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Scotland on Sunday A survey by the University of Zurich of 5,000 deaths in the country found that 51% were a result of ‘end-of-life decisions’. This would mean about 31,000 out of the 62,000 Swiss citizens who die annually were helped to do so by doctors. The study, which looked at a total of 30,000 deaths in six European countries, involved interviewing doctors who signed the death certificates on condition of guaranteeing their anonymity. It is thought a growing number of foreigners travelling to Switzerland for help to commit suicide is boosting the figures. The study, which was carried out in 2001 and 2002 and is the first of its kind in Europe, found Swiss doctors were co-operating with patients’ requests to be allowed to die in several ways. Under Swiss law, doctors are allowed to provide people with the means to end their life as long as the person is deemed to be making a rational decision to die and does it themselves. Those who want to die in this way need to produce records about their illness and a letter explaining why they want to die. They also must have an appointment with a Swiss doctor. In other cases, the survey found doctors administered drugs to alleviate pain, knowing the medication would hasten death, or withheld some treatments to fulfil the wish of a terminally-ill patient to die more quickly. Active euthanasia, where, for example, a doctor personally administers a lethal cocktail of drugs, is illegal in Switzerland, but a small number of doctors admitted to the practice. The Zurich University team of Dr Karin Faisst, Dr Georg Bosshard and sociologist Susanne Fischer said the survey confirmed for the first time what had been suspected about the high numbers of assisted suicides in Switzerland. Bosshard said: "Assisted suicide in Switzerland has not been punishable by law for a long time, and although regulations are in place governing the procedures, we place more emphasis on the wishes of the patient, unlike in Britain. "The results were not particularly shocking and most people involved in the study expected them to be around that level. In Switzerland the subject is widely discussed, but there are many other countries in Europe, including Britain, where I believe more inroads need to be made. "Doctor support for euthanasia is split, although there are more physicians who are in favour of some form of assisted suicide. General public opinion is certainly for the practice, with at least three-quarters of the country in favour." "Assisted suicides will probably increase in other countries in the future too, although I believe the results of the Swiss study will probably remain at this level for some time, without drastically increasing." Bosshard, who is a member of the Swiss Academy for Medical Sciences, said the practice of euthanasia always had to come down to individual cases. He said: "I don’t think you can necessarily label the practice good or bad. Each individual case has to be looked at carefully." The other countries studied were Belgium, Denmark, Italy, the Netherlands and Sweden. Active euthanasia, which is illegal in most EU countries except the Netherlands, is still rare or hidden. Almost 3% of deaths in Holland involved doctors administering lethal drugs to patients who wanted to die compared with 0.27% in Switzerland. Bosshard said: "The Netherlands has the highest number of active euthanasia cases, and I thought Switzerland would have a similar number, but this was not the case. On the other hand there are more cases of passive euthanasia in Switzerland." Faisst, of Zurich University’s Institute for Social and Preventative Medicine, said even in Switzerland the medical profession did not like to talk about helping people to die. "The doctors often feel they are on their own, and some are unhappy about even discussing it," she said. "It may be that this research will help promote more dialogue involving doctors and the public." The small Alpine country’s reputation as a leading advocate of assisted suicide grew with the setting up of a number of private organisations that offered to help people to die. Dubbed ‘suicide tourism’ the number of people visiting the organisations from Switzerland and abroad has drastically increased over the past few years. There is now concern that the trend is causing an image problem for the country. Zurich’s chief public prosecutor Andreas Brunner said: "Switzerland is one of the only countries in Europe to have such liberal laws on euthanasia. "There is probably a good reason why other nations do not have such a law and as such those countries’ citizens should not be allowed to travel abroad for something that is illegal in their own country. "Before long the only reputation Switzerland will have is as a country to come to die in." He added that he was not against the practice of euthanasia in general but that it should not be open to people coming from abroad. "I would like to see a law that allows only Swiss citizens to appeal for assisted suicide," said Brunner. A Swiss group called Dignitas, which pledges to help anyone who wants to "die with dignity", has created headlines throughout the world. Ludwig Minelli, its general secretary, said he found the proposal to limit euthanasia to Swiss citizens offensive and blatantly prejudiced. He said: "The whole thing is ridiculous." The proposal mirrored the country’s isolationist foreign policy during the Second World War, he claimed. "Switzerland closed its borders and sent those who had come to this country for refuge back to their own countries, where many were persecuted and sent to concentration camps," Minelli said. "The public prosecutor’s office now wants to send terminally ill foreigners back to their own countries where all they face is misery and painful deaths." Minelli, who by profession is a lawyer, added: "Our founding principal is that everybody has the right to put an end to their life if their suffering is unbearable and there is no hope of relief." He added he hoped the example they were setting in Switzerland might lead to a more liberal view on euthanasia in other countries.
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