Ludwig Minelli , director of Dignitas wrote to John Todd, then President of Dying with Dignity Qld in 2011 about the effect of Swiss law on assisted suicide and how it might be used to improve life and death for people who want to die. We have included his letter because he wanted it to be distributed to people widely.
Dear Mr. Todd,
Thank you for your e-mail.
Until 31 December 1941, every one of the 24 Swiss Cantons had its own Criminal Code. (There was, however, a federal Criminal Code for the Military.)
The Federal Council, which is the Swiss Government, drafted a federal Criminal Code during the last years of the 19th Century. Only in 1918 was this presented to the Swiss Parliament, which comprises two Chambers, the National Council and the States Council. Article 115 appeared in the draft Criminal Code in the same wording it has today but was numbered as Article 102. In Explanatory Notes that accompanied the draft legislation the Government told Parliament that suicide in modern criminal law is no longer a crime and that no section of society wanted a return to the old ideas in law. Here is the Explanatory Note (in German) as it appeared in the Official Journal (Bundesblatt) 1918, vol. V, page 32:
“Die Selbsttötung ist im modernen Strafrecht kein Vergehen und es liegt keine Veranlassung vor, etwa aus bevölkerungspolitischen Gesichtspunkten auf das frühere Recht zurückzukommen. Aber auch die Überredung zum Selbstmord und die Beihülfe bei einem solchen kann eine Freundestat sein, weshalb hier nur die eigennützige Verleitung und Beihülfe mit Strafe bedroht wird, so z.B. die Überredung einer Person zum Selbstmord, die der Täter zu unterstützen hat oder die er zu beerben hofft.”
“Suicide is not a crime in modern criminal law and there is no suggestion from the people we should return to previous law. Furthermore, the counseling and aiding of a person to suicide can be an act of compassion. Hence, prosecution will ensue only if the counseling and aiding of suicide proceeds from selfish motives, such as when a perpetrator seeks to gain an inheritance or terminate his giving of care.”
Following 20 years of intermittent debate, the Swiss Parliament in 1938 approved the Federal Criminal Code in amended form. There was, however, no amendment to Article 102, now 115. The Federal Criminal Code came into force on 1 January 1942. The long delay between approval and enactment was due to a call for referendum by 50’000 citizens. When a referendum was finally held a majority voted for adoption of the Federal Criminal Code.
There is no mention of any opposition to Article 102 in the record of parliamentary debate.
There is a Record of Discussions of the Committee of Experts who prepared the draft Federal Criminal Code in the late 19th century. In that document there is no expressed intention to help the old or sick with assisted suicide. It was the German-speaking section of the EXIT organisation that discovered Article 115 in the early 1980s and saw the opportunity to legally assist suicides by respecting the condition stipulated in the Article. (This is an application of a common principle in law: argumentum e contrario, argument from the contrary.)
You ask whether Article 115 has increased the rate of suicide in Switzerland.
In Australia with its population of 21 million I understand there are some 2’200 suicides each year. In Switzerland with its population of 7 million there are some 1’450 suicides each year. But how many attempts lie behind these actual suicide figures? I am told that researchers in Australia give a best estimate of 30 attempts for each actual suicide, but concede the true figure could lie anywhere between 20 and 50. The Swiss Government told its parliament on 9 January 2002 that, based on U.S. research, there are possibly 50 attempts for each actual suicide in Switzerland. That would suggest up to 72’000 suicide attempts each year with some 70’000 failures. There are heavy consequences, not only for the persons involved but also for the economy. There are estimates that attempted suicide in Switzerland has an annual cost of 1.2 to 2.4 billion Swiss Francs, most of this arising from failed attempts.
Why is it that most countries have been unable to reduce their annual rates of suicide?
In my opinion the answer lies in the choice of a starting position for corrective measures. If we start from a position that all suicide is detrimental to society and not a single incidence should be accepted, then we create a taboo. And once a taboo surrounds suicide, no one with suicidal tendencies can freely share their thoughts and feelings on the subject with friends, relatives or medical practitioners. Were they to do so they risk embarrassment and worse, incarceration in a psychiatric institution. So the person enters a downward spiral with little chance of recovery.
