INSIDE DIGNITAS – How the work of DIGNITAS is changing
26 November 2024
When the association “DIGNITAS – To live with dignity –To die with dignity” (abbreviated: “DIGNITAS ”) was founded in 1998, it was already legally possible for people from abroad to end their own suffering and life in Switzerland with a doctor’s support. The country set a particularly progressive-liberal precedent in the world in this respect, and the association soon received enquiries from seriously ill people from neighbouring countries who were willing to travel to Switzerland for an accompanied suicide – assisted dying.
There was, and still is, no reason why access to professional assistance in ending one’s own suffering and life should depend on where someone lives. Ideally, this assistance should be legally available where a person is at home. Most people prefer to die at home, and this is why DIGNITAS has been campaigning for this “last human right” worldwide through legal and political work since its foundation, providing information about end-of-life choices and making it possible for people from all over the world to exercise this right in a professional, legal and medically supported setting in Switzerland.
Self-determination until life’s end is a worldwide topic
Today, in many countries, considerably more importance is attached to self-determinately shaping the end of one’s own life than 25 years ago. Information is available worldwide, and the pressure on politicians to enable people to have freedom of choice in their own country is increasing. This – just like DIGNITAS ’ daily advisory and information work – is by far not only about assisted suicide, but also about patients’ rights, advance health care planning, appropriate medical care, palliative measures, appropriate old age care, etc.
This is encouraging, but in many countries any form of assisted dying is still a criminal offence. Moreover, in many countries where some form of assisted dying (i.e. assisted suicide and/or voluntary euthanasia) is now legally possible under certain conditions, a large group of seriously suffering people is still excluded from this right, often because access has been arbitrarily restricted by law to people with a terminal illness and life expectancy of just a few months.
High know-how requirements, more complex cases and longer processing times
This development also has consequences for the daily work of DIGNITAS . The total number of assisted suicides of people from abroad is stable overall, but the requests for assistance are becoming increasingly complex. In a number of countries assisted dying is now legal – for example in Germany, Austria, Spain, Australia, New Zealand, and some US states. In those countries, people suffering from an advanced incurable illness can make use of help locally and will not have to travel to Switzerland. In addition, access to palliative care has improved in many countries in recent years, which can significantly improve the quality of life of those affected in their last period of life.
At the same time, there has been an increase in requests for assisted dying from individuals who do not fulfil the legal criteria in their country for receiving access to medical help to end their life, as well as requests from countries far outside Europe where any form of assisted dying is still prohibited. Many people get in touch with DIGNITAS to inform themselves thoroughly about their options, but the number of requests for assisted suicide by members from these countries is also steadily increasing.
Overall, there has been a sharp increase in requests from people with more complex medical conditions. These include, for example, neurological diseases such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) or so-called comorbidities, i.e. several chronic illnesses which severely impair the quality of life of those affected. In the case of long-term illnesses that are complex and often associated with pain, and which do not lead directly to death, sometimes a depression may also be documented. This requires additional clarification, possibly including up-to-date neurological or psychiatric reports, to ensure that the wish to die is not a symptom of a treatable (secondary) illness, but a well-considered decision based on the overall symptoms.
Every request for an assisted suicide is individual and handled with appropriate care. The preliminary examination, the preparation of a robust medical dossier for examination by a Swiss medical doctor (or several doctors) and – if the member wishes to proceed and make use of an assisted suicide – the procurement and completion of the necessary papers and official documents (see also “The path to an accompanied suicide”, DIGNITAS Newsletter 3/2024) require considerable time and specific know-how and involve a great deal of work – both on the part of the member and on the part of DIGNITAS .
Outlook
In view of demographic developments, the increasing importance of freedom of choice and self-determination until the end of life in societies worldwide, and the very hesitant political processes regarding assisted dying in many countries, it can be assumed that the internationality and complexity of DIGNITAS’ work will continue to increase in the coming years.
DIGNITAS has grown significantly in terms of staff in recent years. The demands on the professional and personal skills and flexibility of employees are high, and a thorough extended staff training is essential. Ongoing education, regular case discussions, the internal exchange of information and the optimisation of processes and documentation are of great importance in the advisory work, in the processing of requests for assisted dying, and in preparing and conducting assisted suicide.
DIGNITAS is in contact with organisations and institutions worldwide which are committed to self-determination until the end of life in their country and can make use of the association’s expertise and experience. The goal of DIGNITAS is and remains that people all over the world should be able to end their suffering and their lives legally, safely and with professional assistance at home, and that no one needs to travel to Switzerland to make use of this end-of-life choice.
