February 10, 2010

SWITZERLAND: Death Becomes Him

. WASHINGTON, DC / The Atlantic / Profile / March 2010 Edition / Published February 10, 2010 Over the past decade, Ludwig Minelli has helped more than 1,000 people kill themselves and has turned Zurich into the undisputed world capital of assisted suicide. Minelli sees himself as a crusader for what he calls “the last human right”—and he believes that helping more and more people to die advances his cause. Even if you believe in an absolute right to die on your own terms, how far is too far in the quest to secure that right? DEATH BECOMES HIM By Bruce Falconer Image credit: David Levene/Guardian News and Media Ltd 2009 Ludwig Minelli, a lawyer and self-described humanitarian, helps people kill themselves. Last summer, he invited me to a party inaugurating the Blue Oasis, the latest in a series of properties he has converted into makeshift death houses for the purposes of Dignitas, an organization he founded in 1998. The Blue Oasis is a two-story blue house with a flat roof, situated next to a machine factory and across from a soccer field in an industrial area a half hour’s drive east of Zurich. In the yard, flowering trees and tall grass frame a clear, round pond flecked with lily pads and stocked with goldfish. A gravel path winds from the front door across the yard to a small take-out restaurant offering soft drinks and sandwiches. On the hot afternoon I arrived, the restaurant’s proprietor, a middle-aged Croatian woman, was standing behind the counter slicing tomatoes. I asked how business was. Not great, she said, and explained that things had been fine until two months earlier, when Minelli purchased the Blue Oasis. “Minelli is a nice man,” she said, “but his presence here has been a disaster for me.” She had lost almost half her business, and most of what remained came from visitors to the house. Even the tomatoes on her cutting board were for a meal of Croatian specialties Minelli had ordered for that evening’s celebration. A few hours later, with the party under way, Minelli led a tour of the Blue Oasis for his employees—five men and nine women, a mix of college students, professionals, and retirees, all of whom work for Dignitas part-time. Minelli himself is 77 and has thinning white hair, thick glasses, and a hearing aid in his right ear, but he displayed a youthful enthusiasm as he walked us through the house. It was clean and new, with hardwood floors and white walls decorated with watercolors of rural Swiss landscapes. In the front hallway hung a framed cartoon of a man concealing a vial of poison behind his back and waving off people approaching him with a wheelchair and a box of diapers. A cooler full of chilled champagne sat beside a hospital bed in one of two rooms specially outfitted for people who want to kill themselves. Dignitas’s slogan is “To live with dignity, to die with dignity,” and for 12 years the group has been serving cocktails of sodium pentobarbital, a highly lethal barbiturate, to clients from around the world. During that time, Ludwig Minelli has helped more than a thousand people kill themselves, and he has cornered the market in what has come to be called “suicide tourism,” transforming his native Zurich into the undisputed world capital of assisted suicide. Assisted suicide is also legal in the Netherlands, Belgium, and Luxembourg, as well as in the American states of Oregon, Washington, and Montana. But in all those places, the practice is restricted to people with incurable diseases, involves extensive medical testing and consultation with physicians, and requires that applicants be permanent residents. By contrast, Switzerland’s penal code was designed such that, without fear of prosecution, you can hand someone a loaded pistol and watch as he blows his brains out in your living room. And there is no residency requirement. There are only two conditions: that you have no self-interest in the victim’s death, and that he be of sound mind when he pulls the trigger. Switzerland’s permissive legal environment is unique, and has given rise to at least four assisted-suicide organizations. The two largest, both called Exit, one based in German-speaking Zurich, the other in French-speaking Geneva, limit their services to Swiss citizens. Another group, called Exit International and located in the Swiss capital of Bern, does occasionally take foreigners, but only in extraordinary cases. This leaves Dignitas as the one organization in Switzerland—and, therefore, the only one in the world—that will expedite the death of almost anyone who asks. Minelli calls suicide “the last human right,” and he has dedicated his life to securing it. As members of Minelli’s staff mingled by the goldfish pond outside the Blue Oasis, clinking glasses of champagne and Bordeaux, I struck up a conversation with a 39-year-old law student named Silvan Luley. Why, I asked, had he decided to work for Dignitas? “Most of us came in through friends and family,” he said, adding that his mother had been one of Minelli’s first employees. In her work as a Dignitas “escort,” she had dispensed cups of sodium pentobarbital, obtained via prescription from sympathetic physicians, and sat by the drinkers’ bedsides in the death house as they died. Other Dignitas volunteers had first contacted Minelli for help with killing themselves, but wound up working for him instead. “There are several people here who were going in that direction,” Luley said, pointing out two of his colleagues. “Minelli always tries to motivate people to make more of their lives,” he continued. “That’s why I work for him, his human approach.” Ludwig Minelli, 76, is now famous around the world as the founder of Dignitas, the not-for-profit assisted suicide organisation that has helped 1,032 people to die since 1998. Photograph: David Levene / The Guardian But Dignitas is concerned with not life but death—a fact Luley not only accepts, but promotes with enthusiasm. “Suicide is not bad,” he explained. “There’s nothing wrong with wanting to end your life. Sometimes life is great, sometimes life is shit. I have the right to say that I’m pissed off with my life, and I want to end it.” Fine, I said, but why involve others in your self-destruction? Why not just sit in the garage with the engine running? Luley smiled. Late-model cars won’t do the trick, he said. In the early 1970s, auto manufacturers began installing catalytic