Mr. Silvan Luley:

In Switzerland, there has never been a real expansion or an organisation which pushed towards extending end-of-life choice beyond assisted suicide to voluntary euthanasia.

Occasional discussions have flared up here and there but nobody or no organisation has pushed for that. It might have to do with the cultural background. Switzerland might sound strange and it is a strange kind of country. On the one hand, we are a very conservative country and, on the other, it is a very individual freedom-orientated country. The culture is: “If you want to make use of assisted suicide, do whatever you want, but leave me alone and do not do it in my back garden.” That is the general approach. It is very much a thing that if you want to do something, you do it yourself. People may reach out to the assistance of third persons, like doctors or an organisation like Dignitas, but at the end of the day, self-responsibility is very much connected to self-determination and freedom of choice. This may be an explanation for why voluntary euthanasia has never been that much of an issue.

It is discussed here and there, and groups and people would say that assisted suicide has its limits. For example, people with dementia might be able to live longer if voluntary euthanasia was possible for them. They might live beyond the point of losing mental capacity, when they would not be eligible for assisted suicide anymore, but if voluntary euthanasia were possible, that would be an emergency exit door. That is true, but there is also, of course, the possibility to make an advance healthcare directive in which people rule that if they lose capacity due to dementia, they do not want their life prolonged. While it is not 100% the same, there is a solution within that.

There has not been that much discussion around expansion of eligibility criteria because the very base of the legal framework and the understanding within society is that this is a freedom of choice thing - it is your personal choice, your personal decision what you do with your life, and the end of life, of course, is included in that. In this regard, there has been little discussion. It was not that we had a development where at the beginning we would say only people with terminal illness, such as terminal cancer, who are supposed to die within a few months, should be eligible for assisted suicide, and we then went on from that to expand it into other fields. That did not happen. I want to keep this simplified as, otherwise, it would be a long discussion, but it was always a freedom of choice thing. That extends beyond people with terminal illness and is around suffering, self-determination and choice.

On the last question about family, we push our members and we bring that in during all discussions. I would stress this very much and ask the committee to take note of it. It is the most vital thing. The big difference between this and violent suicide is that with assisted dying, you can prepare the death, you can prepare the end of life. This preparation process, by getting out of the taboo and getting out of illegality, allows for the patient to include family and friends. It is a process in which everyone together goes to prepare for the goodbye. That is the stark difference to a violent suicide, where the person would not talk with his family and friends and they would be left behind with more questions than answers. Some 98% or 99% of all assisted suicides that Dignitas conducts are in the presence of family members and friends.

We always motivate them to be involved in the preparation process and to be there in the last moment. Here in Switzerland, assisted suicides take place at the family home of the person, with the wife and children there. Everyone the person decides should be there, including friends, is there. This is the way it should be. That would also be possible in Ireland if assisted suicide was legalised.