When suffering becomes unbearable, some people would prefer to die rather than seeing it prolonged.
EXIT will not abandon such people to their fate. Rather, EXIT supports its members in their right to self-determination.
EXIT's option of physician-assisted suicide is actually an effective form of suicide prevention. Living in the certain knowledge of a way out has motivated more than half of the people originally intent on dying to keep enduring their painful lot until they passed away the natural way.
Also, EXIT's physician-assisted suicide keeps people from dying violently at their own hand and alone by themselves.
The official definition of physician-assisted suicide is this:
third-party assistance in suicide.
Suicide and attempted suicide were legalised in the 1890s. Since 1918, the assistance thereto has been legal, too. The law in its current form dates back to 1942, and makes assistance to suicide legal on the condition that the assisting party derive no substantial financial gain from it.
This is why EXIT end-of-life attendants volunteer for the job, and are only paid back for their out-of-pocket expenses.
The Federal Supreme Court of Switzerland has recognised a person's right to seek assistance to commit suicide.
Suicide assistance may be rendered whenever the person wishing to die
- knows what he or she is doing (faculty of judgement)
- does not act on impulse (due consideration)
- has a persistent wish to die (constancy)
- is not under the influence of any third party (autonomy)
- commits suicide by his or her own hand (agency)
This means that even suicide assistance to young healthy people would technically be legal.
In full awareness of its enormous responsibility, however, EXIT has self-imposed restrictions through its by-laws and internal guidelines. Moreover, EXIT proactively orients itself to the diligence criteria that were negotiated in a bilateral agreement with the Canton of Zurich, where EXIT is seated.
EXIT will provide end-of-life care only to persons
- with hopeless prognoses
- or with unbearable symptoms
- or with unacceptable disabilities
EXIT provides end-of-life care only to its members. Members must be at least 18 years of age, and either citizens or permanent residents of Switzerland. Long-term EXIT members are prioritised.
The Federal Supreme Court of Switzerland has ruled that suicide assistance may even be rendered to persons with a psychical illness as long as they retain the capacity to judge the significance of suicide.
The cases in which EXIT assists persons with a psychic disorder, though, are very rare (2 or 3 times a year) and subject to extremely diligent review. The preconditions to be met in such cases are extremely strict, and include two independent expert opinions as well as the verdict of the Society's Ethics Commission.
The number of people suffering from dementia ailments such as Alzheimer's is steadily increasing. Persons belonging in this group are eligible for physician-assisted suicides only during the early stages of the disease. As the disease progresses, persons suffering from dementia increasingly lose their ability to judge. This is why EXIT refuses to assist them to end their lives. Any living will signed during the early stages will protect these members through the end of their lives, though.
The best way to proceed for a member contemplating physician-assisted suicide is to approach the EXIT head office in Zurich - be it directly or through a close relative. EXIT will ask the member to submit a medical diagnosis, including a certificate confirming faculty of judgement, and any hospital reports available.
Once these documents have been received and reviewed, an end-of-life attendant will visit the member and discuss the situation during a personal interview. The purpose of this meeting is to address any issue, question, or concern involved, and to clarify which alternatives to suicide might yet be open to the member in his or her situation.
If the member reconfirms his or her desire to initiate all preparations for a physician-assisted suicide, the Society will ask a physician to make out a prescription for the lethal drug, be it through the general practitioner, the attending physician, or a consultant doctor working for EXIT.
The head office will obtain the prescription medicine in behalf of the member.
As of this moment, the person wishing to die can decide whether and when he or she wished to go ahead with the physician-assisted suicide. The requested date needs to be coordinated with the end-of-life attendant.
Seeking suicide assistance is tolerated and legal in Switzerland. Rendering suicide assistance, too, is entirely legal - unless the person benefits financially from the death of the assisted person (see Article 115, Swiss Criminal Code). This is why working as an EXIT end-of-life attendant is a voluntary unpaid job.
On the date set by the member, the end-of-life attendant will bring the drug to the setting chosen by the member - with family members or friends present.
The end-of-life attendant will ensure that the ambience is appropriate for the occasion.
Precondition for each physician-assisted suicide is that the person wishing to die is able to take the final step on his or her own - by drinking the barbiturate dissolved in water or by opening the tab of the infusion stopcock.
Up to this point, the person wishing to die may abort the process any time.
Having administered the drug, the person will have just enough time to take leave of his or her loved ones. It is in their midst that the person will sink into deep slumber within a few minutes, and then leave this world peacefully and painlessly. Death will set in a short while later due to a combination of respiratory and cardiac arrest.
Any suicide, including a suicide assisted by EXIT, is legally deemed a so-called "extraordinary death." Once the person has passed away, the Swiss police will have to be notified.
The police will normally bring a medical officer of health and possibly a district attorney to conduct a so-called "legal inspection." The purpose of this on-site investigation is to clarify whether all applicable legal provisions have been observed.
Autopsies are rarely if ever ordered for suicides assisted by EXIT.
EXIT performs careful internal checks, and continuously reviews all of its process flows. Its policy has been to uphold the diligence rules defined together with the Canton on Zurich not just in that canton but everywhere in Switzerland.