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Thursday 02 October 2014

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A guide to DIGNITAS

Introduction
The association "DIGNITAS - To live with dignity-to die with dignity" was founded on 17 May J 998 at Forch (Zurich), Switzerland. Dignitas is run by a lawyer, Ludwig Minelli, who says he set up the organisation because he believes that if someone is terminally ill, it is their human right to die when they choose.

"To live with dignity, to die with dignity. That is our motto".

It pursues no commercial interests whatsoever and has the objectives of ensuring a life and a death with dignity for its members, and of allowing other persons to benefit from these values. Dignitas is the only organisation in the world which offers a doctor-assisted suicide service to people from other countries, enabling them to die with dignity and comfort, despite having to travel to Zurich to do so.

Swiss law, unlike the state and territory laws in Australia,*permits a doctor, if specific conditions are met, to write a prescription for a lethal dose of a barbiturate. In order to comply with Swiss law, various documents are required. Acquiring these and going through the necessary procedures can take time and sometimes be difficult.

The object of this guide is to assist people to complete the formalities, alert them to the length of time that may be needed, indicate the cost, and describe procedures upon reaching Zurich so that people know what to expect.

Who can join Dignitas?
Anyone over 18 can join, whether they intend asking for help immediately or wish to have an 'insurance policy' for the future.

Contact Dignitas for an application form:

Dignitas,
PO Box  9
CH 8127  FORCH, Switzerland
Tel: +41 43  366 1070
Fax: +41 43  366 1079
E-mail: dignitas@dignitas.ch Web: www.dignitas.ch

Once you have joined, Dignitas responds by sending you information about the organization, a Patient Instruction form and payment details. When this is completed satisfactorily, Dignitas will send you four identical, passport-sized membership documents.

Should you wish to ask for help immediately, include a letter telling Dignitas something of your circumstances, your medical condition and prognosis, and how it is affecting your desire to continue living.

Who can be helped to die?
Dignitas must keep strictly to Swiss law. They cannot help people whose condition may improve either by itself or with treatment. They accept those who are terminally ill or suffering unbearably from symptoms that cannot be relieved.

As of February 2006 Dignitas has helped 493 individuals to act upon their choice to die, more than half of them from Germany and Britain. To date, at least four people in Australia have availed themselves of this help.

What Dignitas requires
If Dignitas can consider your application for immediate help, they will ask you for the following:

  1. Short CV and personal view of the suffering you are experiencing. This should include the views of your family members. Do they support your intention? Will someone go with you to Zurich - a family member or a friend? (Dignitas' help is not conditional on the family's agreement, but naturally they wish to avoid problems from relatives.)
  2. Medical Reports
    Two or more are required, normally from two different doctors, but in exceptional cases one may be accepted. At least one must be dated within the last four months. The reports should include:
    • Diagnosis
    • State of health
    • Prognosis (if available)
    • Treatment
    • Current medication

    The medical reports are given to a Swiss doctor. If she/he agrees that your condition justifies the ending of your life and your documents are in order, Dignitas will send you a letter giving you a 'provisional green light' and telling you the costs and procedures.

    Note: You have a legal right to obtain a copy of your medical records without giving a reason. If you have a good relationship with your doctor, you can be frank about why you need your records, but unless you are absolutely sure, it may be best not reveal your intentions.

    If you request these records from a private practitioner your doctor is legally allowed to withhold details prior to 2002. There will probably be a charge for these records.

    To obtain your records from a hospital you need to ask the Freedom of Information Office. There should be no charge for hospital records.

  3. Documents
    • Passport
    • Proof of residence, eg service bill that inc1udes your address
    • Full birth certificate, including parents' names
    • Partner's birth certificate, including parents' names
    • Marriage certificate
    • Divorce certificate or partner's death certificate
  4. Everyone is required to provide:-

    In addition, if you are married:-

    In addition, if you are divorced or widowed:-

Travel arrangements
Once the 'green light' has been given, you can decide an approximate date. The timing for going to Zurich can be very difficult and critical.