We can improve this by moving the starting point for our corrective measures. We can accept that in some instances suicide offers the best course of action and that rational humans can make use of that valuable opportunity. That is, suicide can provide the desired release from an untreatable, unrelievable illness. However, we must acknowledge that a person with suicidal tendencies may not be aware of the real situation. So, in line with the precautions we take when going on a long journey (i.e. consulting a travel agency for advice and saying goodbye to our relatives and friends) we should set two conditions on the person contemplating suicide: obtain diagnosis and prognosis from the medical profession and farewell friends and relatives.
These conditions provide opportunity for others to consider the basic problem of the suicidal person and solve that problem by means other than suicide should that be possible. Should there be no better solution and the person persistently seeks suicide, we should be able to give assistance to ensure a peaceful, painless death.
When, as a consequence of such an approach, all suicides become assisted suicides, the total number of suicides would be much lower, and there would be no failed suicides with their heavy consequences. We have already seen the achievement of a similar outcome with abortion. Since legalization, abortions have been carried out under expert medical supervision which has eliminated deaths and serious complications. In some countries we have actually seen a decrease in rate of abortion.
When I started as a journalist in 1956 I noticed that Switzerland’s rate of suicide matched its road deaths, some 1’600 per year. In 2005 this figure had fallen to about 1’350, and it included some 350 assisted suicides. The figures speak for themselves: the availability of assistance actually decreases the rate of suicide.
Has the availability of assistance led to large numbers of people choosing suicide in preference to natural death? Well, Georg Bosshard with others from the Institute of Legal Medicine of the University of Zurich published a study of 748 suicides that were assisted by EXIT in Switzerland over a period of eleven years from 1990 to 2000. He compared the total number of deaths in Switzerland to the total number of assisted suicides by EXIT over those eleven years. Of 100’000 persons who died in these eleven years from cardiac or respiratory disease, only 67 (.07%) chose assisted suicide. Of 100’000 persons who died from Multiple Sclerosis, only 45 (4.5%) chose assisted suicide. These figures (and similar figures released annually in the state of Oregon USA) show that when assisted suicide is legalized, only a small minority will actually use it. (Figures from Oregon USA show that not only is it a small minority but one composed mostly of persons suffering from cancer, motor neurone disease, AIDS and Multiple Sclerosis. These are the particular diseases that too frequently bring on unbearable suffering.)
I have more evidence from Switzerland. In 2001, the City Council of Zurich ruled that organizations such as EXIT and DIGNITAS could attend the homes of old or sick people run by the City of Zurich to give assisted suicide when requested. Only recently I asked the Chief physician of the City of Zurich, Dr. Albert Wettstein, how many people live in these institutions and how many cases of assisted suicide have occurred in the last few years. He informed me that about 3’000 people live in these homes and there are no more than three assisted suicides each year. (I am aware that the actual figure might be slightly higher because an EXIT official, Werner Kriesi, told me that in 2004, three persons – all members of EXIT – came from these institutions to the EXIT house to die because they did not want to go through the official bureaucracy in the home.) Whether the actual figure is three or six per year, it amounts to a very small percentage.
Our experience at DIGNITAS is that 70 percent of our members who approach us for assisted suicide never call again after we have told them that a Swiss physician is ready to write a prescription for them.
So what is the conclusion? A country wishing to reduce its rates of both attempted and actual suicide will achieve this by legalizing assisted suicide. This should be combined with information campaigns so that people learn that it is not a simple matter to commit suicide successfully. Many of the methods thought to work do not. Persons contemplating suicide should be strongly advised to seek assistance. In doing so they would discuss their problems and possibly find better solutions than death. But should death be the best solution, each would be assisted to die peacefully and painlessly.
To achieve this requires human intelligence freed of religious and medical dogma. There may lie the rub.
Ludwig A. Minelli