensified about their decision–and about Switzerland's legalized assisted-suicide movement.

The suicides took place not in a private medical facility, but in an industrial space next to a large brothel, Mr. Gall says, just two spare rooms without a bathroom. He says two Dignitas volunteers, neither a doctor, helped prepare the couple. There was just one single bed, forcing Mr. Peninou to sit in a chair near his wife when the couple took the lethal dose.

"It seemed like a factory," recalls Mr. Gall, 71. "It was an awful, ugly place." He adds: "Everyone should have the right to decide about his death. But it shouldn't be possible to help people who are not sick die. Assisted suicide should be a last resort."

In the 1960s, when the first right-to-die organizations began helping terminally ill people end their lives in Switzerland, the Swiss gave broad support to a practice widely viewed as a personal choice. Backed by the world's most liberal right-to-die laws, assisted-suicide groups have since then quietly helped thousands kill themselves.

Lately, the increasingly controversial activities of Dignitas and its founder, Ludwig Minelli, are pushing even the famously tolerant Swiss too far, prompting calls for changes in the nation's assisted-suicide law.

Mr. Minelli has long played the agent provocateur of Switzerland's right-to-die movement, most notably because his group helps the lion's share of foreigners who come to Switzerland seeking to end their lives.

At first glance, Mr. Minelli seems an unlikely hardliner in the right-to-die movement. An avuncular 77-year-old, he favors thick cardigans and sandals worn over heavy socks and collects kitschy teapots. But his vision is a radical one, going well beyond helping the terminally ill to shorten their suffering.

Instead, he argues that anyone—the chronically ill, the mentally ill or those who are simply tired of living—deserves help to end it all. He has faced criticism over everything from the fees Dignitas charges to the places where it assists suicides to the means it has used to enable some deaths.

"We have to accept that even healthy people have reasonable motives to end their lives," Mr. Minelli said in an interview. He reels off case law supporting his argument that the choice to die is a basic human right and frequently blasts right-to-life groups as "hypocrites." He said he isn't bothered by critics who say his organization goes too far: "Let the stupid people talk."

From the start, Mr. Minelli has kicked up controversy for his willingness to help foreigners die. Most groups in Switzerland don't assist foreigners. Dignitas only helps foreigners. The number of foreigners Dignitas helps each year—132 in 2007, compared to 91 in 2003—has increasingly left the Swiss uncomfortable with the country's growing reputation for "suicide tourism." As of the end of last year, Dignitas had helped a total of 1,046 people to commit suicide.

Over the past two years, Mr. Minelli has gone even further, helping to organize suicides of people who weren't terminally ill, including a prominent British conductor who had gone blind and deaf and a 23-year-old rugby player who was left paralyzed during a game.

The Swiss government has proposed a law making it tougher for groups to help people die. A report attached to the bill discusses in detail the practices of Dignitas. In coming months, Swiss legislators will grapple with the choice between letting people decide when and how to end their lives and guarding against abuses by assisted-suicide organizations.

"If there is a backlash against assisted suicide here, we will have Minelli to thank for it," said Alberto Bondolfi, a medical ethicist and member of a government panel that drew up the proposals. "He is the most aggressive in demanding a right to assisted suicide."

Under Swiss law, it is illegal for a person to assist a suicide for their own "selfish" reasons. But there are otherwise no limits on helping someone to die. By contrast, most countries allowing assisted suicide require the person to be terminally ill or demand that a doctor assist the suicide. Switzerland is also the only country permitting right-to-die organizations to help foreigners die.

"At the moment, there is really no law," says Andreas Brunner, a Zurich prosecutor who has fought for greater restrictions on right-to-die organizations, particularly Dignitas. "You have to have some rules and standards. The worst solution is what we have now."

As medical advances prolong lives even for the seriously ill, the debate over assisted suicide is surging elsewhere.

In Oregon—the one state in the U.S. where assisted suicide is legal—doctors are allowed to help only state residents who are expected to die within six months.

The U.K., which has restrictive laws on euthanasia, was forced in a court case last fall to clarify whether it would prosecute Britons who help family members make the trip to Switzerland to die. (It won't.) Luxembourg legalized euthanasia last year. Activists in Belgium and the Netherlands are pushing to broaden the group of patients who can avail themselves of assisted suicide to the elderly, minors and chronically ill.

Mr. Minelli was the Swiss correspondent for German magazine Der Spiegel starting in the 1960s and covered Switzerland's ratification of the European Convention on Human Rights in 1974. In the 1980s, he says, a memory of his seriously ill grandmother's pleading in vain with her doctor to help her die left him with a particular interest in Switzerland's growing right-to-die movement, and he joined one of the main groups. In 1998, he quit to found Dignitas.

