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ASSISTED DYING

Reader question: Can foreigners access Switzerland’s assisted suicide clinics?

This is not a pleasant subject, but the fact remains that as Swiss ‘death with dignity’ legislation is the most liberal in Europe, a number of foreign nationals choose to die here. What rules must they follow?

Reader question: Can foreigners access Switzerland’s assisted suicide clinics?
Australian scientist David Goodall before he died in Basel in May 2018. Photo by SEBASTIEN BOZON / AFP)

Switzerland has had an assisted suicide law on the books since 1942 — a constitutional right of each person to determine the manner of his or her death.

And because the legislation is the most liberal in Europe (and in most foreign countries as well), a number of terminally sick foreigners have made a sometimes very long trek to Switzerland to put an end to their lives.

One such well publicised case, in 2018, was David Goodall, a 104-year-old Australian scientist who flew to Switzerland from his home in Perth to die in an assisted-suicide facility in Basel, as this option was not available to him in his home country.

A ‘normal’ practice

While many people across the world may be shocked by the medical community legally helping someone to die, in Switzerland it is considered a legitimate way to end one’s life (as the above-mentioned right to self-determination proves).

In fact, the majority of the population supports this right — even if they have no plan to benefit from this practice themselves.

For instance, in 2011, voters in the canton of Zurich rejected proposed bans on assisted suicide and “suicide tourism” (that is, extension of this right to people from abroad). A year later, the national parliament voted against tightening controls on the practice.

Vaud and Valais also subsequently voted to allow this practice in elderly-care facilities for residents in palliative care or those suffering from incurable illnesses or disabilities.

Some elderly care facilities allow assisted suicide on their premises. Photo: Pixabay
 

Do foreigners have access to Switzerland’s end-of-life assistance?

Some organisations don’t provide this service to people coming from outside Switzerland, while others do.

The country’s largest right-to-die group, EXIT, says on its website it only helps people residing in Switzerland (Swiss or permanent foreign residents) or Swiss citizens living abroad — though this act must always take place in Switzerland. 

So if you are foreign national with residence status in Switzerland, you are eligible.

But if you are merely a visitor, you can’t avail yourself of these services through EXIT, though there are other Swiss organisations you can turn to.

Dignitas, located in canton Zurich, was the first to accept people from abroad; to this day, its ‘clients’ are primarily foreigners. 

Another Swiss organisation, LifeCircle, is also open to people from abroad. In fact, this is the group that helped David Goodall die.

How can foreigners (or anyone else) avail themselves of these services?

There are many rules in place.

The first one is that, regardless of whether you live in Switzerland or abroad, you can’t just walk off the street and request assisted suicide.
You must start by joining a right-to-die organisation — this can be done at any time, regardless of your age.

Some people join while they are young and healthy to make sure these services will be available if they should ever need them later on. Also, the law states you can only exercise your right to die if you are mentally alert, so some people prefer to join while they still have the capacity of discernment.

Annual membership at EXIT costs 45 francs; at LifeCircle it is 50 francs; and 80 francs at Dignitas.

There will be additional fees at the time of the actual dying assistance if you choose to opt for that — amounts typically vary from several thousand to over 10,000 francs, mostly for the medical and administrative costs associated with the process.

What else is there to know about assisted suicide in Switzerland?

While for many years, only people suffering from medically-certified terminal conditions qualified for death assistance, rules have been relaxed over the years, to include disabilities and suffering.

Also, Swiss legislation permits assisted suicide only under certain conditions: if the patient is over the age of 18, mentally and physically capable of making the decision to die, and administers the drug him/herself in a private residence.

If a physician or another third party administers the drug, the act would be considered euthanasia, which remains illegal in Switzerland.

Additionally, the person assisting in the suicide must not have any selfish motives.

To ensure that the process complies with the law, a video is shot of the patient stating their name, date of birth and that they understand what they are about to do. The camera keeps rolling as they open the valve that allows a barbiturate to begin flowing into their vein. This footage is used as evidence that they willingly took their own life.

You must release the IV drip yourself, Photo by Hiroshi Tsubono on Unsplash

READ ALSO: What you need to know about assisted suicide in Switzerland

New assisted suicide guidelines went into effect in 2022

In May of last year, the Swiss Academy of Medical Sciences updated its guidelines for assisted suicide. Four points were added to the existing rules :

  • Doctors must now have two consultations with patients (instead of just one), which must be at least two weeks apart, to give the person a chance to change their minds
  • The condition of the patient must be serious and severe to the point where it is “unbearable” (though ‘unbearable’ is clearly subjective and not quantifiable)
  • A patient’s environment must be taken into account
  • There is no ethical or medical justification for providing assisted suicide to healthy people 

These rules are not legally binding. However, they have since been adopted by the Swiss Medical Association (FMH). 

Around 90 percent of Swiss doctors and medical professionals – including those who provide assisted suicide services – are members of the FMH. 

READ ALSO: What to know about Switzerland’s latest court judgement on assisted suicide

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ASSISTED DYING

‘I felt manipulated’: Conflict prevents American woman from using Swiss ‘death pod

Switzerland's controversial ‘suicide capsule’, Sarco, was supposed to be inaugurated on July 17th, but in the end it was cancelled. The prospective client - an American woman - explained the conflict behind the aborted ‘launch’.

'I felt manipulated': Conflict prevents American woman from using Swiss 'death pod

The device works by flooding a 3D-printed capsule with nitrogen gas at the press of a button from the occupier, reportedly leading to painless asphyxiation without ingesting a poisonous substance. 

Though assisted dying is legal in Switzerland under well-defined rules (read more about this below), Sarco has been stirring controversy even among the most liberal advocates of ‘death with dignity’ due to doubts over whether death by asphyxiation is really painless.

The usual method practised in Switzerland involves the patient opening the valve that allows a barbiturate to flow into their vein, causing them to fall asleep peacefully.

The first person approved to use Sarco on July 17th was an American woman identified by the Swiss media as Jessica Campbell (though this is not her real name). The 55-year-old from Alabama has been suffering from a variety of debilitating health problems — including kidney failure and  a painful  disease of the nervous system.

After trying to kill herself (unsuccessfully) with an overdose of painkillers, Campbell became interested in a quick and painless death in the Sarco pod.

After contacting Exit International organisation that created the capsule, and undergoing the process of determining whether she was a suitable candidate (that is, sound of mind and persistent in her wish to die), Campbell was cleared, cashed out her life savings of 40,000 USD and flew to Switzerland.

What happened afterwards?

In a lengthy article published on July 31st and based on a letter Campbell wrote, Neue Zürcher Zeitung (NZZ) reported about various conflicts that arose between Campbell and her ‘minders’ from The Last Resort (a sub-group of Exit International) once she was already in Switzerland.

They arose from misunderstandings and diverging expectations of each party, but ultimately created unsurmountable grievances on Campbell’s part.

Regardless of whether they were justified or not, these ‘offences’ drove a wedge between the two parties, which ultimately led to The Last Resort’s refusal to help her die.

What did Campbell complain about?

She evoked a wide-range of complaints, ranging from her planned death becoming a “media circus” to the fact that the group pushed her to spend her money indiscriminately, reportedly telling her she “won’t need it after I die.”

“I felt manipulated and exploited,” she added.
 
“If I had known that the deeply heartless people who held my fate in their hands were mainly driven by their own media presence and marketing, I would never have subjected myself to this ordeal,” she pointed out.

For its part, The Last Resort denies Campbell’s accusations, saying she spent her money herself for last-moment wishes like a ride on a scenic mountain train.

She was also aware ahead of time that there would be some media interviews and agreed to participate, the organisation said.

“She seemed to enjoy all the attention and conversations with journalists.”

What happened in the end?

NZZ reported simply that “Campbell died on Friday.”

It did not offer any explanations about where and how she died — presumably at another Swiss assisted dying clinic.

The newspaper did, however, mention that “a psychiatrist examined her on Wednesday, and found her of sound mind” — one of the conditions to be eligible for assisted dying in Switzerland.

What other conditions that must be met?

Switzerland’s Federal Court has ruled the following: people must die by their own hand by taking medication themselves. A doctor cannot administer a lethal injection without being liable for criminal prosecution.

Only people over the age of 18, who are mentally and physically capable of discernment, can make the decision to die.
People must also be aware of actions they are undertaking and have given due consideration to this decision.

In addition, they must be consistently sure that they wish to die. They must make this decision themselves and not be influenced by others.

More information about assisted dying rules in Switzerland is found here:

READ ALSO: What you should know about assisted dying in Switzerland 
 

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