Travelling to Switzerland to end one's life demands strength of purpose and determination. The journey from Australia is long and arduous, especially for someone terminally ill and/or suffering unrelenting pain. The person accompanying the patient must also be focused and strong willed. Practical difficulties may arise and need to be sorted out quickly. Throughout, the welfare of the patient must come first. A sense of humour in both parties is a great help!

Flights from Australia to Zurich are via Singapore or Hong Kong. Total flying time is at least 22 hours and there is additional change-over time as well. A stop-over of at least a day in Singapore or Hong Kong is highly recommended.  All travel arrangements can be made through a travel agent or via the Internet. Return air fare is probably cheaper than one way.

Official data sheet for the Zurich authorities
Before you leave Australia to come to Zurich, you will need to complete and return a data sheet (sent to you by Dignitas) for the Swiss authorities.

On arrival in Zurich
There are always two appointments required when you reach Zurich: The first, at the doctor's room to meet the doctor who is going to prescribe the barbiturate; the second, at the apartment for the final 'accompaniment', as the assisted dying process is called by Dignitas. Although the choice is up to you, the two visits are preferred on consecutive days, partly to ensure that there is no change of mind.

Once you arrive in Zurich, take a taxi to the Dignitas office in Forch or to the doctor's consulting room, as advised by Dignitas. If you will need an ambulance, notify Dignitas in advance and it will be arranged for you. The ambulance comes up to the plane and the stretcher is fork-lifted directly into it. (Note - this will involve an extra cost.) All goes as smoothly as a Swiss watch and their paramedics are superb!

Meeting the doctor
You will meet the doctor, who will have your medical reports, in his/her rooms at Forch. S/he needs to determine that you are quite certain that you wish to die and that you can swallow the drink unaided or that means are available for the drug to be administered by yourself. S/he will answer any questions you wish to ask.

The Dignitas Apartment
Once you arrive the volunteer who is trained to assist, will take you up to the apartment and offer you coffee.

There you must sign three documents which are needed by the Swiss authorities. The volunteer goes through these with you. One of these is a Power of Attorney to the Director of Dignitas to enable him to handle your case with the local authority. This is a carefully drafted legal document but has no effect on your rights or estate.

The 'accompaniment' is then described in detail. You must first take an anti-emetic solution (pleasant taste), followed 30 minutes later by the bitter tasting lethal barbiturate preparation - both about an average sherry glassful in volume. The volunteer is kind and thoughtful, and everything is done at the pace you wish. For example, if you wish to spend time with the people who have come with you, the volunteer will wait outside.

When you are ready you can sit on a chair or lie on the bed. The barbiturate should be drunk quickly but, even if you do not drain the glass, the dose will be fatal. You may have help holding the glass or the straw, but you must swallow it unaided. For those who cannot swallow arrangements are made so that you can trigger the self-administration of the drug by injection. You go to sleep within 1-2 minutes and die 20-30 minutes later. There is a video camera at the end of the bed to provide proof that you were not helped. Two witnesses are required, one of whom must be the volunteer.

The Swiss authorities
The person who came with you has to stay to see the authorities. As soon as you are dead, the volunteer phones the local police station to report what has happened. Officials come from the police and the Prosecutor's office, and there is also an official doctor. (They may be delayed for up to 2 hours if they have other urgent demands on their time.)

Dignitas will send your death certificate to whomever you requested to receive it. Your ashes will also be sent as soon as possible but this may not be for up to 10 days later.

Arrangements for the body
Ensure that you tell Dignitas the:

If you wish the body to be sent back, the arrangements must be made in advance in Australia.

Legal position
It is not illegal to travel to Switzerland in order to have an assisted death. To date no one has been prosecuted for accompanying a person, but this has not so far been tested in law.

In 2006 a British man, who accompanied his mother to Zurich, was questioned by the authorities upon his return to England, but no charges were laid.

A COUPLE OF AUSTRALIAN STORIES
John Elliott

At approximately 10.30am on Thursday 25 January 2007 - retired medical practitioner Dr John Elliott - died at Dignitas in Zurich, Switzerland.

His rapidly deteriorating health dictated that he travelled to Switzerland with his wife Angelika and Dr Philip Nitschke of Exit International even though he did not have a fixed appointment with Dignitas. The acceptance letter from Dignitas only arrived at the Elliott's home as they were leaving for the airport.