convertors that filter out as much as 99 percent of the carbon monoxide from exhaust fumes. You might cough, but you’re not likely to die. Other do-it-yourself methods can be even more problematic. Luley described some of the people who, having failed in their own suicide attempts, had contacted Dignitas to finish the job. “One lady jumped eight stories down to a paved parking lot. Now she is in a wheelchair. Then there was a man who shot himself in the face, but survived. Another leapt in front of a train and lost both his legs.” Dignitas exists to prevent these outcomes, to see to it that those wishing to kill themselves may do so without fear of pain or failure. The fact that most people lack legal access to a death like this is the group’s organizing principle. “Our goal is to make ourselves obsolete,” Luley said. “It should no longer be that one has to travel from his home country to Switzerland to end his life.” If you do go to Switzerland to end your life, you might meet a man I will call Arnold, who asked that I not use his real name. I found him chain-smoking at a picnic table by the goldfish pond. He was short, with gray stubble and greasy hair swept back from his forehead, and he looked disheveled in a blue polyester shirt and dirty shorts. Since starting with Dignitas in 2004, Arnold guessed he had helped perhaps 200 people kill themselves. Maybe more. He could not be sure of the number. The first was a former British military officer suffering the pains of old age. “He was quite a humorous old man,” Arnold remembered. “He told us about his life, that he was in Palestine, that he was in Burma.” Arnold and the officer had passed the day together smoking cigarettes and talking until, late that night, the man drank the poison. Afterward, Arnold went dancing. “I could not go to sleep,” he said. “I could only go out and dance.” He did so again after his next several “accompaniments” —Dignitas’s term for the assisted suicides it conducts. He told me it was his way of giving expression to a feeling he had experienced through his proximity to death. “There’s a connection between human beings. Maybe you’re not usually conscious of it, but there’s something that connects us. You’re not alone, even if you feel alone.” Any remaining doubts Arnold may have had about Dignitas quickly evaporated. “I think it’s good that people are going in a safe way,” he said, “and that’s why I do this work.” The owners of Arnold’s apartment building think otherwise. In October 2008, Swiss television aired a documentary about Dignitas in which Arnold was shown handing a cup of sodium pentobarbital to an American man suffering from a motor neuron disease. His landlords responded by changing the locks on his apartment. Arnold was not surprised by their reaction. “There are forces that want to stop us, mostly from the religious corner,” he told me. “It’s very difficult to discuss this with them.” Discussing this practice with anyone can be difficult, not just because of differences in religious or moral values but for the sheer range of terms used to describe it. The variations include assisted suicide; physician-assisted suicide; euthanasia by action; euthanasia by omission; passive euthanasia; active euthanasia; voluntary euthanasia; involuntary euthanasia; voluntary passive euthanasia; involuntary passive euthanasia; voluntary active euthanasia; and involuntary active euthanasia. To these, add ideological slogans like “the right to die,” “dying with dignity,” and “end-of-life decision-making.” This multiplicity of terms is the fruit of more than 2,000 years of argument, during which opinions have shifted dramatically. Assisted suicide did not always carry the stigma it does today. It was an accepted practice in the ancient world. Athenian magistrates stockpiled poisons for their citizens, with the admonition “If your life is hateful to you, die; if you are overwhelmed by fate, drink the hemlock.” The Hippocratic Oath, written sometime between the fifth and third centuries B.C., pledged doctors to refrain from hastening the deaths of their patients and specifically prohibited the prescription of fatal drugs. The oath was a seminal development in the ethics of medicine, but was ignored by most ancient physicians. Only hundreds of years later, with the rise of Christianity and its belief in the sanctity of human life, did attitudes toward euthanasia swing decisively in the other direction. By the 12th century, mercy killing was opposed throughout the Western world. Thomas More’s Utopia, published in 1516, reinvigorated debate with its vision of a society in which “the magistrates and priests do not hesitate to prescribe euthanasia,” and where the sick “end their lives willingly, either by starvation or drugs.” Later, during the Enlightenment, thinkers like Francis Bacon, David Hume, and Montesquieu, among others, also defended the practice, though their writings did little to alter the prevailing wisdom. The modern argument over euthanasia began only in the 19th century with the advent of medical anesthetics like ether and morphine. In 1870, a schoolteacher named Samuel D. Williams delivered a speech to the Birmingham Speculative Club in England. He argued that, for patients suffering from terminal illness, physicians should use chloroform not only to relieve pain, but to “destroy consciousness at once, and put the sufferer to a quick and painless death.” His comments were later collected into a book that received favorable attention from prestigious political and scientific journals and inaugurated a period of spirited discussion, in both Europe and the United States, over euthanasia’s potential to cure certain social ills. Scientific rationality was the byword of the age. Darwin’s theory of evolution had itself evolved into the sociological notion of “survival of the fittest.” Euthanasia promised the possibility of a healthier and more productive society, free from the burden of caring for its weakest members—the sick, the old, and the mentally ill. In 1906, two bills introduced in the Ohio legislature called for the legalization of euthanasia for terminally ill adults and for “hideously deformed and idiotic children.” They were voted down. [rc] Click here to continue reading Bruce Falconer, a former reporter for The Atlantic and for Mother Jones, is the associate editor of The American Scholar. Copyright © 2010 by The Atlantic Monthly Group.