Dignitas is a Swiss nonprofit organization providing physician-assisted suicide to members with terminal illness or severe physical or mental illness, supported by independent Swiss doctors. By the end of 2020, they had assisted 3,248 people with suicide at home within Switzerland and at Dignitas' house/flat near Zürich.[1] They provide advisory work on palliative care, health care advance directives, suicide attempt prevention, and legislation for right-to-die laws around the world.[2]
Members who wish to commit suicide must be able to prove they are of sound mind, as determined by the organization; be themselves able to bring about death; and submit a formal request including a letter explaining their wish to die and medical reports showing diagnosis and attempted treatment. For people with severe psychiatric illness, an in-depth medical report prepared by a psychiatrist is additionally required per a Swiss Supreme Court decision.[3]
History and operation
Dignitas was founded 17 May 1998 by Swiss lawyer Ludwig Minelli, who specialises in human rights law. Swiss laws provide that assistance to suicide is legal as long as it is not driven by selfish motives.
The person who wishes to die attends two private consultations (separated by time) with several Dignitas personnel in addition to an independent medical doctor who assesses the evidence provided by the patient in advance.[4] Legally admissible proof that the person wishes to die is also created in the form of a signed affidavit countersigned by independent witnesses. If a patient is physically unable to sign a document, a short video of the patient is made in which they are asked to confirm their identity, that they wish to die, and that their decision is made of their own free will, without persuasion or coercion. This evidence of informed consent remains private and is preserved only for use in any possible legal dispute.[citation needed]
Finally, a few minutes before the lethal overdose is provided, the person is once again reminded that taking the overdose will end their life. Additionally, they are asked several times whether they want to proceed, or take some time to consider the matter further. This gives the person the opportunity to stop the process at any time. However, if at this point the person states that they are determined to proceed, a lethal overdose is provided and ingested.[citation needed]
Euthanasia method
In general, Dignitas uses the following protocol to assist death: an oral dose of an antiemetic drug, followed approximately half an hour later by a lethal overdose of 15 grams of powdered pentobarbital dissolved in a glass of water. If necessary, the drugs can be ingested through a drinking straw. The pentobarbital overdose depresses the central nervous system, causing the patient to become drowsy and fall asleep within 3–5 minutes of drinking it; anaesthesia progresses to coma, followed by respiratory arrest and death, which occurs within 30–40 minutes of ingesting the pentobarbital.
Exceptionally, in four cases in 2008, Dignitas used helium gas[5] as a suicide method instead of a pentobarbital overdose. The medical supervision was still observed, however, and the method avoided controlled drugs, which reduced the risk of medical authorities disciplining the medical doctor who authorized the accompanied suicide.[clarification needed]
Referendum
In two referendums on 15 May 2011, voters in the Canton of Zürich overwhelmingly rejected calls to ban assisted suicide or to outlaw the practice for non-residents. Out of more than 278,000 ballots cast, the initiative to ban assisted suicide was rejected by 85 percent of voters and the initiative to outlaw it for non-residents was turned down by 78 percent.[6][7][8]
Statistics
Ludwig Minelli said in an interview in March 2008 that Dignitas had assisted 840 people to die, 60% of them Germans.[5] By 2010, that number had exceeded a thousand assisted suicides.[9]
Most people contacting Dignitas do not plan to die but wish for insurance in case their illness becomes intolerable. Of those who receive the so-called "provisional green light", 70% never return to Dignitas.[5]
21% of people receiving assisted suicide in Dignitas do not have a terminal or progressive illness, but rather "weariness of life".[10]
Costs and finances
According to the official Dignitas website,[11]as of 2017[update] Dignitas charged its patients 7,000 Swiss Francs (approximately £5,180/US$7,980) for preparation and suicide assistance, or 10,500 Swiss Francs (approximately £7,770/US$11,970) in case of taking over family duties, including funerals, medical costs, and official fees. Dignitas has been known to waive certain costs where there is hardship.[12] Under Swiss Law, Dignitas operates as a non-profit organization, but does not open its finances to the public,[13] which has elicited criticism from some quarters.
Although it is mainly Germans who turn to Dignitas for assisted suicide, as of August 2015[update], approximately 300 British citizens have travelled to Switzerland to die at one of Dignitas' rented apartments in Zürich.[14]
Reaction of local Swiss people and authorities
Dignitas has faced difficulties over the years.[15] In September 2007, Dignitas was evicted, blocked or locked out of three flats, and so Minelli offered assisted suicide in his private house. This, however, was then prohibited by the local council. In October 2007, Dignitas was again prevented from working in a private house by the local council and refused rooms on an industrial site. In December 2007, an interim judgment prevented Dignitas from working in a building next to a busy brothel. The media frenzy led to several people offering Dignitas flats or houses, of which one turned out to be suitable. Since 2009, Dignitas has a house at an undisclosed location where accompanied suicide for people from abroad has taken place.
