In terms of the billions of years represented by the movement of the stars, one person’s death on Earth seems insignificant to him. "If this is his [the old man’s] decision, we should accept it. Why fear death? It comes to us all. Death has a [success] rate of 100%," and he laughs heartily, peering at me over his spectacles.
Minelli’s attitude is infuriating to faith-led groups such as the Society for the Protection of Unborn Children and pro-life groups, who fear that opening the debate in Britain about suicide and assisted dying might lead us into ethical anarchy. Minelli describes himself as agnostic and does not rule out the possibility of faith, but says: "I do not need to make up reasons for why we are here or why we die." He is driven by the belief that it is the right of each individual to control their own life.
Minelli first became interested in the question of assisted dying at 14, when he saw his grandmother refused help to die by a doctor as she was lying in great pain, on her deathbed. He worked for 11 years as the Swiss correspondent for Der Spiegel magazine before retraining as a human-rights lawyer, and was then employed as the legal adviser of the pro-euthanasia group Exit. But he saw internal power struggles disable the group and left to set up his own clinic.
Last year he opened an associated Dignitas office in Germany and has plans to widen the scope of his activities further. He is setting out on a course to scandalise conventional thinking and lift what he calls the "taboo" against suicide by encouraging other countries to set up clinics offering information about effective methods and warning people about the risks associated with unsuccessful suicide attempts. These might include loss of limbs or brain function, and family trauma, as well as what he calls "huge collateral damage" – the costs of emergency services, police and medical treatment. All this trouble and expense could be saved by lifting the restrictions and helping people to do it, if suicide is "the appropriate solution" to their problems.
He points at his forehead and says: "Many people who attempt suicide don’t know how to do it. They don’t even know how to shoot themselves. They aim here and just blow the front of the head off, and live on as a vegetable."
Killing yourself is not easy. "We need to set up advisory centres where people can openly discuss problems and seek advice about methods and risks, without the fear of losing their freedom and being put in an institution. These centres can only be credible if they can offer assisted suicide." In his view, all potentially suicidal people should be given information about the best way to kill themselves, and if they choose to die, they should be helped to do it properly. This approach is hugely controversial, and in England and Wales, divulging information about suicidal methods is against the law. But in Scotland, where there is no suicide act, an organisation called Fate (Friends at the End) has published a UK Guide to Dignitas, at £3 a copy.
However, the Samaritans, who field 400,000 calls from people contemplating suicide every year, say it is irresponsible to promote effective methods of suicide. A spokesman, Mike Cobb, says: "We want to reduce the number of deaths by suicide and, given such information, vulnerable people with reversible conditions or those with mental illnesses might act prematurely." But Minelli would like to help some of these vulnerable and mentally ill people, too.
In Britain, Lord Joffe’s Assisted Dying for the Terminally Ill bill will receive its second hearing in May. The bill is aimed at helping those who are terminally ill, who will die within six months, who are mentally competent, in unbearable pain and have persistently requested help to die. If passed, it will allow doctors under these conditions – and with 20 additional safeguards – to help a patient commit suicide. If passed, it will also amount to a big breakthrough for the UK’s right-to-die campaign: some of the 800 British members of Dignitas may feel they do not have to travel to Zurich to die after all.
But Minelli is not content. He wants to make assisted suicide available to those whose situation is beyond the bill’s scope. As part of his wider plan to make it available to the mentally ill, he and his Dignitas team of doctors and collaborators encourage clients to challenge the law. One of Dignitas’s members is a man with manic depression who is currently fighting a case against the state in the Supreme Court of Switzerland. He is asking for an assisted suicide with Dignitas, without medical prescription. "If we lose, I’ll take the case to Strasbourg [the European Court of Human Rights]," Minelli says. "I tell members suffering from mental illnesses: I am fighting for your freedom."
Minelli is prepared to fight for the right of the mentally ill to be given an assisted death. He says they have the same right as everyone else to "the choice of a choice". He says that "the idea of a terminal illness as a condition for assisted suicide is a British obsession". Yet the Swiss are also getting nervous about his activities. Zurich’s chief prosecutor, Andreas Brunner, has drafted new legislation to restrict access for foreigners to Dignitas. He is making the process more difficult by insisting on further medical checks by independent doctors and witnesses. Minelli says he will fight attempts to crack down on his work.
Meanwhile, he continues to battle on with calm determination. "We never say no. Even those suffering from Alzheimer’s will have lucid moments in which they may choose to die once a certain point has been reached, such as when they can no longer recognise their children." The Alzheimer’s Society does not support euthanasia, and in Britain, a living will, which may or may not influence doctors to withdraw tube-feeding or antibiotics in the later stages, is the only recourse for those with severe mental illness.
"We would never assist the death of someone with acute depression, because the depression is a symptom of the illness," says Minelli. "But if somebody comes after 10 or 12 years of depression and says they do not want to prolong their life under such conditions, then we might help them to die."