In 2008, when neighbors' complaints forced Dignitas out of the rented apartment it had long used for suicides, Zurich city officials refused permission for a new venue.

So, Mr. Minelli organized suicides in cars, a hotel room and his own home, drawing the ire of local officials. For a time, he was forced to use the industrial site criticized by Mr. Gall. "Someone who is used to a five-star hotel can't come to Dignitas and expect the same," Mr. Minelli says.

The Zurich prosecutor's office spoke with family members who complained about the 10,000-Swiss-franc fee Mr. Minelli charges people to die, but found insufficient grounds to open an inquiry. One rival right-to-die organization asks for nothing beyond a 45-Swiss-franc membership fee, while another charges 4,000 Swiss francs. Mr. Minelli says the fee helps with his legal and lobbying expenses.

When Zurich government officials demanded in 2008 that assisted-suicide groups get two doctors to sign off on a suicide before one of them could write a prescription for the lethal drug, Mr. Minelli helped four people suffocate themselves with helium and masks, without doctors in attendance. The media coverage in Switzerland kicked up a storm of protest against Dignitas.

"We needed to send a signal to authorities that we aren't reduced to using only sodium pentabarbitol," Mr. Minelli says.

Mr. Minelli argues that making assisted suicide available removes a taboo around suicide, helping people who want to kill themselves open a dialogue and seek help. About 70% of people who get the green light from Dignitas for an assisted suicide never contact the group again, proving the palliative effect of knowing help is available, he says.

At the same time, Mr. Minelli courts controversy with incendiary comments. He compares talk of prohibiting foreigners from coming to Switzerland to die to the country's decision to deny entry to Jews fleeing from the Holocaust during the war. He likes to call suicide "a marvelous possibility."

A vote is planned in March on a bill that would sharply restrict the activities of right-to-die organizations. For instance, two doctors must testify that a person is terminally ill, thus ruling out assistance for the chronically or mentally ill. The person seeking help must have given long consideration to his wish to die before doctors can prescribe lethal drugs. Moreover, right-to-die groups would be barred from accepting payments beyond those covering the costs of the suicide. The government also tabled a second bill that would ban assisted suicides altogether.

"These right-to-die organizations have completely exhausted the current legal framework," said Justice Minister Eveline Widmer-Schlumpf at a press conference in October announcing the bill. "We have had to deal with them repeatedly in recent years. They have repeatedly created cause for concern and disturbed public opinion."

Supporters of Dignitas say the new law will add to the burden of people in severe pain or distress by forcing them to find doctors willing to testify that a patient has only months to live. Craig Ewert, a retired university professor who suffered from Amyotrophic Lateral Sclerosis, or Lou Gehrig's disease, and whom Dignitas helped to die, may have been prevented from seeking help, says his wife Mary.

Doctors diagnosed Mr. Ewert in April 2006 and initially gave him several years to live, but by that autumn he was confined to a wheelchair. He decided to end his life before he lost all ability to decide his fate, overcoming the resistance of his doctors.

"When you're completely paralyzed and can't talk, how do you let someone know you are suffering?" he told a television interviewer before his death in September 2006. "This could be a complete and utter hell."

The Ewerts, who were living in the U.K., traveled to Switzerland and chose Mr. Minelli's group because it accepts foreigners. Mrs. Ewert says the proposed new law might have forced her to help her husband die, given how difficult it is for doctors to predict how long someone can survive with ALS. She worries that she wouldn't have known exactly what to do.

She defends Mr. Minelli. "Sure, there have to be some protections for people, but I think we're going way beyond what there needs to be," she says. "I admire Minelli for being willing to take the heat."

Other assisted-suicide groups say the proposed law would undermine the right of seriously ill people to decide their fate, and may make doctors even more reluctant to help them for fear of legal reprisal.

Exit, a Swiss right-to-die organization that helps about 160 people commit suicide each year, estimates it would be allowed to assist only about half the number of people it currently helps to die. Indeed, because the Canton of Zurich has tightened restrictions, now requiring patients to have two doctors' consultations, the number of people Dignitas helped to die last year was 90, down from an annual average of roughly 135.

Mr. Minelli is sanguine about the new proposal.

"It will never pass," he says. Even if Swiss legislators did approve the bill, he thinks Swiss voters would subsequently reject it in a referendum, citing polls that have shown support for assisted suicide.

In the meantime, he has bought a new building—hidden by tall bushes and featuring a waterfall and a goldfish pond—where Dignitas assists with suicides.