Patient selection
In certain right-to-die organisations, an age restriction is in place for potential patients, so as to prevent young people from using their services.[10]
Cremation urns found in Lake Zürich
In April 2010, private divers found a group of over 60 cremationurns in Lake Zürich. Each of the urns bore the logo of the Zürich Nordheim crematorium (German: Krematorium Nordheim), also used by Dignitas. Soraya Wernli, a former employee, had told The Times 18 months previously that Dignitas had dumped at least 300 urns in the lake. She claimed that Minelli dumped them there himself, but later asked his daughter and another member of staff to do it. In 2008, allegedly two members of Dignitas were caught trying to pour the ashes of 20 dead people into the lake.[16] However, it was never established whether Dignitas had anything to do with it and no charges were taken. In Switzerland, it is not against the law to scatter cremation ashes out into nature.
Dignitas in media
In 2008, the documentary film Right to Die? was broadcast on Sky Real Lives (rebroadcast on PBSFrontline in March 2010 as The Suicide Tourist). It includes the story of Craig Ewert, a 59-year-old retired university professor who suffered from a motor neurone disease. Ewert traveled to Switzerland, where he was assisted by the Dignitas NGO. The documentary shows him passing away with Mary, his wife of 37 years, at his side. It was shown on the Swiss television network SF1 and is available as a web movie on the Dignitas website.[17]
The BBC produced a film titled A Short Stay in Switzerland, telling the story of Dr Anne Turner, who made the journey to the Dignitas assisted suicide facility. On 24 January 2006, the day before her 67th birthday, she ended her life. The film was shown on BBC1 on 25 January 2009.
Maestro Sir Edward Downes, conductor of the BBC Philharmonic and the Royal Opera, who struggled as his hearing and sight failed (but was not terminally ill), died with his wife, who had terminal cancer, at an assisted suicide facility in Switzerland in July 2009. He was 85 and she was 74.[18]
Theorist and translator Michele Causse chose to die on her birthday, 29 July 2010, in association with Dignitas.[19][20]
On 13 June 2011, BBC Two aired a documentary titled Terry Pratchett: Choosing to Die, featuring author and Alzheimer's disease sufferer Sir Terry Pratchett guiding viewers through an assisted suicide which took place at Dignitas facilities in Switzerland. Peter Smedley, a British hotelier and millionaire, and his wife Christine allowed for Pratchett to film Smedley's deliberate consumption of prepared barbiturate in a glass in order to kill himself as Christine comforted Smedley in his demise. The documentary received a highly polarized reaction in the United Kingdom, with much praise for the programme as "brave", "sensitive"[21] and "important"[22] whilst it also gathered accusations of "pro-death" bias from anti-euthanasia pressure groups and of encouraging the view that disability was a good reason for killing from disability groups.[23][24]
Dignitas continued to be presented in the media as a political stance on the right to die. BBC featured an article regarding the death of UK citizen Jeffrey Spector, a businessman who decided to travel to Switzerland to undergo assisted suicide through Dignitas for an inoperable tumour which most likely would have caused paralysis later on in its development. This situation reignited the debate around the morality of assisted suicides in certain dilemmas, and incited current stances concerning euthanasia. Former Lord Chancellor Lord Falconer said he would "attempt to reintroduce a bill that would allow assisted dying in the UK".[25]
Assisted suicide – sometimes referred to as medical aid in dying – means a procedure in which people take medications to end their own lives with the help of others, usually medical professionals. The term usually refers to physician-assisted suicide (PAS), which is an end of life measure for a person suffering a painful, terminal illness. Once it is determined that the person's situation qualifies under the physician-assisted suicide laws for that location, the physician's assistance is usually limited to writing a prescription for a lethal dose of drugs.
Philip Haig Nitschke is an Australian humanist, author, former physician, and founder and director of the pro-euthanasia group Exit International. He campaigned successfully to have a legal euthanasia law passed in Australia's Northern Territory and assisted four people in ending their lives before the law was overturned by the Government of Australia. Nitschke was the first doctor in the world to administer a legal, voluntary, lethal injection, after which the patient activated the syringe using a computer. Nitschke states that he and his group are regularly subject to harassment by authorities. In 2015, Nitschke burned his medical practising certificate in response to what he saw as onerous conditions that violated his right to free speech, imposed on him by the Medical Board of Australia. Nitschke has been referred to in the media as "Dr Death" or "the Elon Musk of assisted suicide".
The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of the right to die is often bestowed with the understanding that a person with a terminal illness, incurable pain, or without the will to continue living should be allowed to end their own life, use assisted suicide, or decline life-prolonging treatment. The question of who, if anyone, may be empowered to make this decision is often the subject of debate.
Pentobarbital (US) or pentobarbitone is a short-acting barbiturate typically used as a sedative, a preanesthetic, and to control convulsions in emergencies. It can also be used for short-term treatment of insomnia but has been largely replaced by the benzodiazepine family of drugs.
