14 May, 09 | by BMJ
Philip Nitschke is in the UK giving his DIY suicide workshops again. I attended one of these in October and blogged about it then. His reappearance reminded me that last month BBC Radio 4 aired “The Report“, in which Simon Cox investigated some concerns about the conduct of the head of another assisted suicide organisation, this time the Swiss organisation Dignitas.
Dignitas is not the only such organisation in Switzerland, but the reason it is so well known in the UK is because unlike other similar organisations such as Exit it assists in the suicides of foreigners. To assist someone to die is illegal in the UK, but there have been no prosecutions of those accompanying Dignitas clients to Switzerland.
Ludwig Manelli founded Dignitas in 1998 and (along with Exit International, Philip Nitschke’s organisation) it is a splinter group of the earlier-formed Exit. Dignitas has assisted in the suicides of over 100 Britons, but its legality and that of the whole assisted dying industry in Switzerland is an amazing example of unintended consequences: Article 115 of the Swiss Penal Code states that assisting or inciting someone else to kill themselves is a crime if carried out for selfish reasons. Assisting someone to kill themselves for unselfish reasons is therefore legal.
Various interviewees criticised Dignitas during the programme, including family members of a couple who both had mental health problems and were assisted in killing themselves by Dignitas as part of a pact. A former Dignitas employee described being deceived by Manelli over this case: She helped with the suicide of one of them and her colleague helped with the other. Only later did she discover from Manelli they were a couple, had a pact, both had mental health problems, and one of the couple had faked paralysis in an attempt to appear a more suitable candidate for assisted dying.
The real illumination was provided in an interview with Manelli himself. He is a human rights lawyer who views human rights as absolute. He views suicide as a human right, and therefore it should be available to everyone. As he put it, “Suicide is a marvellous opportunity”. He cited the large number of ‘failed’ suicides in the UK , suggesting that a great deal of money could be saved if those episodes of self harm could be made into suicides, ignoring the good prognosis of most episodes of self harm and the alarming totalitarian resonance of his view. He then described how he imagines the treatment of people who have harmed themselves: Institutionalisation, ‘for fifty years or so': A rather ill-informed view of modern mental health services (read more for what really may happen when a seriously suicidal person presents to A+E).
There may be valid arguments in favour of legalising assisted suicide, but it is difficult to get beyond this prominent global campaigner applauding the idea of people suffering with mental health problems saving the country money by killing themselves, and equating a choice to commit suicide with an ordinary personal choice such as which shoes to wear.
The GMC is now consulting on new guidance for doctors entitled “End of life treatment and care: Good practice in decision-making“. This document outlines what is expected of doctors when caring for patients at the end of their lives. The inclusion of a section entitled “Presumption in favour of prolonging life” reminds the reader the legalisation of assisted dying is not inevitable, which is good news for patients and doctors.
William Lee is a clinical lecturer and MRC training fellow in general hospital psychiatry at the Institute of Psychiatry, London SE5 9RJ