SAVES is not affiliated with Exit International / Dr Philip Nitschke and opposes the public availability of a 'peaceful pill'.

United States

As discussed in previous issues of the VE Bulletin there is a plurality of opinion held by medical practitioners on the issue of voluntary euthanasia, mirroring that of the wider population. However the AMA leadership's refusal to canvas the views of its members, preferring instead to make executive decisions, guarantees that both the membership and general population remain unaware of the true level of support for law reform from within an association representing approximately 50% of medical practitioners. The reasons why this decision remains largely unchallenged by the membership is open to conjecture, but is nevertheless surprising, considering the professional and legal challenges faced by many doctors who will continue to act at personal risk, in the best interests of their patient.

A national survey of General Practitioners, who were members of the RACGP, was carried out in 1996. (1) It found that more GPs (46%) would wish to have the option of voluntary euthanasia than not (36%). Fifty six percent would not be distressed if euthanasia were available to others, 56% believed that the option should be limited to the terminal stage of a terminal illness and 64% believed that euthanasia can be an act of caring.

It is therefore interesting to read of the views of members of the American Medical Association (2), which also reflect a statistically significant difference of opinion between grassroots physicians and physician leaders. Dr Simon Whitney of Baylor College of Medicine in Houston conducted a nationwide random sample of 930 physicians of all ages and specialties, as well as all 390 eligible members of the AMA House of Delegates, on the legalisation of physician assisted suicide. Six hundred and fifty eight questionnaires from the random sample and 315 from the House of Delegates were analysed. Of the random sample 44.5% favoured legalisation, 33.9% opposed it and 22% were unsure. By contrast only 23.5% of AMA House Delegates supported legalisation, with 61.6% opposed and 15% unsure.

Dr Whitney said he 'suspects that many rank and file physicians see assisted suicide as another tool, one to be used rarely and reluctantly, but still a way to widen options for patients who are in great suffering. The leadership of the AMA is more concerned with the profession as a whole and worried that the legalisation…may lead to abuses down the road.'

Dr Whitney argued that these views are neither right nor wrong, but that the AMA leadership is placed in an awkward position when they choose to categorically state that voluntary euthanasia is unethical, when this view does not predominate in society. Such statements resolve the issue for neither patients nor practitioners.

As reported in the July 2001 VE Bulletin, the Oregon experience has shown that physician assisted suicide has been used rarely and concerns of abuse appear unfounded.

Julia Anaf

References:

1. Wilson, I., Kay, B., Steven, I., 'General Practitioners and euthanasia' in Australian Family Physician 1997; 26: 399-401
2. Whitney, S., 'Assisted Suicide: Views of physicians and physician leaders 'strikingly' different', Journal of General Internal Medicine 2001; 16: 290-296

The Japan Society for Dying with Dignity, founded 25 years ago, currently has 94,156 paid up members, of whom 26 percent are in their sixties, 38 percent in their seventies, and 18 percent in their eighties. There are 2,263 members in their nineties, and 25 more than 100 years old.

As most people know, suicide is neither forbidden nor taboo in this society, and has been glorified in ancient times and as late as World War Two. It is therefore ironic that assistance to die is a taboo and not openly discussed in society. Never-the-less voluntary euthanasia has been legal since 1962 if certain conditions are met, but remains a very uncommon phenomenon.

Of greater social importance to many is that people often still die without being fully informed of their true condition. Overuse of life-support systems is also a major problem, as was the case with Emperor Hirohito who was kept alive for 111 days by machinery and drugs.

The impetus for the Dying with Dignity movement therefore reflects a revolution in attitude that looks towards society moving away from routine over-medicalisation at the end of life, and towards the right to be fully informed of ones prognosis. This is seen to respect the right to die with dignity.

References:

Japan Society for Dying with Dignity newsletter No 102, June 2001.

web site: http://www.songenshi-kyokai.com/

Humphry D Supplement to Final Exit, Norris Lane Press USA 2000
 

Switzerland

Known historically for its independence, Switzerland is now setting the pace for the practice of assisted suicide on a wide scale. Today there are several 'right-to-die' organizations in a country with a population of seven million. Two offer help with hastened death to both terminally and chronically ill residents and foreigners. One group will even visit a dying patient in another country if there is no alternative. Switzerland has not had a law forbidding assisted suicide since the criminal code was revised in l937. The relevant law is interpreted to mean that anyone may assist the suicide of a hopelessly ill person provided it is done for altruistic reasons. If assistance is given out of evil motives or financial gain, then it is treated as a crime. Estimates in recent years have put the number of hastened deaths at between one and 200 a year.

Because most nations will not legalize assisted suicide, desperate persons who believe in the freedom to die are looking to Switzerland. Neither the Netherlands nor Oregon will accept non-residents for help in dying. The Dutch require that the physician has known the patient for several years, while Oregon law has a 'Residents Only' provision. The more flexible law in Switzerland, together with four pro-active organizations, means that interest has mounted from persons with intolerable physical health problems in surrounding countries, including Austria, Germany, France and Spain.

EXIT, a powerful Zurich group with fifty thousand members, is the most active in helping Swiss citizens to die, but does not help foreigners. The drugs are obtained from the patient's doctor, but the EXIT helper usually makes all the arrangements, even to handing over the medication, but leaving just before death and informing local police of the situation. This organization receives over 300 calls a year from people wanting help to die, with 120 actually getting assistance in an average year. Swiss professional medical groups generally discourage doctors from engaging in assisted suicide, but some do, particularly when an intravenous injection is required. Persons with mental health problems are not helped.

EXIT International is a breakaway group from the Zurich organization. It is a small but wide-ranging group run by an elderly doctor of philosophy, the Rev. Rolf Sigg. Although small, the group is apparently well - funded and willing to travel throughout Europe to help people die; though for the time being only German-speaking persons are assisted because of language problems. Law enforcement authorities in Germany have several times pressed charges and secured convictions against Dr. Sigg for bringing the medication into the country, only to have them overturned on appeal. Appeal judges have warned him not to continue importing narcotics, but at the same time have praised his humanitarianism.

Another group, DIGNITAS, was formed three years ago with a motto of 'To Live With Dignity - To Die With Dignity.' It is headed by attorney Ludwig Minelli and has helped approximately 30 people to die. It has a cautious and law -abiding approach, while also helping foreigners who are members who come to the country. The member must obtain a prescription from a Swiss physician for narcotics, after examination of physical symptoms and case documentation, and the case must also fit Swiss law.

The fact that voluntary euthanasia and assisted suicide has become legal in the Netherlands has resulted in opposition from Roman Catholic, Orthodox and Protestant churches throughout Europe and Russia. According to polls 75 percent of Germans support law reform on assisted suicide, while 60 percent say the church has no right to intervene on questions of dying. These powerful churches are organizing to stop any similar legislation in their own countries. This suggests that there will continue to be a role for those 'Exit' groups mentioned above.For further information contact http://www.finalexit.org/pract-swiss.phpl

Based on an article 'Swiss assisted suicide branching out' By Derek Humphry, Euthanasia Research and Guidance Organisation 22 July 2001