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“They choose to die”

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Dr Eri­ka Preisig says that help­ing peo­ple die in Switzer­land glad­dens her heart

 “The joy of the dying gives me strength to go on,” says Doc­tor Eri­ka Preisig. The 61-year old orig­i­nal­ly became a doc­tor to save lives. How­ev­er, now she fights for the legal­iza­tion of assist­ed sui­cide abroad and her­self helps peo­ple die. In Switzer­land, where she lives, this has been legal for over 100 years. 

This week, Ger­many became the lat­est coun­try to legal­ize assist­ed sui­cide. But Switzer­land remains the place most asso­ci­at­ed with the prac­tice. So-called “death tourists” – for­eign­ers who don’t have the option of assist­ed sui­cide in their home coun­try – still come to Switzer­land from all over the world to die. Accord­ing to Dig­ni­tas, one of the lead­ing Swiss assist­ed sui­cide asso­ci­a­tions, of 256 peo­ple whom they helped to com­mit sui­cide in 2019, 42 came from the UK. And demand is on the rise.

Preisig is the founder of the foun­da­tion “Eter­nal SPIRIT”, which grants their most des­per­ate patients the chance to end their lives. Preisig was first con­front­ed with the top­ic of assist­ed sui­cide in 2005, when her father tried to kill him­self and failed. She then told him that she’d rather have him com­mit assist­ed sui­cide than jump in front of a train and trau­ma­tize the train dri­ver and the pas­sen­gers. So that’s what he did. “As a physi­cian, I felt ashamed of myself for accept­ing his sui­cide at the time.” She has, how­ev­er, been work­ing in this field ever since.

Ter­mi­nal­ly ill peo­ple can get the “green light” — the foundation’s per­mis­sion to com­mit assist­ed sui­cide – based on their med­ical con­di­tion. Yet two thirds of them don’t actu­al­ly make use of it; they die of nat­ur­al caus­es, but secure in the knowl­edge that if their suf­fer­ing became unbear­able, an emer­gency exit would be avail­able. Notably, a major­i­ty of them are women. In fact, two thirds of the clients are female. “Many more men com­mit non-assist­ed sui­cide than women do,” says Preisig. “Yet the num­ber of assist­ed sui­cides com­mit­ted by women is a lot high­er, since women are more like­ly to go to the doc­tor and seek help.”

Like sim­i­lar orga­ni­za­tions, Dig­ni­tas insists that it focus­es pri­mar­i­ly on pre­vent­ing sui­cide and sui­cide attempts. Only when there’s no hope left do they grant their clients the so-called “green light”. That’s why Preisig found­ed life­cir­cle, an orga­ni­za­tion ded­i­cat­ed to pro­mot­ing a good qual­i­ty of life rather than a good death. Through life­cir­cle she can help ensure that even very old and dis­abled peo­ple who are so lone­ly that they don’t see the pur­pose in going on liv­ing can be cared for by those around them – and sud­den­ly don’t want to die any longer. 

Preisig men­tions the case of a man who killed him­self in an inhu­mane way after being denied the “green light”. “I looked after this man for three years. For three years I tried to dis­suade him from com­mit­ting sui­cide. He had depres­sion. I was in legal trou­ble already, so I couldn’t risk assist­ing some­one with depres­sion with­out him hav­ing been declared as capa­ble of con­sent by a psy­chi­a­trist. So, I told him to go to anoth­er orga­ni­za­tion where there were psy­chi­a­trists avail­able.” He went there, but the psy­chi­a­trists didn’t realise how he was real­ly feel­ing and told him that his prob­lems were sim­ply mar­i­tal ones. Fur­ther­more, they told him that assist­ed sui­cide wasn’t an option for him as long as he didn’t solve those prob­lems. “This man jumped straight off the near­est build­ing and died. But first he called his fam­i­ly and his physi­cian – and the police to tell them where they could clean up the mess he was going to make. This kind of things should be pre­vent­ed. He should have been allowed to die peace­ful­ly with his fam­i­ly sur­round­ing him, but that pos­si­bil­i­ty was tak­en from him by some­one who didn’t under­stand his issues.”