An appointment with a Swiss doctor was scheduled. The purpose of the meeting with the doctor was so Dr Elliot's medical condition could be reviewed, his state of mind assessed, and if he was satisfied, the required Nembutal prescribed.

This is not a formality and the doctor spent considerable time interviewing and talking with him. Once satisfied, the doctor agreed to provide the needed prescription and all paperwork was handled by Dignitas. Dignitas staff filled the script and brought the 15 gm of sodium pentabarbital to the Dignitas unit on the day of Dr Elliott's death.
On the following morning of Thursday 25 January - exactly 2 months short of his 80th birthday - John Elliott took one final taxi ride to the Dignitas apartment which was only minutes away from his hotel. Upon arrival at the apartment, they were met by a male nurse and a female social worker. A final set of paperwork was completed including Power of Attorney forms in order to protect Dignitas from any possible legal challenge.

He was given a choice of lying down but chose to stay seated at the dining table.
At this stage he was again asked about whether he wished to follow through on his plans. It was emphasised to him repeatedly that he could change his mind at any time.

"You can opt out at any time," says the nurse, several times.

He responded "Hurry up, let me be free."

At 10am he drank the first of two drinks. The first small drink was the drug metoclopramide (Maxolon), an anti-vomiting drug. This drug was given half an hour to take effect. At around 10.30am the liquid Nembutal was prepared. The small glass was placed on the table and he was told he could drink it at any time.

With a videotape rolling for legal purposes, the nurse asks Dr Elliott whether he realises that if he takes the drink he will die. Dr Elliott states that he does.

Without hesitation he took the glass, and drank its small contents, saying "that didn't taste too bitter." Then he toasted his "bad health" with a glass of Cognac. In less than 5 minutes Dr Elliott fell asleep in his chair. In around 15 minutes, Dr Nitschke took his wrist and whispered quietly that he was gone. It was another 45 minutes until Dignitas nurse performed his own check and announced that he had died.

At this point the nurse called the police and the coroner who attended, along with a police doctor and interviewed all present at the death, including Dr Philip Nitschke and Angelika Elliott. Shortly after, the undertaker arrived.

John Elliott's story received widespread coverage across all Australian media including print, radio and TV. The story attracted front page coverage in both
the Sydney Morning Herald and The Age. Other highlights included the 7.30 Report on ABC TV. The story continues to receive ongoing attention as the issue of Voluntary Euthanasia is discussed in the media.

Andries Verschoor
Gold Coast man, Andries Verschoor chose the "Swiss Option" because he had a very aggressive cancer of a salivary gland, which resulted in destructive surgery, and no hope of cure. He said while he did not choose to die, he could choose the time and manner of his dying. His story also received media attention. Read here...

Two of his daughters accompanied him to Zurich with a two-day stopover in Singapore. They said there was quite a lot of paperwork required and that the timing for going to Zurich was very difficult and critical: Their father had to get there before he could no longer swallow and/or need a tracheotomy to breathe.

In describing their father's death one of the daughters said, "He just sat on the bed and sipped about an eggcup full of clear liquid ... A minute later he said he didn't think the drug was working but within seconds began to yawn and said he felt tired. He just fell asleep. He was very peaceful and asleep. We sat with dad until he died."

Andries' daughters had only praise for the whole process, their welcome, counselling, etc. Any wishes they had for a funeral and disposal of the body were met without difficulty. The ashes were sent by post back to Australia. After the death, a doctor was called. He notified the police. A police doctor and the police prosecutor came. This is the normal procedure. As confirmation that all was above board, a video was taken of the counselling process and of their father swallowing the Nembutal.

They had obtained a return ticket for their father and on return the travel agent refunded the airport taxes.

* In the Northern Territory. Marshall Perron's Bill, the Rights of the Terminally III Act (ROTl) came into effect on I July 1996, the world's first VE law. The Federal Government subsequently reversed the changes in the Northern Territory in 1997. Four persons chose to use the Act to end their lives peacefully and with dignity during the brief period the law was in effect. Many hope that when the Northern Territory becomes a State, the issue will be re-visited.

Here a list of links to additional information in English: