Radio: An Instinct for Kindness

26 March 2018

BBC Radio 4, available via the iPlayer until 30 March 2018

The powerful and personal account of how Chris Larner was asked by his ex-wife if he would accompany her to Dignitas to die when her illness became too much for her to bear. Adapted from his one man stage show.


Job: Post-doctoral fellowship in transplantation

22 March 2017

Post-doctoral fellow 100%
Institute of Nursing Science, Department Public Health,
University of Basel, Switzerland
Spring 2017 (or as per agreement) –2021

The Institute of Nursing Science (INS) of the Department Public Health at the University of Basel invites applications for a position of a post-doctoral fellow to join the Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) Research Group and the Psychosocial Interest research Group (PSIG) of the Swiss Transplant Cohort Study (STCS). The BRIGHT study is an externally funded international research project studying behavioral and health system outcomes in solid organ transplantation. The STCS is funded through the Swiss National Science Foundation and is a national cohort study including a comprehensive dataset of biomedical, psychosocial, behavioral and genetic data from pre-transplant to up to 9 years post-transplant. The successful candidate will be part of the interdisciplinary international research group analyzing the data of these 2 studies as well as participate in the preparation and execution of planned intervention studies.

Your tasks
The successful candidate is expected to:
– Participate in the analysis and dissemination of the BRIGHT and STCS data.
– Develop your own research projects using existing BRIGHT & STCS data.
– Participate in the planning and execution of intervention studies.
– Acquire external research funding.
– Participate in teaching in the Master in Nursing Science and PhD Health Sciences curriculum.

Your profile
– PhD in Nursing Science, Public Health, Medicine, Health Economics or another field of the health sciences.
– Experience in the field of transplantation and behavioral/psychosocial science is desirable.
– Sound knowledge of basic office (e.g. Word, PowerPoint) programs.
– Sound methodological and statistical skills and knowledge of statistical analysis software such as R, SAS or SPSS.
– Proficiency of German or willingness to learn German in a short term.
– Excellent oral and written English skills.
– Outcome oriented, a good team player, able to meet deadlines and be stress resistant.

Our offer
The successful candidate will:
– benefit from being part of an international interdisciplinary research group and work closely with leading researchers in the field of transplantation.
– benefit from the well-established INS research infrastructure as well as from the infrastructure of the University of Basel.
– have the opportunity to develop own research projects and get support in view of statistical, behavioral science and intervention research methodologies.
– work in the heart of Basel.
– receive compensation in accordance with the University of Basel wage scales for post-doctoral students.

Further inquiries and application
More information on this application can be received from Professor Dr Sabina De Geest (PI BRIGHT study & chair PSIG of the STCS) sabina.degees [at] unibas.ch.
Please send your application in a single electronic document by March 31 2017 to bewerbung-nursing [at] unibas.ch. Your application must include a letter of interest (max. 700 words), curriculum vitae, a statement of research interests (max. 200 words) and details of three referees.


Radio: When assisted death is legal

19 February 2013

BBC World Service

Episode 1: Tuesday 19 February 2013 at 9.05, 13.05, 16.05, 20.05, Wednesday 20 February at 02.05, Saturday 23 February at 19.05, Sunday 24 February at 13.05, also available via the iPlayer

Episode 2: Wednesday 20 February 2013 at 9.05, 13.05, 16.05, 20.05, Thursday 21 February at 02.05, Sunday 24 February at 22.05, also available via the iPlayer after first broadcast

From the programme’s website: “The debate over assisted suicide and euthanasia is a passionate one. But as the discussions continue to rage around the world, there are a few places where assisted death is already legal. Switzerland, Belgium, Luxembourg, the Netherlands, and Oregon and Washington States in the US all have laws permitting assisted suicide or euthanasia in some form. In this two-part documentary for the BBC World Service, actress and broadcaster Liz Carr goes on a personal journey to all six places to see how it works. As a long-standing campaigner against assisted suicide legislation in the UK, she wants to find out what assisted death means in practice – and whether she’s right to be concerned. In part one, Carr travels to Switzerland, where she visits the rooms where volunteers help people die, and finds out why the Swiss law on assisted suicide goes back to the 19th Century. In Belgium she meets a doctor who admits to performing euthanasia before it was legal; and in Luxembourg, she finds out why the law on assisted suicide nearly caused a constitutional crisis. Carr questions whether it is possible to balance the right of the individual who wants to die with the responsibility of society to protect those who don’t. … In part two, Carr visits the Netherlands, where she meets the group behind the ‘mobile euthanasia units’ which hit the headlines last year, and asks whether a law on voluntary life-ending procedures might open the door to involuntary ones. She also visits Oregon and Washington State in the US, where she finds out who is most likely to use the Death with Dignity law, and hears about the cancer patient whose health-care plan refused to pay for chemotherapy – but offered assisted suicide instead.”

