One-Way Ticket

By HELENA BACHMANN/Zurich Sunday, Oct. 06, 2002

Klaus Eckstein hopes that he will never have to go to Zurich. Four years ago the 70-year-old retired schoolteacher, who lives in Cambridge, England, was diagnosed with bladder cancer. The disease was successfully treated with chemotherapy and surgery, "but if it returns and can no longer be cured, I am determined to go to Switzerland," Eckstein says. "I don't want to suffer needlessly."

Eckstein would not be traveling to Zurich to see its famous Bahnhofstrasse. He would be part of a small but growing number of non-Swiss known grimly as "death tourists," terminally ill people who come to Zurich to take their own lives.

Eckstein is a member of Dignitas, a controversial Zurich-based organization that offers assisted suicide to people suffering from incurable conditions. Dignitas rents an apartment in the city where clients self-administer a fatal dose of barbiturates and slowly fade away while listening to their favorite music. "These people are like the ones who jumped from the World Trade Center on Sept. 11," says Ludwig Minelli, Dignitas' director. "They want to be spared terrible pain and suffering. Helping them is a very humane thing."

Not everyone agrees. Dignitas' work is fueling criticism at home and abroad, and a debate about the organization is expected in the Swiss parliament soon. Some critics accuse Dignitas of luring people to Switzerland who might never contemplate ending their own lives at home. "Tourists come at lunchtime and by the afternoon they are dead," says Dorle Vallender, a Member of Parliament. "This is not an image we want of our country and legal system." Minelli says such fears are overblown: "We are not 'recruiting' foreigners. But it would be ethically wrong for me to turn them away." Last week Vallender filed a motion in parliament asking for tougher guidelines on assisted suicide and the exclusion of foreigners from the procedure.

Dignitas may be ruffling a lot of feathers, but it isn't breaking any laws. Switzerland has some of the world's most liberal statutes on assisted suicide: a doctor may provide a lethal dose of drugs to a terminally ill person if a physician is convinced that the patient has no chance of recovery, that he or she is mentally and physically capable of making the decision to die, and that the patient administers the drug him- or herself. Euthanasia, however — in which a doctor administers the drugs to end a patient's life — remains illegal in Switzerland, though not in the Netherlands or Belgium. Both these countries permit a physician to end a patient's life, provided that the patient requests it, that he or she is mentally sound at the time and that a second medical professional confirms the terminal diagnosis.

Dignitas recently caused an uproar when it was reported that the organization had helped several mentally ill people take their own lives. "Someone suffering from depression may not be capable of making a rational decision," argues Thomas Schläpfer, a psychiatrist at Bern University Hospital. "Suicidal impulse is not uncommon in people with severe mental disorders and they see Dignitas as an easy, clean way out. It is morally and ethically wrong to help them die." Minelli defends Dignitas' action, saying psychological pain can be just as wrenching as physical suffering. "There are cases of longtime chronic mental disorders that defy treatment," he says. "And many of these people have long periods of lucidity when they are capable of deciding for themselves."

Minelli used to work as a legal counsel for another Swiss assisted-suicide group, which did not accept clients from outside the country. He founded Dignitas in 1998 to help foreigners, and word about the organization soon spread abroad. "I wasn't going to ask people what passports they had," he says. "Everyone deserves to die with dignity." To date, 125 people — mostly non-Swiss — have come to Dignitas to die. Over 1,800 are now members, paying an annual j17 fee. Swiss law prohibits making a profit from assisted suicide, so all the money goes to cover administrative and operating costs.

When approached by potential members, Minelli refers them to one of several local doctors, who examine medical records and decide whether the person's condition is indeed untreatable. Some potential suicides are turned away because the doctor believes their situation is not hopeless and recommends further treatment. And, says Hans Nägeli, 70, one of the physicians working for Dignitas, "A few change their minds and go home. But it helps them to know that this option is always open to them."

According to Minelli, at least several months usually go by before a Dignitas member actually comes to Zurich to die. During that time, Minelli sometimes travels to meet the person and his or her family in their home country in order to establish the personal connection that he considers essential. "If somebody asks me to come because they are bedridden and can't travel, I always go," he says. "Sometimes one of the doctors goes with me, to make an initial assessment of the client's condition."

Once in Zurich, Dignitas members are taken by Minelli to a simply furnished apartment, where they are provided with the barbiturates. To avoid potential murder charges, clients must swallow the drug or open the valve on an IV drip themselves. Two witnesses are present — a Dignitas staff member and a relative of the client — to make sure this procedure is followed.

Although the process sounds cold and clinical, "it's bittersweet and peaceful," says Johanna, a 38-year-old homemaker from Bremen, Germany, who accompanied her mother to Zurich earlier this year. She says her mother, who at 63 suffered from the terminal stages of bone cancer, "never wavered in her resolve to end her suffering this way. And I'm grateful she was given that chance." So far no formal complaints have been filed against Dignitas by relatives or governments of countries where assisted suicide is illegal. But some in Switzerland are voicing concern that the organization's activities could spur the growth of a "death industry." And other groups offering assisted suicide to foreigners are reportedly already springing up in Zurich. "If this continues, Switzerland could become known as a suicide country," warns Andreas Brunner, Zurich's chief public prosecutor, whose job it is to keep an eye on Dignitas' activities and make sure it doesn't break any laws.

Such concerns do not sway Nägeli from pursuing what he sees as a purely humanitarian endeavour. "I can identify with these people," he says. "As a doctor, I just can't stand to see them suffer." Without tough new legislation — which is unlikely at this point — Nägeli and Minelli's mission of mercy looks set to continue.