Dignitas is a good thing, Exit of course too. What do you think about this? I know what I am talking about because I am one of the doctors who writes prescriptions for members of Dignitas. A prescription for what? A prescription that allows the person in question to end his life in a pain-free way, free of brutality, and moreover to do so not alone but accompanied by people standing lovingly at his side.

I know that many people disapprove of my activities. These people are convinced that no individual has the right to determine the end of his life. They are also sure that a doctor should never prescribe a medication to end life because he is professionally obliged to save life. The Hippocratic oath is what they have in mind.

We doctors today do not swear this oath and there is a reason for that — it is largely out of date. For example it forbids the surgical removal of a bladderstone, a sensitive issue in the old days. Today every surgeon can perform this operation without a problem.

The oath also forbids giving abortive medication to a pregnant woman. This used to be a risky matter for mothers because their pregnancies were usually well advanced before the foetus was detected. Nowadays an effective and safe drug can end a pregnancy in the early weeks without a problem. The excision of bladderstones is not immoral and the same can be said for a socially approved termination of pregnancy administered by a doctor.

When it comes to prescribing medication to a patient to help end his life, I view the Hippocratic oath in a similar way. With sodium pentobarbital, NaP, we have a drug that gives us for the first time the possibility of allowing a person to swiftly and gently pass away.

And what if there is no God?

The social rejection of suicide does not so much derive from the Hippocratic oath but rather from Christian traditions. Suicide is abhorred by all monotheistic religions. The Christian religion, which has influenced most of us, trusts to God's will in all of life's difficult moments. Only God who gave us life is entitled to take it away, runs the argument. So suicide becomes a sin. But what if this God doesn't exist? For those who do not believe, can there not be arguments for deciding the end of one's life: a life of suffering perhaps, or one blighted by increasing isolation, or the dependency on outside care?

Certainly committing suicide can be pointless. And killing oneself without outside help is always uncertain and usually a violent way of ending life. A suicide does not make sense if it is prompted by a lack of life experience: love sickness for example, financial problems or other accumulated minor woes that have been blown up out of proportion by ones own ego.

How does it look though when an illness occupies more and more space in one's life or when life is coming rapidly to a close end? Or when one's despair is so enduring that even long-term psychiatric help cannot give real assistance?

Should one not be allowed to make use of medical means to release oneself from suffering? The wish to commit suicide is most understandable when it develops over time, rather than overnight.

Only a doctor with a medical practice can prescribe strong sleeping medication. For me there is no question about writing such a prescription in a tragic situation, knowing that it cannot help his illness but will help him realise his wish for a self-determined suicide.

In my experience with would-be suicides it is practically always the case that the mere act of writing out the prescription evokes a sense of great relief in the patient: "at last someone understands me and is ready to help in the way I want. Others want to persuade me that my life is worth living at any cost. But I know better." That is what they say.

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