Dignitas was established on 17 May 1998 by Ludwig Minelli in Switzerland. The motto of the organization is ‘to live with dignity, to die with dignity’. It is the only organization in the world has not limited itself to offering assisted suicide to people who reside in Switzerland. It welcomes foreigners.
The request for assisted suicide usually starts with contact by the person concerned or by an authorized third person. The first reaction of the Dignitas is usually immediate referral for counseling and an example will be referral to palliative care specialist for pain control. The next step will be membership application. In case of emergency, the Dignitas will advise on measures of dealing it and will usually advise the person to contact with the connected person abroad. If the person still insists on making the actual request of assisted suicide, he or she will be required to submit all required documentation including a letter written and signed by the member or an interested person, a medical documentation as proof of reasons, and an account of the member’s life with details about his or her character as well as their family and work situations. Dignitas will examine the documents and they will usually make some immediate recommendations for possible alternatives with the hope of being able to continue life under better conditions. They will contact the member and offer alternatives of improving therapy such as palliative care and pain control, and passive assisted suicide (an example will be sedation for breathing difficulties). The request will be passed to a doctor to see whether the doctor is prepared to prescribe a suitable medication for the applicant if the member insists on assisted suicide. After further evaluation and clarification, a ‘provisional green light’ will be provided if the doctor agrees. If the doctor refuses and the patient insists on the action, Dignitas will continue the searching for a doctor. ‘Provisional green light’ means the doctor is ready to prescribe the lethal medication. The doctor must see and speak with the member for twice and the planned medical consultation do not present any obstacles such as impaired or doubtful mental capacity or pressure from a third party with regard to premature death or evidence of an acute depressive phase. Three options come with the ‘provisional green light’:-
one extended visit;
two trips for doctor’s visit (twice) and the actual assisted suicide;
not undertake anything further.
Dignitas will involve and prepare the family at all times. The member then need to carry out additional administrative preparations and fill in documents not more than 6 months old at the time of planned assisted suicide according to relevant Swiss Ordinance on Civil States. Only 13% made actual appointment after receiving a ‘provisional green light’ and 70% never contact the organization again. An up-to-date medical report must be submitted to the Swiss authorities of not more than 3 to 4 months old at the time of assisted suicide. After completing the relevant documents and medical report, Dignitas will provide a desired appointment and the member will travel to Zurich and stay at the accommodation of the Dignitas. He or she will meet the Dignitas escort and the escort will greet and introduce himself or herself to the member and start conversation with the member so as to understand the reasons for assisted suicide. The conversation will also include the details of the procedures and stress the complete freedom to decide against assisted suicide at any time. The process will be explained in details. The member will swallow the medication and place the medication through stomach tube or percutaneous endoscopic gastrostomy tube at abdominal wall. For the pre-existing intravenous drip, the member will administer the medication through a syringe or a remote. For artificial ventilation, the member needs to activate the power termination. The member needs to initiate next phase by his or her own but not the Dignitas. Assisted suicide will be cancelled if any doubts of member’s mental capacity or not decision free from external pressure. A ‘declaration of suicide’ will be signed by the member or an authorized third person and this will give Dignitas power of attorney for death certification and the cremation or the transport of their body. After the farewell, the member will be questioned again for decision of assisted suicide. Assistance of administration of medications is permitted as long as it does not in any way lead to someone else administering the medication, e.g. holding the glass containing a straw is allowed but not tipping the glass. Sweetened beverage or chocolate will be given to remove the bitter taste. After confirmation of the death, the police will be notified for official investigation.