In the first episode, Carr states that in Belgium, only euthanasia (termination of life on request) is lawful, and that assisted suicide is therefore not practised (lawfully). It is correct that in Belgium, the Euthanasia Act 2002 allows only physicians to perform euthanasia (understood in the Netherlands as termination of life on request). Assisted suicide is not explicitly covered, but Belgium’s oversight body, the Federal Control and Evaluation Commission (Commission Féderale de Contrôle et Évaluation or CFCE), accepted early on that cases of assisted suicide fall under the law (Commission fédérale de contrôle et d’évaluation de l’euthanasie, Premier rapport aux chambres legislatives (2002–2003), 2004, pp 13–14). Cases of assisted suicide are now reported to the CFCE and reviewed in the same way as cases of termination of life on request. In 2010-2011, eight such cases were reported (out of a total of 2086 cases) (Commission fédérale de contrôle et d’évaluation de l’euthanasie, Cinquième rapport aux chambres legislatives (2010–2011), 2012, p 17).


News: Switzerland decides against regulating assisted suicide

26 July 2011

The Swiss process of reviewing the legal regulation of assisted suicide has ended with a decision by the Federal Council not to regulate either organised assisted suicide or ‘suicide tourism’, as was originally proposed in 2009. The Federal Council reached the view that the practice of assisted suicide is already adequately regulated through the Penal Code, the Therapeutic Products Act, the Narcotics Act and professional rules. The Federal Council described continuing goals of suicide prevention and promotion of self-determination at the end of life including the choice of palliative care rather than assisted suicide:

the Federal Council wishes to continue to support the prevention of suicide, palliative care, and the care and treatment of people with terminal, life-threatening and chronic illnesses. The focus is on improving self-determination at the end of life. To this end, the public should be made aware of the alternatives to suicide.


News: assisted suicide in Switzerland on the KCLMEL blog

12 June 2011

The law and practice of assisted suicide in Switzerland will be much discussed this week following the broadcast of Terry Pratchett’s documentary. Earlier posts have discussed the Swiss government’s plans for reform of the law, and a recent court decision allowing the defence of necessity in a case of euthanasia (termination of life on request).

The DPP’s policy on prosecuting cases of assisted suicide, including cases in which the assisted suicide takes place in Switzerland, has been discussed in a series of posts, the links to the most recent of which can be found in this post on the Caractacus Downes case. Earlier posts on the interim policy and the Purdy case can be found by scrolling through the posts tagged ‘Switzerland’.


TV: Terry Pratchett: Choosing to Die

7 June 2011

BBC Two, Monday 13th June, 9pm-10pm, followed by Choosing to Die: Newsnight Debate, BBC Two, Monday 13th June, 10pm-10:30pm

From BBC News: “British author Sir Terry Pratchett is to participate in a BBC Two documentary about assisted suicide, it has been announced. The Discworld writer will travel to a Dignitas clinic in Switzerland with a 71-year-old who suffers from motor neurone disease. Sir Terry, who was diagnosed with a form of Alzheimer’s in 2008, said he was “a firm believer in assisted death” and wanted to learn more about it. …

“I believe everybody possessed of a debilitating and incurable disease should be allowed to pick the hour of their death,” Sir Terry said. “And I wanted to know more about Dignitas in case I ever wanted to go there myself.”

Last year, a UK inquiry into the issue of assisted dying was launched with funding from Sir Terry [the Commission on Assisted Dying].

The BBC’s commissioning editor for documentaries, Charlotte Moore, said: “Assisted death is an important topic of debate in the UK, and this is a chance for the BBC Two audience to follow Sir Terry as he wrestles with the difficult issues that many across Britain are also faced with.”

The documentary will also see the writer explore how different European countries deal with the issue.”

