Swiss Group Serves Grim Task
By Providing Visitors' Suicides

ZURICH -- Last Thursday, Marie Hascoet didn't bother combing her hair.

That morning, the 66-year-old Frenchwoman, a resident of Paris, sat quietly in a seedy hotel cafe here. She drank coffee and smoked one of her last cigarettes. Then she pulled out a pair of scissors and cut her credit card in two.

She wasn't going to be needing it. In about two hours, the cancer-ridden, pain-racked Ms. Hascoet intended to end her life.

"I don't want to be a vegetable anymore," she said calmly, in French. "I just hope that my death will help change the law in France."

Until recently, Switzerland stood for years as the only Western nation in which assisted suicide was officially tolerated and commonly practiced. Part of the practice was an unofficial code upheld by the several long-established euthanasia groups in the country: to accept only Swiss clients.

But an organization called Dignitas has taken the practice a controversial step further by enabling non-Swiss clients to end their lives in Switzerland. Since 1998, Dignitas has assisted in nearly 140 suicides, about 80% of them citizens of other countries. Dignitas clients have traveled from Britain, Egypt, Israel, Lebanon and the U.S. Many are from Germany, where the practice is banned partly because the country is still haunted by the euthanasia experiments conducted under Hitler.

Swiss authorities fear that their nation will turn into a hub for what officials have called "suicide tourists." In September, a member of the Swiss Parliament proposed legislation that would ban foreigners from taking advantage of the country's tolerance.

"It's not good if Zurich becomes known as the city to die in," says Andreas Brunner, a prosecutor for the canton of Zurich, who monitors and frequently criticizes the activities of Dignitas.

In the U.S., Oregon is the only state that allows physician-assisted suicides, but its statute is under constant attack. Last month, the U.S. Supreme Court turned down an appeal by Jack Kevorkian, the Michigan doctor who is serving a 10 to 25 year sentence for helping a terminally ill man die. Dr. Kevorkian has said that he assisted in the death of more than 130 terminally ill patients.

In Europe, attitudes and laws are changing much faster. Last year, the Netherlands legalized euthanasia. In May, Belgium did the same. Other countries, such as Sweden, Finland and Norway, don't always prosecute physicians who help terminally ill patients die.

Even in Britain, which has one of the most restrictive approaches to euthanasia in Europe, public demand for reform is growing. Last spring, Britons were gripped by the case of Diane Pretty, a paralyzed woman who wanted her husband to be protected from prosecution if he helped her die. About 10,000 people signed a petition backing her plea, which was delivered to Prime Minister Tony Blair's office. But Ms. Pretty, 43, was turned down by the British courts, as well as the European Court of Human Rights. She died two weeks later.

When it was established in 1942, the Swiss euthanasia law was meant mainly to offer the opportunity for a dignified death to those with just two or three weeks to live. In the past few years, though, it has been applied to patients with a range of ailments -- those with terminal illnesses or with acute mental disabilities, and even those suffering unbearable distress, such as a musician, for example, who has gone deaf.

There are several requirements under the Swiss law. People who opt for euthanasia must be rationally capable of making the decision to die. They must perform the final act -- usually the drinking of a lethal dose of barbiturates -- without assistance. And the event must be witnessed by a nurse or physician, and two other people.

Dignitas was founded in 1998 by Ludwig Minelli, a 70-year-old former journalist who specialized in stories about human-rights abuse. He left journalism to become a lawyer and at age 54 joined the legal team of Exit, Switzerland's oldest euthanasia group. Ten years later, he quit and founded Dignitas.

'Sense of Peace'

In the past year alone, membership in Dignitas has doubled to 2,000. Members have the right to use the organization's services, but not all members choose to take their own lives. So far, half of those members who have died have done so from natural causes, Mr. Minelli says. "But being a member at least gives them a sense of peace," he says. "They know that they have a secure exit if they need one."

Does Mr. Minelli worry that he might be turning Zurich into a suicide destination for foreigners, as his critics contend? "If I see someone drowning, I must rescue him -- without asking about the color of his passport," Mr. Minelli says.

