The controversy has led to criticism of Germany's low hospice provisionImage: dpa
November 23, 2007
The German branch of a Swiss right-to-die organization has unleashed a storm of protest by saying it is planning to carry out an assisted suicide in Germany. DW-WORLD.DE spoke to Dignitate's deputy director.
A few weeks ago, Dignitas hit the headlines for helping two Germans to die in a car park in Switzerland. The apparently undignified circumstances of their deaths sparked renewed criticism of the controversial organization, which has been accused of treating assisted suicide as a money-making enterprise.
While assisted suicide is legal in Switzerland, German law is much less clear-cut. Uwe-Christian Arnold, the deputy director of Dignitate, the German branch of Dignitas, and himself a doctor, says his group wants to set a legal precedent by carrying out an assisted suicide here in Germany. The head of the German doctors' chamber has called for Dignitate to be banned.
DW-WORLD.DE: Why do you think your plan has created such an uproar in Germany?
Uwe-Christian Arnold: The reason that certain circles get so worked up about this topic is because it was completely taboo for decades. It was linked to euthanasia and the Nazis. Anyone who concerned themselves with this subject was lumped together with the Nazis. No one differentiated between the fact, for example, that no one asked the people who were killed then whether they wanted to die or not. Someone else decided that they should die. That is completely different from what we're planning.
The precondition is that the patient wants to die and that they have legitimate reason to want to end their life. This is quite different from what the Nazis did. Doctors tend to be conservative and the German medical association is particularly conservative because it was closely involved with the Nazis. They have not dealt with this past over the last 60 years. On the occasions they did, it was always very uncomfortable. I don't want to reproach them for the fact that they want to avoid the topic of assisted suicide, but we have to deal with this topic. It is a pressing social need.
Have significant numbers of Germans been traveling to Switzerland to take up the services of Dignitas?
No, the numbers are not very significant. Last year, there were 176 or so assisted suicides in total, 120 of those were Germans. That is a bit of an increase in the numbers of Germans, but it roughly corresponds to that of previous years. And it corresponds to the numbers going to other assisted suicide organizations, in Switzerland and in Oregon. The number of people who decide to end their lives in this way has remained steady.
Why is assisted suicide such a pressing social need?
The majority of people -- 82 percent of the Germans and the same numbers in England, in France, the US and Canada -- are in favor of legalizing assisted suicide. In Oregon it was made legal, but many other American cities want it. And I think Germany should have it. It is a big country and the patients have big problems with this topic.
Is it partly a problem that was created by modern medicine?
It is exclusively a problem of medicine -- high tech medicine -- that for decades has only been concerned with progress and it has notched up fantastic achievements. But it has completely forgotten that death also stands, lurks, at the end of all these strivings. Making this taboo can be very unpleasant for the patient. Many people have the experience that death can be dreadful with high-tech medicine. It can be something as simple as a feeding probe for an old person in a nursing-care home.
Isn't it also partly a problem that the hospice system and palliative medicine isn't sufficient in Germany?
That is a very important factor. But even if we had such good palliative medicine and hospice provision as there is in Scandinavia -- where they have provision for 20 percent of people against our 4 percent -- then there would still be a very small minority who, if they got certain illnesses, would want to be able to determine the time when they die -- and if they can't with the help of a doctor. There are still illnesses that palliative medicine can't help, such as amyotrophic lateral sclerosis and multiple sclerosis.
There are certain preconditions that you have to fulfill to be eligible for assisted suicide. What are they?
You need to have a terminal illness or a serious illness that you can't live with anymore, one that handicaps you so strongly that you can no longer lead a dignified life. In other words, if you're lovelorn or you're suffering from an acute depression, then you won't be able to ask for assisted suicide.
Why are you trying to create a legal precedent here in Germany?
We are looking to set a test case because it is not clear whether a person can be prosecuted if they do not go to the aid of a person who is dying. There are judgments and a statement from the Ministry of Justice that confirms that you can do it under certain conditions, if the person has made the decision freely and that the will of the patient should be placed above the duty to preserve life.
Is it possible to protect this area from abuse?
In other countries, in the United States and, as far as I know, in the UK, things are more advanced. There are ethical committees that meet and when there is an 86-year-old and he has a serious illness and he is due for a big operation, then they will discuss whether he should be operated on or given palliative medicine. A lot more is done to spare people from this hyper-medicine. That should be done more in Germany, too. It should be considered when there are cases where death might be the better solution. You don't have to kill them. You can just leave them. This can be entrusted in the hands of doctors. Of course, it is open to abuse. But this argument is not a good one. Every area in life is open to abuse. Abuse can always happen with or without assisted suicide.
You referred to ethical committees. Do you want to make assisted suicide into something that the state is involved in and remove it from the private sector?
That is the sense of our campaign that we get a sensible assisted-suicide policy in Germany. It shouldn't be the case that this only can be carried out in private. It should be possible in accordance with certain regulations as in Switzerland. In Switzerland, a doctor visits a patient after long and thorough preparation. You can't ring me and say, "Doctor, will you give me a lethal injection tomorrow." That's out of the question. This topic is much too serious and much too sensitive for that.
The chief accusation that has been leveled at Dignitas is that it is trying to profit from people. And that Dignitas demands three times as much money as EXIT, another Swiss-based right-to-die group. What would you say to that?
EXIT has 50 million members and it carried out a constant number of assisted suicides a year, 35, 40 or 50 in a year. They have a certain price. For long-term members it is free and for those who have just recently joined, they take around 2,000 euros ($2,950). I can't tell you exactly, but they take a fee and it is lower than Dignitas. From their Swiss members Dignitas takes 2,000 euros. Only for those coming from abroad, they take more because they have cremation costs, counseling costs that are much higher than for people in Switzerland, who can just go to their local doctor. And then fees have to be paid to the Swiss authorities because costs are incurred by the foreigners. This isn't about making money. Dignitas has a large office and, unlike EXIT, which works with volunteers, it works consciously with professionals.
Do you think you will be successful with your demands?
Something will happen. There has been so much media attention. I think that if we make a test case, then we will see how they react. Only two things can happen. Either people will accept it, as with abortion in Germany. Or we will get a reactionary solution and fall back into the Middle Ages. But I'm hopeful. Because of the churches and the medical association, abortion was also completely taboo here for years, and nowadays we can perform abortion here just like in England and other countries.