In the Newsnight special debate which follows, “Jeremy Paxman talks to Terry Pratchett about his documentary, and a panel of studio guests debate the issues surrounding assisted death.” (from the Radio Times)


Conference: call for conferences to be organised at the Foundation Brocher

11 February 2011

ORGANIZE A ONE AND A HALF DAY PLURIDISCIPLINARY SYMPOSIUM
OR A TWO, THREE OR FOUR DAY PLURIDISCIPLINARY WORKSHOP
on the ethical, legal and social implications of the development of new medical technologies

Take advantage of a uniquely located Conference Room at the Brocher Centre in the middle of a peaceful park on the shores of Lake Geneva
Have the opportunity to invite experts from numerous International Organizations & Non Governmental Organizations based in Geneva (WHO, WTO, WIPO, UNHCR, ILO, WMA, ICRC, …)

THE BROCHER SYMPOSIA

The Brocher Foundation is inviting junior and senior researchers to submit proposals for a 1.5 day multidisciplinary symposium project on the ethical, legal and social implications of new medical developments.
The fully equipped Brocher Centre Conference room – situated in Hermance, 15 kilometers from Geneva, Switzerland — can host up to 60 participants in an exceptional location on the shores of Lake Geneva.
The Brocher Foundation will host the event and cover :
• Accommodation for a maximum of 12 speakers
• Grant of 11,000 Swiss francs for travel expenses
• Lunches, coffee breaks, one official dinner for a maximum of 52 participants (including speakers).
• Possible support for a publication issued from the symposium upon agreement with the Foundation.
The Brocher Foundation will organize all the logistics.

THE BROCHER WORKSHOPS

The Brocher Foundation is inviting junior and senior researchers to submit 2 to 4 day proposals for a workshop on the ethical, legal and social implications of new medical developments.
The Brocher Foundation will host the event between 1 November 2012 and 31 January 2013 at the Brocher Centre and cover:
• Accommodation for a maximum of 16 participants in the “Villa Brocher”,
• Grant of 11,000 Swiss francs for travel expenses
• Lunches, coffee breaks and dinners for a maximum of 26 participants.
• Possible support for a publication issued from the symposium upon agreement with the Foundation.
The Brocher Foundation will organize all the logistics according to its high standards.

TOPICS FOR THE YEAR 2012

Ethical, Legal & Social Implications of recent medical research and new medical technologies :

Among the following disciplines

Bioethics, Health Anthropology, Health Economics, Health Governance, Health Law, Health Philosophy, Health Psychology, Health Sociology, Medical Ethics, History of medicine.

Ethical, Legal & Social Issues on the following topics (non-exhaustive list):

Access to medicines, Biobanks, Biosecurity and Dual Use Dilemma, Clinical Trials and Research on Human Subjects, Genetic testing and screening, Health Care Reform, Nanotechnology, Neglected disease, Pandemic planning, Reproduction & Technology, Stem Cells, Transplantation.

For further details, see the Fondation Brocher website. The deadline for submission is 21 March 2011.


News: Switzerland court allows defence of necessity in a case of termination of life on request

29 December 2010

While the legal position of assisted suicide in Switzerland is well-known, termination of life on request has been less discussed. In addition to the offence of murder, some civil law jurisdictions have a separate, lesser offence of consensual homicide or termination of life on request. This is the case in Switzerland, where Article 114 of the Penal Code provides that: ‘Every person who shall for honourable reasons, especially mercy, kill a person on his or her serious and pressing request, shall be liable to imprisonment.’

In 2009, Daphné Berner, a retired physician who was a member of the organisation Exit, terminated the life of a woman with Amyotrophic Lateral Schlerosis (ALS) who had, subsequent to her repeated requests for assistance with suicide, lost the ability to perform the suicidal act herself as a result of a sudden deterioration in her condition. The judge in Neuchâtel found that it “would have been cruel not to act” and that the defence of necessity was applicable to the defendant’s actions and therefore acquitted her.

The decision may have limited value as a precedent as the judge found it significant that the defendant’s initial intention had been only to assist a suicide; the termination of life on request was not “premeditated”. Moreover, the decision is likely to be appealed by the prosecutor to the Tribunal fédéral, and until then it is not in force.

Update (4 January 2011): the prosecutor has decided not to appeal but he stated publicly that the decision of the Neuchâtel court would not be binding on other courts.


News and Comment: first application of DPP’s Final Policy on assisted suicide

19 March 2010

In the first case in which the DPP’s Final Policy on Prosecutions for Assisted Suicide has been applied, the DPP has decided that it would not be in the public interest to prosecute Caractacus Downes, the son of Sir Edward and Lady Joan Downes.

