Mr. Silvan Luley:

I will make a point regarding demographics, and the rise in numbers of assisted dying cases in most jurisdictions that have legalised one or another form of assisted dying. We should not overlook the fact that the population is growing in most countries. We now have people coming to an age where they face more health problems. They are a generation that has grown up in a society where they are more used to deciding for themselves what happens in their lives. Naturally, they are also inclined to that culture. The baby boomers are now coming to an age where they simply say, "Well I have decided what my life goes like all of my life, and it is natural for me to also decide about the end of my life." That of course was different 50 years ago,100 years ago or even 200 years ago. The image of "my doctor knows best" or "the state knows best what is good for me" is crumbling. More and more people say they will decide for themselves and lead their lives the way they want, within the legal framework, and this includes deciding about their end-of-life choices. The rising number of assisted deaths has very much to do with a change in the culture of how we live today.

As for people who sign up and change their minds, there are a few nonprofit organisations like Dignitas here in Switzerland. The two largest and oldest right to die or end of life choice groups are the two EXIT organisations: EXIT Deutsche Schweiz in the Swiss-German part of Switzerland; and EXIT for the Swiss-French region. Together, these organisations now have more than 170,000 members. The number of people making use of assisted suicide is at this time approximately 1,400 per year. Many more people sign up with an organisation like Dignitas than actually apply for assisted suicide, and finally make use of it. It is like a multilayered system where people sign up, like an insurance. I am part of the nonprofit organisation that actually provides this option and advice on all aspects of end of life. It is seen like an insurance, like one has health insurance or home insurance and so on. People sign up who might never need to use the option in their lives. That is how it works. Once people apply and they request a preparation of an assisted suicide and hand in their documents, all through the process they can say that they will no longer continue. People request it, but do not hand in all of the documents. They pause it and at a later stage hand in additional documents.

I will give an example. I have been taking care of a gentleman in Spain who has been a member of Dignitas for 19 years. He suffers from excruciating pain due to massive back problems and some other health issues. He has his ups and downs and all through the years he has made contact with Dignitas asking, "Is it still possible in Switzerland?" We say, " Yes". He replies, "Here are some new medical reports that show the development of the situation; I will try that treatment now and maybe try surgery". All through the years he kept continually updating his file, along with the development of his suffering. This is how it works.

The same applies to the process here in Switzerland, where people apply for assisted suicide and say, "Here is my application, here is my request." They hand in some documents and then at some point they might get a provisional green light from a Swiss physician saying, "Yes, I basically agree with this request and would be ready to write a prescription for the lethal medication." That provisional green light is then communicated to the person. In 50% of cases in which someone gets that provisional green light - the emergency exit door, as we sometimes call it - the person does not make use of the assisted suicide. In the second part of the procedure, which involves talking to the doctor on two occasions and then actually coming to Dignitas and making use of the option for Swiss people at home, even then, up to the last moment, there are still people who say, "Thank you for giving me the assurance that this possibility has started; I will get professional help when I want to end my suffering", and then they continue living. There is the connection with the quality of life. They may find something that improves their quality of life.

One important factor, for example, is palliative care. There is a big misunderstanding around palliative care, that it is only about pain control for cancer patients towards the end of life. That is only one small part of palliative care. It goes far beyond that. We should install a healthcare system that not only gives choice to people but also provides many options from which people can choose. On top of that, we have to educate the public that these options are available without prejudging what is better or what is worse. Then more people will have a basis on which to say they will use this path to maintain their quality of life until the end. Then they might not need an assisted death at all. That is what we see here in Switzerland. Most patients, especially cancer patients, turning to us are already on palliative care, and we encourage them to make use of palliative care. Then they have two ways out and, depending on the development of their suffering, they can either opt for palliative care and go along that route or opt to make use of assisted suicide. This then connects again with good care in age, with hospice care and mobile palliative care teams to take care of people at home.

All these things soothe the suffering of the individual in order that the individual, embedded in his or her social field and family and friends or in a care home or whatever it may be, has options without anyone prejudging and saying that one option is better than the other one or people should make use of this before they are allowed to make use of that. If we do away with that and offer this full package of respect for the individual and options to soothe suffering, then we are there and there is the maximum to do it. Assisted dying is just one element in the concept of soothing suffering.