Voluntary euthanasia is the ending of a person's life at their request in order to relieve them of suffering. Voluntary euthanasia and physician-assisted suicide (PAS) have been the focus of intense debate in recent years. Some forms of voluntary euthanasia are legal in Australia, Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, and Spain.
Peter Baumann was a Swiss psychiatrist who engendered controversy for conducting physician assisted suicides.
Euthanasia in the Netherlands is regulated by the "Termination of Life on Request and Assisted Suicide Act" which was passed in 2001 and took effect in 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient's request, the patient's suffering, the information provided to the patient, the absence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.
Dignity in Dying is a United Kingdom nationwide campaigning organisation. It is funded by voluntary contributions from members of the public, and as of December 2010, it claimed to have 25,000 actively subscribing supporters. The organisation declares it is independent of any political, religious or other affiliations, and has the stated primary aim of campaigning for individuals to have greater choice and more control over end-of-life decisions, so as to alleviate any suffering they may be undergoing as they near the end of their life.
The legality of euthanasia varies between countries and territories. Efforts to change government policies on euthanasia of humans in the 20th and 21st centuries have met with limited success in Western countries. Human euthanasia policies have also been developed by a variety of NGOs, most advocacy organisations although medical associations express a range of perspectives, and supporters of palliative care broadly oppose euthanasia.
Right to Die?, also known as The Suicide Tourist, is a documentary film directed by Canadian John Zaritsky about the assisted suicide of Craig Colby Ewert (1947–2006), a 59-year-old retired university professor who suffered from amyotrophic lateral sclerosis.
Suicide tourism, or euthanasia tourism, is the practice of potential suicide candidates travelling to a jurisdiction to die by suicide or assisted suicide which is legal in some jurisdictions, or the practice of travelling to a jurisdiction in order to obtain drugs that can aid in the process of ending one's own life.
Active euthanasia is illegal in Switzerland, but supplying the means for dying is legal, as long as the action which directly causes death is performed by the one wishing to die. Assisted suicide in the country has been legal since 1941, and Switzerland was the first country in the world to permit any kind of assisted dying. In 2014, a total of 752 assisted suicides were performed, compared to 1,029 non-assisted suicides ; most of the assisted suicides concerned elderly people suffering from a terminal disease. In what critics have termed suicide tourism, Swiss euthanasia organisations have been widely used by foreigners. As of 2008, German citizens were 60 percent of the total number of suicides assisted by the organisation Dignitas.
Betty and George Coumbias were a Canadian married couple who sought to become the first husband and wife to complete simultaneous suicides with legal authorization. They were featured in John Zaritsky's 2007 documentary, The Suicide Tourist. Although assisted suicide was illegal in Canada, they hoped to end their lives with the approval of the government of Switzerland.
Ludwig A. Minelli is a Swiss lawyer. He is the founder of Dignitas, an organization that helps permanently ill people to end life in a manner which relieves pain and suffering. He is also the founder and general secretary of the Swiss Society for the European Convention on Human Rights.
Euthanasia in Canada in its legal voluntary form is called Medical Assistance in Dying and it first became legal along with assisted suicide in June 2016 for those whose death was reasonably foreseeable. In March 2021, the law was further amended by Bill C-7 which to include those suffering from a grievous and irremediable condition whose death was not reasonably foreseeable. According to the Fourth Annual Report on MAID, there were 13,241 MAID deaths reported in Canada in 2022.
Terry Pratchett: Choosing to Die is a 2011 one-off television documentary produced by KEO North for BBC Scotland on the subject of assisted death, directed and produced by Charlie Russell. It is presented by Terry Pratchett and features Peter Smedley, a 71-year-old motor neurone disease sufferer, dying by assisted death at the Swiss assisted dying organisation, Dignitas.
Switzerland had a standardised suicide rate of 10.7 per 100,000 as of 2015. The actual (non-standardised) rate was 12.5 in 2014.
My Death, My Decision (MDMD) is an organisation that campaigns for the legalisation of assisted dying in England and Wales. The group was founded in 2009, in order to campaign for a change in the law and advocate on behalf of adults of sound mind, who are either terminally ill or incurably suffering.
Assisted suicide is the ending of one's own life with the assistance of another. Physician-assisted suicide is medical assistance in helping another person end their own life for the purpose of relieving their suffering, and voluntary euthanasia is the act of ending the life of another, also for the purpose of relieving their suffering. The phrase "assisted dying" is often used instead of physician-assisted suicide by proponents of legalisation and the media when used in the context of a medically assisted suicide for the purpose of relieving suffering. "Assisted dying" is also the phrase used by politicians when bills are proposed in parliament. Assisted suicide is illegal under English law.
References
↑ Karin. "Statistics". www.dignitas.ch. Retrieved 14 March 2021.
↑ Ludwig A. Minelli, Secretary-General, Attorney-at-law. "Friends At The End (FATE)"(PDF). Archived from the original(PDF) on 6 March 2009. Retrieved 17 December 2017.{{cite web}}: CS1 maint: multiple names: authors list (link)
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