This is not the only trau­mat­ic sto­ry she has been drawn into. But how does she cope with so much death in her life? “If I were an oncol­o­gist and had to admin­is­ter chemother­a­py to peo­ple whom I knew had no chance, it would get me down. It would depress me to know that I take qual­i­ty of life from them, per­haps even extend their suf­fer­ing.” By con­trast, she says, what she does pro­vokes grat­i­tude and joy. “That’s why it’s not wear­ing work for me. Peo­ple who are suf­fer­ing so much that they only wish to push a but­ton to start the lethal infu­sion and fall asleep for­ev­er repay me with an immense amount of grat­i­tude.” 

What hap­pens, how­ev­er, when a patient is phys­i­cal­ly unable to push that but­ton? No one can do it for them, since euthana­sia – as opposed to assist­ed sui­cide – is ille­gal in Switzer­land. “When there real­ly is no way for the patient to move or swal­low while still being capa­ble of con­sent, which thank­ful­ly doesn’t occur often, we can’t help.” Yet there is a solu­tion for every oth­er sit­u­a­tion. “Many of our patients can only move their head or tongue. For cas­es of this sort we have a spe­cial tool which attach­es a con­nect­ing bar to the infu­sion. This allows the patient to start the infu­sion with a head move­ment.” There also remains the pos­si­bil­i­ty of swal­low­ing the poi­son. 

Even though she finds the relief of her patients uplift­ing, there is one aspect that gets Eri­ka Preisig down: the grief of rel­a­tives who have to let go of a per­son dear to them. “Some­times I do cry with them. It hap­pens and it does every­one good. It’s noth­ing bad, it isn’t a weak­ness. If I’m sad that we have to let go of some­one, I can show it shame­less­ly. But it can be painful, the grief of those who have to let go. How­ev­er, the joy of the dying gives me strength to go on.” 

Although they have suf­fered a ter­ri­ble loss, the rel­a­tives are very thank­ful too, since Eter­nal SPIRIT helps their loved ones attain hap­pi­ness. “It’s real­ly quite beau­ti­ful. We receive many thank-you let­ters which are excep­tion­al­ly impor­tant to me. There are many rel­a­tives who invite us to their coun­tries. The amount of grat­i­tude is unbe­liev­able, we gain won­der­ful con­tacts all over the world. We have already vis­it­ed fam­i­lies in Que­bec and Aus­tralia who have lost a fam­i­ly mem­ber to our ser­vice. We win new friend­ships.”

Dr Eri­ka Preisig

Preisig’s work has also affect­ed her feel­ings towards her own death. Before tak­ing up her activ­i­ty as a sui­cide assis­tant, she worked in the field of pal­lia­tive med­i­cine and expe­ri­enced many deaths of patients. “Despite very good pal­lia­tive med­i­cine I saw peo­ple die in ways that made me think ‘I don’t want to die like that. It scares me.’” But ever since her father’s death, her views have changed. “I see the hap­pi­ness when peo­ple can final­ly go. They don’t have to die; they choose to die. Now it is very impor­tant for me to have an open emer­gency exit.” Still, there remains one set of cir­cum­stances that scares her. Her moth­er died of a cere­bral haem­or­rhage when Preisig was just a young girl. She fears that if this or some­thing sim­i­lar that leads to severe brain dam­age was to hap­pen to her, she would lose her capac­i­ty of con­sent and wouldn’t be allowed to com­mit assist­ed sui­cide, even if she want­ed to. Her hope is that if she had no capac­i­ty of con­sent, it would mean that her brain is so dam­aged that she won’t actu­al­ly suf­fer. “We can’t know for sure.”

Preisig fights for her con­vic­tions. “I think my core mes­sage”, she says, “is that each of us should be allowed to die the way they choose to. I want the world to final­ly com­pre­hend that assist­ed sui­cide isn’t a bad thing. Bad for me is when some­one throws them­selves in front of a train, or if a woman arrives at home to find the hanged body of her hus­band. Inhu­mane things like that should not hap­pen. All of us must take respon­si­bil­i­ty for our lives. So why for heaven’s sake is the way we have to die pre­scribed? We are per­fect­ly able to take respon­si­bil­i­ty for our death too! That’s what I want to achieve with my work, that’s what I am fight­ing for.”

Eri­ka Preisig is not alone in think­ing that the free­dom to choose when to die should be a uni­ver­sal right. In 2011, 84% of vot­ers in a Zurich ref­er­en­dum agreed that for­eign­ers should still be allowed to com­mit assist­ed sui­cide in Zurich, since most don’t get the chance in their home coun­tries.

 

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