"Senator Death's been at it again!" roared the yellow press last October, after 84-year-old Inge Iassov was found dead on September 30 in her Würzburg flat in Bavaria. If Hamburg's former justice senator (minister), Dr. Roger Kusch, were a more sensitive type, reading the German tabloids could deal him quite an ego-blow. But the pro-euthanasia activist says the lurid headlines don't bother him at all: "The situation for dying patients in Germany is really bad. Doctors aren't allowed to help them commit suicide," explains the Herr Doktor, who is a lawyer, and not a medical doctor.
Far to the contrary: the scandal brought his new business to the spotlight - an assisted suicide service which for just €8,000 helps willing volunteers to, well, top themselves. Inge Iassov was not his first customer. In July, Kusch provided similar assistance to 79-year-old Bettina Schardt.
The Kusch case
Kusch is certainly a controversial figure. A doctor of law, the man was Hamburg's CDU justice minister from 2001 to 2006. Forced to come out of the closet in 2003 because he was accused of having an affair with mayor Ole von Beust, his boss, Kusch was heavily criticised by his party for his pro-euthanasia position, until finally being sacked for refusing to co-operate with a parliamentary inquiry.
Early this year, Kusch started his own party, Heimat Hamburg, which was meant to offer citizens a more conservative alternative to the CDU. Along with racist promises, law and order clichés and anti-Islamic propaganda, the liberalizing of existing euthanasia laws figured highly in his programme.
Heimat Hamburg did so badly in the 2008 local elections that they disbanded in April. Never short of initiatives, Roger Kusch then proceeded to set up his foundation, Dr. Roger Kusch Sterbehilfe e.V., which, as well as campaigning for the rights of those who wish to end their own lives, offers a special suicide machine - an intravenous device - which he plans to offer for sale. But his most popular idea so far has been his assisted suicide service. Bettina Schardt was Kusch's first client.
After his first success, Kusch decided to take things even further. Advertising the assisted suicide service on his website, Kusch even named the price - for €8,000 one can be helped to a humane death.
Euthanasia auf Deutsch
The moral debate surrounding euthanasia and assisted suicide is complex. Even finding an adequate definition for euthanasia is tricky. Things get even trickier in translation because 'euthanasia' is usually translated into German as Sterbehilfe, or "death help,“ because Euthanasie is associated with Nazi eugenics.
But what is Sterbehilfe? There is passive, active and indirect Sterbehilfe. Passive is when doctors and family members agree to discontinue use of, for example, dialysis machines or artificial feeding methods, and thus shorten the dying process.
Active Sterbehilfe is when a doctor administers a dying patient with an extra dose of painkiller, usually morphine, which they know will kill. This is illegal in Germany. Then there's indirect Sterbehilfe, which is when the doctor gives the dying patient some kind of painkiller, primarily to ease pain, but which 'could' shorten the patient's life.
Physician assisted suicide (PAS) is a bit different from Sterbehilfe. Here the patient expresses their wish to die and is physically capable of administering the medication on their own. Although this is not legally considered Sterbehilfe, when we discuss euthanasia, we often mean PAS. PAS is allowed in very few places in the world, including Switzerland and Oregon, USA.
In the Netherlands assisted suicide and other forms of euthanasia are still technically illegal, but doctors will not be prosecuted.
"Assisted suicide is against German medical ethics"
Interestingly, assisted suicide in itself is not illegal in Germany. "No, you couldn't be prosecuted for helping someone to commit suicide," Edgar Dahl, Bio-Ethics professor at the University of Giessen, explains. "Suicide is not a crime, so helping someone to commit suicide isn't a crime either."
The only trouble is that, once the patient actually starts dying, the doctors should do everything they can to bring them back to life, or they could get prosecuted for Unterlassene Hilfeleistung, i.e. the failure to assist a person in danger. Dahl chuckles. "I mean, it's a grey area. But the trouble isn't the law. The law was changed in 2006 so that if it's a case of PAS, rather than normal suicide, a doctor will be given the benefit of the doubt. If I came in and found my partner had attempted suicide, and didn't phone the ambulance, that is Unterlassene Hilfeleistung. But that's not the case for doctors helping a terminally- ill patient. Lawyers decided that in such cases the doctor would not get in trouble."
But if it's not illegal, what's the problem? "The trouble is the German Medical Council. They say that assisted suicide is against medical ethics." Doctors who assist with suicides are scared of losing the right to practice.
The Medical Council's harsh stance allows Roger Kusch to take advantage of the situation. Becuase he's not a medical doctor, he doesn't have a license to lose. As a trained lawyer, Kusch takes all legal precautions: like with the case of Bettina Schardt. This elderly but healthy woman contacted Dr. Kusch via his pro-euthanasia foundation with the concrete wish to commit suicide. Kusch then counseled her through the necessary medication to take, but, importantly, Kusch did not provide or administer the drugs himself. Instead, he entered the woman's home, and videotaped not only her suicide request but also the actual moment when she swallowed the deadly tablets. He left the room before she fell into a coma, and re-entered the room three hours later, to find her dead. He then publicized her death widely – and his own participation in the process. Dahl comments, "I think Kusch knows that it isn't ideal. It's an emergency solution until the Medical Council sees reason."