In July 2009, the conductor Sir Edward and his wife Lady Joan ended their lives at the Dignitas clinic in Zurich. Sir Edward was described as “almost blind and increasingly deaf” in a statement released by the couple’s children, while Lady Joan was described as “terminally ill”.

Following a police investigation, senior Crown Prosecution Service prosecutors determined that no public interest determination was necessary in relation to the couple’s daughter, Boudicca — who lives in Rome and met her parents and brother in Zurich — as “there is no evidence that she undertook any act in England and Wales that could have assisted her parents in committing suicide.”

The CPS found that the couple’s son, Caractacus, had booked a hotel room in Switzerland for his parents before leaving England with them and accompanying them to Zurich.

“We have considered carefully whether these acts can properly be characterised as assistance for the purposes of section 2(1) of the Suicide Act 1961. Whilst we recognise that some may take a different view, we are satisfied that, taken together, such acts are capable of constituting assistance. As Mr Downes fully accepts that he undertook those acts, there is sufficient evidence to provide a realistic prospect of conviction for an offence contrary to section 2(1) of the Suicide Act 1961 in accordance with the Full Code Test, as set out in the Code for Crown Prosecutors (the Code).”

Thus the CPS then considered whether such a prosecution would be in the public interest, applying the factors from the Final Policy:

“With regard to factors tending in favour of prosecution, it is clear that both Sir Edward and Lady Downes were able to undertake the acts that Mr Downes undertook on their behalf.

However, with regard to factors tending against prosecution, it is also clear that Sir Edward and Lady Downes had each reached a voluntary, clear, settled and informed decision to commit suicide.

In the context of those decisions and the steps taken by Sir Edward and Lady Downes to give effect to their decisions, the actions of Mr Downes, although sufficient to come within the definition of the offence, were very much only of minor assistance.

The evidence and information available indicates that Mr Downes was wholly motivated by compassion.

The police have confirmed that Mr Downes reported his parents’ suicide to them through his solicitor and that he fully assisted them in their enquiries into the circumstances of his parents’ suicide and his part in providing assistance.

There is information to suggest that Mr Downes has benefited financially from the death of his parents as a result of their wills. It might be said, as a result, that it is difficult to conclude that he was wholly motivated by compassion in giving his parents the assistance that he did.

The relationship between compassion and financial gain is considered in paragraph 44 of the Policy. There, it is recognised that a suspect may gain some benefit from the resultant suicide of the victims. The Policy states that the critical element to consider is the motive behind the suspect’s act. If it is shown that compassion was the only driving force behind his actions, the fact that the suspect may gain some benefit will not usually be treated as a factor tending in favour of prosecution.

Having reviewed all the available information, we have concluded that this is a case where the only driving force behind Mr Downes’ actions was compassion. Accordingly, we do not regard the fact that he stands to gain financially in accordance with the terms of his parents’ wills as a factor tending in favour of prosecution in this case.

Having assessed the public interest factors in accordance with the Code for Crown Prosecutors and the Policy for Prosecutors in respect of Cases of Encouraging or Assisting Suicide, we are sure that the public interest factors tending against prosecution outweigh those tending in favour. As a result, consent has not been given to the bringing of a prosecution against Mr Downes for his part in the suicide of his parents.”

The decision is unsurprising, given the large number of similar cases in which no prosecution has been brought. It is interesting, though, that no mention was made by the DPP of factors 4 and 5 against prosecution:

4. the suspect had sought to dissuade the victim from taking the course of action which resulted in his or her suicide;

5. the actions of the suspect may be characterised as reluctant encouragement or assistance in the face of a determined wish on the part of the victim to commit suicide;

As I have recently written in the Solicitors Journal, these two factors

“encapsulate an idealised scenario that involves an unwilling ‘suspect’ and a determined ‘victim’ . . .

No reasons for the inclusion of these factors have been provided, although they were supported by two thirds of consultation respondents.

What if the suspect is fully supportive of the victim’s decision, recognising that the victim has reached his or her own decision and agreeing that it is the right course of action for him or her in the circumstances? Does this make prosecution more in the public interest than if the suspect is ‘reluctant’ and sought to ‘dissuade’ the victim? Factor 4 envisages the decision to seek assisted suicide as an unwise or irrational decision from which the person should be dissuaded, or at least suggests that this is how the ideal suspect should react to the decision. The inclusion of these two factors seems to prescribe a certain kind of emotional reaction on the part of a family member or friend to the victim’s condition; for example, not accepting a terminal diagnosis, or wanting the person to remain alive as long as possible.”

It will be worth watching whether these factors are omitted from further decisions on the application of the Final Policy. If they are applied in future cases, it will be interesting to see how this will work.

More difficult cases will undoubtedly emerge, including those where:

  • the assisted suicide takes place within England and Wales
  • the act of assistance is not a minor one
  • a healthcare professional has provided assistance

In relation to the latter, a decision is expected next month in the case of Dr. Michael Irwin, who paid for his patient Raymond Cutkelvin’s flight to Zurich. Dr. Irwin was also involved in the earlier assisted suicide of Patrick Kneen.


News and Comment: Switzerland considers plan to restrict suicide tourism

29 October 2009

In Switzerland, assisted suicide is criminalised only where the assister’s motive was selfish rather than compassionate. (Penal Code, Art. 115).  When it was originally drafted, medically-assisted suicide for the terminally ill was not envisaged as a possible use of the relevant article of the Penal Code: “the whole discussion did not envisage assisted suicide from a medical perspective. Instead, it was inspired by romantic stories about people committing suicide in defence of their own, or their family’s, honour and about suicides committed by rejected lovers.” (Olivier Guillod & Aline Schmidt, ‘Assisted suicide under Swiss law’ (2005) 12 Eur. J. Health L. 25, 29 (Shibboleth login required)). However, the current use of the Penal Code provision is well-known, and for some time the Swiss Government has been troubled over the increase in suicide tourism. The Swiss Minister of Justice has now announced plans to send two different draft bills to Parliament for debate. The option favoured by the Government would regulate the practice of organised assisted suicide (currently by Exit Deutsche Schweiz, Exit ADMD (Association pour le droit de mourir dans la dignité), Dignitas and Exit International). The regulation proposed focuses on ensuring an informed, voluntary and well-considered request for assistance in suicide including a mandatory discussion of alternatives; independent medical certification of capacity; independent medical certification of a terminal illness; medical involvement in the prescription of the drug used; and provisions to ensure that assisted suicide is non-commercial and that only costs and expenses can be recovered. The explicit aim of the proposals is to prevent “the negative aspects and abuse of organised assisted suicide . . . and [to reduce] ‘suicide tourism’ . . .” The terminal illness requirement would be a new one for the Swiss, although it finds a precedent in the Oregon legislation (and the UK Assisted Dying for the Terminally Ill Bill). The press release observes that:

“This would rule out organised assisted suicide for those with chronic illnesses that are not in themselves terminal, and for those suffering mental illness. Comprehensive treatment, care and support, in the sense of palliative medicine, should allow these people to continue to live in dignity.”

Certainly such a requirement would have prevented some of the British persons who have recently obtained assisted suicide in Switzerland from doing so, including Daniel James and Sir Edward Thomas Downes. The requirement of medical involvement in the prescription of the drug used appears to be aimed at Dignitas, which, according to media reports, has recently been using helium (which does not require medical involvement) to assist in suicide, in order to avoid local regulation in the canton of Zürich requiring that non-residents seeking assistance in suicide have at least two interviews with the doctor who prescribes the lethal medication. Apparently because of a split in the Government, a second and much more radical option has also been tabled: a complete ban on organised assisted suicide. According to the press release:

“This option rests on the belief that individuals working in assisted suicide organisations are never actually motivated by purely altruistic reasons, and may develop a close relationship with the suicidal person.”

The May 2009 Federal Department of Justice and Police Report on Organised assistance with suicide, which led to the current proposals, is available in French, German and Italian. The Times believes that the move will “set off a rush of patients from Britain and elsewhere in Europe since Switzerland has become the main destination for those seeking assisted suicide.” As approximately 75% of all assisted suicides in Switzerland are cases of terminal illness, this may be an over-statement. Terminally ill patients will not be hugely affected by the proposed regulatory changes of the preferred option. However, this proportion does seem to be falling, and this is clearly of concern to the Swiss Government who view the liberalisation of the criteria used by Dignitas and Exit Deutsche Schweiz as a worrying development (Report, §2.1). The data here is from Fischer et al., ‘Suicide assisted by two Swiss right-to-die organisations’ (2008) 34 J Med Ethics 810-14, Tables 1 & 4 (Shibboleth login required), which is cited in the Report, §2.1, n. 17.