When euthanasia is requested, the Dignitas member's medical records are sent to a Swiss physician, who determines whether the person's condition merits assisted death. If everything is in order, Mr. Minelli meets the client when the person arrives in Zurich. He accompanies the person to the apartment where death will occur, and then leaves. (Mr. Minelli says he is never present at the actual suicide because he doesn't serve as a witness, nurse or physician.)

When it's over, the attending nurse or physician telephones the police. If everything is in order, the body is taken to the morgue. Sometimes there's an autopsy. If the client has asked for cremation, as is typically the case, Dignitas ships the ashes to relatives in the home country.

The more-open attitude of Dignitas sometimes leads to unusual cases. A Dutchman afflicted with advanced Alzheimer's disease wasn't permitted assisted-suicide in the Netherlands because Alzheimer's isn't deemed to be a terminal disease in that country. But Mr. Minelli took him on, and the man did kill himself. In another Dignitas case, a 33-year-old Frenchman and his 29-year-old sister, both suffering from schizophrenia, chose to end their lives simultaneously and side by side.

Mr. Brunner, the Zurich prosecutor, says it isn't always easy to figure out who should be permitted to commit suicide. He alleges that many Dignitas clients don't have proper medical records. Mr. Minelli says that in virtually every case, Dignitas clients have "abundant" medical paperwork. The only occasional exceptions, he says, are French patients, because they aren't always provided with detailed records by their doctors.

Mr. Brunner also questions whether some patients, in different circumstances, might reconsider their decision to take their lives. "These people who travel from France or Germany are not really that free to change their minds and go home," he says. "Once they've traveled all the way to Zurich there's too much pressure" for them to backtrack, Mr. Brunner says.

Mr. Minelli disagrees. He cites the case of a German woman who came to Zurich fully intent on killing herself but changed her mind at the last minute. She's still alive today, he says. Another client, who lived in Lebanon and belonged to the Greek Orthodox church, had last-minute qualms. She flew back. "She was in fear of hell," according to Mr. Minelli. But a fortnight later, the lady was back. This time, Mr. Minelli says, she went through with the plan.

Last week in Zurich, Ms. Hascoet, the Frenchwoman, didn't appear to have any second thoughts. Lighting up another Marlboro, she described how the cancer had spread during six years from breast to bones and lungs. She was in constant pain, she said, and found it especially hard to breathe while lying down. During her illness, she had refused chemotherapy, and when her doctor in Paris advised a tracheotomy and an oxygen machine, she refused that as well. French law doesn't permit assisted suicides. A French euthanasia group referred her to Dignitas. She got in touch with Mr. Minelli in June.

After receiving the Dignitas prospectus in the mail, Ms. Hascoet, a former accountant, sent back her $18 annual membership fee. Mr. Minelli mailed her a form that described the group's services. She responded with details of her medical condition and a written declaration of her desire for euthanasia. In September, Mr. Minelli forwarded to her the name of a Zurich physician who would determine whether Ms. Hascoet's condition was severe enough to merit an assisted death.

In September, Ms. Hascoet visited the physician in Zurich and he gave her a green light: a prescription for a swiftly lethal dose of a barbiturate.

Ms. Hascoet returned to Paris and put her affairs in order. In a few weeks, she informed Mr. Minelli that she was ready. She then bought a one-way ticket for the six-hour train journey from Paris, arriving in Zurich on the evening of Nov. 13.

Ms. Hascoet was eager to publicize her case in the hope that France would adopt a euthanasia-friendly law. So when a French TV crew asked if they could interview her during her last hours, she agreed.

Like any other person considering assisted suicide in Switzerland, Ms. Hascoet needed two witnesses to her death. Her one surviving relative, an older brother, was too frail to travel to Switzerland. So the unmarried Ms. Hascoet was accompanied by an old school friend, and another woman, the representative of a French euthanasia society.

'I Am Alone'

"I might not do this if I had children," Ms. Hascoet said, "but I am alone."

After cutting up her credit card that morning, Ms. Hascoet was driven to a building about 200 yards down the road from her hotel. There she was led to the sparsely furnished two-room flat that Dignitas rents solely for euthanasia clients. The group's name appears on a small black sign beneath the doorbell. Inside, the first room served as a kitchenette, and included a refrigerator, a coffee machine and assorted champagne and wine glasses on a shelf.

The main room was larger, with two beds, a small table, and a window that overlooked the city's rooftops and let in the bright autumn sun. A few paintings, mainly rural scenes, hung on the walls. A folded-up wheelchair stood in one corner. Leaning against a wall near the door of the flat was a collection of walking sticks. "Remains," said Mr. Minelli. It was 10:15 a.m.

The arrival of so many people had apparently alerted the neighbors. Next door, someone turned up the volume on a television set. Mr. Minelli acknowledged that some neighbors had grumbled about "bodies being constantly carried out" of the apartment, but no one had lodged a formal complaint.

Mr. Minelli and Ms. Hascoet sat at the table, surrounded by her two companions, a nurse named Erika Luley and the hovering TV crew. Mr. Minelli asked her if she was absolutely certain about wanting to die. "Oui," she responded, without hesitation.

At 10:41 -- the nurse was keeping precise records -- Ms. Hascoet signed a "Declaration of Suicide" in French, affirming that she had made a reasoned and rational decision to end her life. Ms. Hascoet then thanked Mr. Minelli. He shook her hand, said goodbye, and left.

Ms. Luley lit a candle and placed it on the table. At 10:59, she dissolved some antinausea medication in a tumbler. It prevents a person from vomiting the extremely bitter barbiturate.

"Are you here often?" Ms. Hascoet asked as she drank the antinausea drug. "No," replied Ms. Luley. "Just once or twice a week -- and that's enough." Ms. Luley is part of a regular roster of doctors and nurses that Dignitas uses.

The TV presenter asked Ms. Hascoet what some of her regrets were. "It's very expensive to come to Switzerland," replied Ms. Hascoet. " I hope my testimony will help the creation of a law" permitting assisted suicides in France. Then she quietly added: "It's difficult to die so far from home."

The TV crew left the room and Ms. Hascoet's friend, who wore a six-inch silver cross on her jacket, closed the door of the bedroom. In the kitchenette, Ms. Luley -- tall, white-haired and clad in a casual dress and knee-high boots -- emptied the barbiturate into a glass of water. Ms. Hascoet would have to wait about 20 minutes, she said, while the antinausea drug took effect.

Ms. Luley, 64, has performed assisted suicides for nearly three decades. She said she isn't religious. Yet she wears a necklace with two conspicuous tokens -- an amulet given to her by an Egyptian woman whose death she assisted and a cross given by another patient.

What last requests do patients have? Some like to listen to music; others prefer to sit with family members and recall good times, Ms. Luley said. One woman insisted on finishing her crime novel because she was eager to know how it ended. Another threw a party just hours before she was scheduled to end her life and drank too much champagne. Alcohol mixes badly with barbiturates and can prolong the dying process. "I had to wait eight hours" before she died, Ms. Luley recalled.

Ms. Hascoet's last request: that her tan winter coat, with a fur collar, be cremated with her.

The 20 minutes had passed. Ms. Luley took the glass with the barbiturates and joined the others in the bedroom, shutting the door. At 11:20, the nurse later recounted, Ms. Hascoet picked up the glass from the table and rapidly drank the contents. Within a few minutes, she slipped into a deep coma. Her friend was holding her hand, Ms. Luley said. At 11:34 a.m., Ms. Hascoet died.

Ms. Luley emerged from the bedroom. Inside, Ms. Hascoet lay motionless on the bed by the window. Her eyes were closed. "It's finished. She's gone," Ms. Luley said.

She then briskly picked up her mobile phone and dialed 117, the number for the Swiss police.

Write to Gautam Naik at gautam.naik@wsj.com¹

Updated November 22, 2002