Alois Geiger, "Why I Prescribe Drugs for Suicide," Times Online, October 24, 2008. Copyright © 2008 Times Newspapers Ltd. Reproduced by permission.
Alois Geiger is a physician at the Dignitas Center in Switzerland.
Physician-assisted suicide is a compassionate option for those who suffer and have reached a clear decision to end their lives peacefully. While suicide is not the preferred way to end life, it is a perfectly reasonable option. Physicians are in the unique position of being able to prescribe medication that can, in worst cases, make such a peaceful end possible.
Dignitas1 is a good thing, Exit2 of course too. What do you think about this? I know what I am talking about because I am one of the doctors who writes prescriptions for members of Dignitas. A prescription for what? A prescription that allows the person in question to end his life in a pain-free way, free of brutality, and moreover to do so not alone but accompanied by people standing lovingly at his side.
I know that many people disapprove of my activities. These people are convinced that no individual has the right to determine the end of his life. They are also sure that a doctor should never prescribe a medication to end life because he is professionally obliged to save life. The Hippocratic oath is what they have in mind.
The Hippocratic Oath Today
We doctors today do not swear this oath and there is a reason for that—it is largely out of date. For example it forbids the surgical removal of a bladderstone, a sensitive issue in the old days. Today every surgeon can perform this operation without a problem.
The oath also forbids giving abortive medication to a pregnant woman. This used to be a risky matter for mothers because their pregnancies were usually well advanced before the foetus was detected. Nowadays an effective and safe drug can end a pregnancy in the early weeks without a problem. The excision of bladderstones is not immoral and the same can be said for a socially approved termination of pregnancy administered by a doctor.
When it comes to prescribing medication to a patient to help end his life, I view the Hippocratic oath in a similar way. With sodium pentobarbital, NaP, we have a drug that gives us for the first time the possibility of allowing a person to swiftly and gently pass away.
The social rejection of suicide does not so much derive from the Hippocratic oath but rather from Christian traditions.
Religion Is the Biggest Obstacle
And what if there is no God?
The social rejection of suicide does not so much derive from the Hippocratic oath but rather from Christian traditions. Suicide is abhorred by all monotheistic religions. The Christian religion, which has influenced most of us, trusts to God's will in all of life's difficult moments. Only God who gave us life is entitled to take it away, runs the argument. So suicide becomes a sin. But what if this God doesn't exist? For those who do not believe, can there not be arguments for deciding the end of one's life: a life of suffering perhaps, or one blighted by increasing isolation, or the dependency on outside care?
When Is Assisted Suicide Reasonable?
Certainly committing suicide can be pointless. And killing oneself without outside help is always uncertain and usually a violent way of ending life. A suicide does not make sense if it is prompted by a lack of life experience: love sickness for example, financial problems or other accumulated minor woes that have been blown up out of proportion by one's own ego.
How does it look though when an illness occupies more and more space in one's life or when life is coming rapidly to a close ...? Or when one's despair is so enduring that even long-term psychiatric help cannot give real assistance?
Should one not be allowed to make use of medical means to release oneself from suffering? The wish to commit suicide is most understandable when it develops over time, rather than overnight.
Only a doctor with a medical practice can prescribe strong sleeping medication. For me there is no question about writing such a prescription in a tragic situation, knowing that it cannot help his illness but will help him realise his wish for a self-determined suicide.
The wish to commit suicide is most understandable when it develops over time, rather than overnight.
In my experience with would-be suicides it is practically always the case that the mere act of writing out the prescription evokes a sense of great relief in the patient: "At last someone understands me and is ready to help in the way I want. Others want to persuade me that my life is worth living at any cost. But I know better." That is what they say.
Naturally I would rather help a person in a traditional medical way. Sadly that is only rarely the case because I am not a Super-Doctor who can second guess the many medical authorities already consulted by the patient. But I always receive the gratitude of the sick person when I give him the prescription. At that moment they know that they can get something almost unobtainable elsewhere in the world—a suicide, without legal repercussions, accompanied by people, mostly close family.
A Doctor's Obligation
The other day a patient came to me suffering from a spreading neurological disease that was increasingly paralysing his muscles. He lived alone, had no family responsibilities. As a doctor I have seen many people in worse conditions and who nonetheless were ready to carry on living with their suffering and disabilities. Is it my right, or even my duty as a doctor to turn down a prescription for NaP for this man and make it very difficult for him to end his life—just because somebody in a similar situation is prepared to live longer? Does the opinion of other people overrule one's own sense of worth?
Just now, there was another conversation with him. He is not wheelchair-bound yet. With a stick he can still climb a few stairs. He is missing everything that he has lost through illness—his career, his walking, climbing, driving a car. He will not be able to take care of himself much longer, already depends on outside help. And there is the rub—he does not want to be ever more dependent on other people.
It is my duty as a doctor to tell him that there is no shame in being dependent on others, that he should see the good sides of life. I should tell him that everything would change if he could only see that the bottle is half full not half empty. Is it really my duty to treat him like a child in that I deny him the prescription? He needs me for that slip of paper. Is it correct to deny him the indisputably most humane means to determine the end of his life? If I do not help him, do I not play God, taking away from him the option of a gentle and, in his eyes, a rational death?
Someone who does not want to live is seen as clinically ill. He is labelled a depressive and sent to a psychiatrist. Often a psychiatrist really can help. On the other hand there are people who are labelled healthy even though they continue to live because of countless risky surgical interventions and aggressive treatment. Is not this distinction, between healthy and sick, an arbitrary one? Is everyone who is tired of life, because of illness or advanced age, automatically depressed and in need of psychiatric treatment? What happens when anti-depressants stop working? Does one then have to defend him from himself?
I am a gynaecologist and as such help women to give birth. I have helped many children into this world. And I have done so gladly, it has always been an act on the borders of existence, bringing someone new to the world. But it is also part of my job to terminate pregnancies, that is to destroy something that could have led a healthy life. I have done this with less enthusiasm because the decision to end pregnancy is never taken with the knowledge of the creature whose life is about to be ended.
If a person is determined to die, that does not mean he is mentally ill.
Now I am consciously active at another existential borderline, the voluntary exit from this world. I am not saying of course that suicide is the ideal resolution of a life. But it is just as legitimate as soldiering on to the natural end of a life. Both possibilities should exist—neither course is better than the other. And only those directly affected can decide on which way is the best for them.
If a person is determined to die, that does not mean he is mentally ill. Perhaps he simply does not believe in life after death and has drawn concrete conclusions.
Suicide is a human right. But it is vital not just to have that right but to be able to exercise it, with dignity and without using brutal methods. That can only occur with the medical prescription of sodium pentobarbital and with sympathetic human assistance. Suicide-help organisations make this possible.
That is why I am doing what I can to help.
1. An assisted suicide facility in Switzerland.
2. An international assisted suicide information and advocacy organization based in Australia.