But Kusch is not the only option. Many Germans seeking PAS are turning to Switzerland, where, although the legal situation is more or less the same as here, doctors have a little more leeway. "The Swiss Medical Council added one line to their charter that gives doctors the freedom of discretion: the doctor's decision must be respected in individual cases." This loophole allows Dignitas, a Swiss foundation which campaigns for the right to die, to offer an assisted suicide service to both Swiss and foreign citizens. Dignitas charges its patients €4,000 for preparation and suicide assistance. Despite being a non-profit organization, Dignitas has repeatedly refused to open its finances to the public. Around 80 Germans go to Switzerland to use Dignitas' services each year. This practice is referred to in the German media as Sterbetourismus - death tourism.
"Making money through assisted suicide should be a criminal offence"
Kusch's methods raised many outraged voices, notably among the German clergy. If the Archbishop of Berlin, Cardinal Sterzinsky, had his way, assisted suicide would be a crime and suicide organizations would be forbidden from advertising their services in Germany. "Suicide can't be made into a criminal offence," explains Cardinal Sterzinsky. "But 'helping' someone to commit suicide, that should be made illegal."
The Church's stance is irremediably opposed to euthanasia. "We have to be careful here. Helping someone while they die is one thing. But helping someone to die is not allowed. We cannot choose to end life!"
Eugen Brysch, the CEO of the German Hospice Foundation, was also shocked by Kusch's shameless business approach: "Making money through assisted suicide - that should be a criminal offence. I think Roger Kusch is showing his true face here - rather than really being there for the dying people, he just wants to make money. In fact he is exploiting the biggest fear of elderly people - the fear of becoming a burden." Many politicians agree.
In July this year a group of German politicians, including Baden-Württemberg's justice minister Prof. Dr. Ulrich Goll (FDP), tabled a motion demanding that assisted suicide be made illegal. But the motion failed. "It's this political inaction which enables an inhumane egocentric like Kusch to abuse people's natural fears," laments Brysch.
"What we need in Germany is a situation like in Oregon"
Many doctors are scared that tightening the rules will lead to more doctors being discredited, prosecuted, or even imprisoned: increasing numbers of medical practitioners are asking for the rules to be made more flexible. "What we need in Germany is a situation like in Oregon, in the US." Edgar Dahl says. "There, the Death with Dignity Act, which is about 10 years old, gives terminally-ill patients the freedom to apply for the right to die. They have to apply for it twice, and they have to think about it for two weeks. Two independent doctors have to sign the application, and then the patient can receive the necessary medication to die."
Sara, an American-German PR consultant based in Berlin, knows all about the difficulties of growing old in today's medically advanced society. Her sickly German grandmother has been in and out of old people's homes for the past 20 years. "It's awful to see her like this. But I think we should worry that a more liberal approach towards euthanasia could lead to state-sanctioned murder. Old people are getting older and poorer all the time - they've got no pensions, of course they're going to be depressed! And we might just end up ... getting rid of them."
But Edgar Dahl says she shouldn't really worry about that. "The figures from Oregon show that it is not the more vulnerable members of society who are taking advantage of the system. It is the more privileged - people with private health insurance." Kusch also rejects the idea of a slippery slope to state-condoned murder. "This danger simply doesn't exist. Even in the future people won't have to justify their will to live! Wanting to live will always be the norm in our society, and the desire to commit suicide an exception!"
Fear of the old people's home
Whichever side of the euthanasia debate you're on, one thing is deadly clear. The current situation in Germany is good for no-one, except Kusch, who is making €8,000 per dead granny. And what exactly does that money get you? It seems like a steep price for a few drugs. Dahl says he was surprised to learn that Kusch was charging a fee. "I don't really know what Dr. Kusch is charging €8,000 for. I do find it a bit hard to understand. The whole reason we want to allow assisted suicides here is to spare people the cost and trouble of going to Switzerland. At the moment the trip to Switzerland costs around €6,000. That's why we want the doctors to change their rules - so that poorer people can have some autonomy at the end of their lives."
Roger Kusch is certainly a dodgy figure. It's not even certain that the pensioners he's been helping to die would have been allowed to kill themselves legally in Oregon or Switzerland. Although Kusch says that he was absolutely convinced of Bettina Schardt's determination to die, the truth is she was not terminally ill and did not suffer from constant pain.
Instead, she lived under a terrible fear - of a retirement home, which in Germany has a truly horrible reputation: "I will never enter a Seniorenheim," announced Bettina S. resolutely in her video-recorded suicide statement.
According to the Federal Statistics Office 9,402 people in Germany committed suicide last year. Of these, 3,993 were over 60 years old. Suicide numbers in Germany are going down - but amongst older people they are rising. "The situation for old people in Germany is not good enough," says one caregiver, who wished to remain anonymous. "Old people can't grow old with any dignity in homes like ours - instead they are left alone all day, to lie in their own excrement, open wounds, hungry, thirsty - no wonder most people say they would rather die than end up in a home."
In the meantime, until the rules in Germany are finally tightened up - or loosened - how many more grannies will be ending their days at the hands of Roger Kusch? Meanwhile, the Hamburg police say they are investigating the case of Inge Iassov's death - but not, at this point, as murder.