March 31, 2014

Where Can You Go for Lawful Assisted Suicide?

That question came up at my Parkinson's support group meeting last Friday. I said I thought Switzerland was the only jurisdiction with an assisted suicide law that permitted non-residents to use it. I checked over the weekend, and that's still the case.

Assisted Suicide Laws in U.S. 
Three states -- Oregon, Vermont and Washington -- have legalized physician assisted-suicide laws by legislation. One -- Montana -- has done so by court ruling. Thirty-nine states have laws prohibiting assisted suicide. 

All four of the states permitting physician-assisted suicide make it available only to residents of the state. The three that do so by law require that the patient be diagnosed with a terminal illness that is expected to lead to death within six months. The laws also require that the patient be capable of making healthcare decisions for herself.

For more information on these laws, see the state-by-state comparison charts at

Assisted Suicide Laws in Europe
European countries that permit assisted suicide include Belgium, Luxembourg, the Netherlands and Switzerland, Only Switzerland allows non-residents to travel to the the country for an assisted suicide.

Assisted Suicide, Not Euthanasia
Commentators and journalists often claim that euthanasia is allowed in these jurisdictions but that's not true. Only assisted suicide is permitted. Euthanasia involves the killing of a person who has a terminally illness -- the Dr. Kevorkian scenario. 

Assisted Suicide in Switzerland
Switzerland has permitted assisted suicide since the 1930s, but only in recent years has that country become a magnet for foreigners who want to commit suicide.

The Swiss law has two significant differences from the other assisted-suicide laws:
  • No doctor need be involved.
  • There need be no terminal medical condition.
The law is so loosely phrased that the only certain criterion is that the person requesting help be mentally competent. That relaxed guideline has given rise to a number of non-profit assisted-suicide agencies; the leading one is Dignitas.

Among the services it provides for its members is procuring the necessary medication (a lethal, fast-acting and painless barbiturate that is dissolved in drinking water). Each assisted suicide requires a Swiss doctor's prescription. For foreigners and Swiss who don't have their own doctor, Dignitas uses cooperating doctors.

After an in-depth evaluation of the member's written request -- and at least two face-to-face meetings between doctor and patient -- the doctor, if satisfied that the patient meets the conditions, issues the prescription to Dignitas. The member then arranges the time and place with Dignitas. At least two people must be present at the suicide as witnesses. Dignitas emphasizes the importance of involving friends and family in the process.

Most Members Decline the Offer
Dignitas reports that only a few of its members take advantage of the assisted-suicide service. They usually end up feeling sufficiently reassured by their instructions that no life-prolonging measures should be initiated, and that any life-threatening situation should lead to a natural death.

In a hopeless situation, the member feels comforted knowing he can say, "I've had enough now. I want to die." 

This has been the experience of every other jurisdiction that has an assisted suicide law, Few of those who sign up end up taking their own life.

As an example of the openness of the Swiss law, in July 2009, British conductor Sir Edward Downes and his wife Joan died together at a suicide clinic outside Zurich. Sir Edward was not terminally ill, but his wife had rapidly progressing cancer.

In a referendum conducted in May 2011, Swiss voters were asked whether (1) assisted suicide should be banned, and (2) foreigners should be denied access to the assisted-suicide services. A ban on access to assisted suicide was rejected by  84 percent  of the voters, and 78 percent voted against banning access to foreigners. 

The Story of an Australian Couple's Experience with the Swiss Law
This video recounts the experience of a dying Australian doctor and his wife:

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