Assisted dying in Switzerland

Speaker:

Dr. Erika Preisig was born in Basel, Switzerland as one of seven children. She went to school and studied medicine in Basel. After finishing her studies, she worked as an assistant doctor for two years in Manchester England. She then started doing locums for doctors in the countryside of Switzerland.

Erika had three children between 1989 and 1992, still working as a GP, doing a lot of palliative care. In 2005, her father accessed assisted dying with Dignitas, which led her to start working for Dignitas from 2007 to 2012 as a consultant doctor. In 2011, Erika founded lifecircle as she wanted to do more than be a consultant doctor of Dignitas. “With lifecircle, we can be active for promoting quality of life, if quality of life cannot be promoted any more, we can at least give a peaceful death with the foundation Eternal Spirit.”

Hello altogether. Thank you for being able to speak here. I love to tell you about my experiences and also my problems in Switzerland, which are not little, not few. I don’t know … Oh yes, you are seeing the first slide.

On this slide, you see my father and me. This was in 2005. My father had two times a stroke and in 2005, he tried to commit suicide by eating a lot of pills, all the pills that he was able to get. He slept for three days and then woke up. Then he told me … He showed me, he couldn’t speak anymore because of his stroke. He showed me that he was going to kill himself by jumping onto the train. I couldn’t accept that. This is why I told him, “Look in Switzerland, you have the choice that you can have an assisted dying and you do not have to go and kill yourself by jumping onto the train.” So, I experienced assisted dying for the first time. And when you see this picture, you see his hands pointing up. You see his face. I was asking him, “Are you looking forward to die tomorrow?” And this is how he showed how much he was looking forward to tomorrow, when he could die.

When I became a doctor in 1984, I was working for palliative care only. All my patients or most of my patients died at home. Palliative care is a wonderful thing, but it has its limits. Sometimes it’s very hard to die with palliative care. So when I experienced the death of somebody who is so much so full of joy, that you can see it on a picture, because he can die in peace. But then you start thinking over whether palliative care is the only thing or maybe assisted dying can be something good also.

So I started to work for Dignitas 2005. I had six years of experience with a lot of foreigners coming to Switzerland, wanting to die. And as I saw that there is only one bad thing about assisted dying and this is that foreigners have to travel to Switzerland for a peaceful death, I wanted to have my own organization to help fighting for legalization. If I was still working for Dignitas, I wouldn’t be allowed to speak to you now and this is what I want to do. I want to speak to people about my experiences and how important it is to have assisted dying or medical assisted aid in dying.

Switzerland has a problem. If we can have a look at the next slide, the Swiss law is very open. There are only two conditions that you have to meet. The person who wants to die has to be of sound mind, and the person helping must not earn more money than in his normal profession. This means, he is allowed to earn some money, but he must not do it for financial interest only. But because the Swiss Law is so open, it can also be a problem for the doctors. We have a medical association and on the next slide, you see the conditions of the medical association, and this is not Swiss Law.

So medical association asks for mental capacity like the Swiss Law, but it also asks for an incurable disease or unbearable pain. You must be well informed about possible therapies, which is very good. The wish to die must be well reflected and stable. You must not be influenced by any other people. You must inform the family. Two doctors must agree to your wish to die. And the medication must be taken by the patient itself.

The big problem is the uncurable disease or unbearable pain. Who tells which disease is uncurable? Who says which pain is unbearable? It can only be the patient itself who says, if a pain is unbearable. Uncurable disease is very difficult because doctors usually don’t say it’s uncurable. They say, “We can still do something, still do something, still do something.” And sometimes they take a lot of life quality away by doing more and more therapies, especially with cancer diseases.

So it is a little bit of a problem. Actually by the Swiss Law, which is so open, everybody would be allowed to die, even people who are not ill at all. And I guess no doctor would give the medication to somebody who is not ill at all. And doctors can have big problems with the public prosecutors, if they accept people who are not ill, who do not have really incurable disease or unbearable pain.

On the next slide, you can see the practice, how medical aid in dying is practiced in Switzerland. We not do not know euthanasia. Euthanasia is forbidden in Switzerland. And MAID is practiced that you have to a personal letter explaining your suffering. You have to send some medical records, proof of your mental capacity, which means you go to a lawyer or to a doctor or to a psychiatrist and he tells in a short letter that you have your mental capacity. And then doctor or nurse sets a intravenous drip in Switzerland. The patient must open the drip himself/herself.

We have a lot of tetraplegic people by motor neurone disease or by accident breaking the spine, up and at the neck and they cannot move their hands anymore. So how can they open intravenous drip themselves? We have a little machine, they can just push with the head and the drip opens. Then after 30 seconds, the medication goes from the back of the intravenous drip into the vein. They fall asleep in a very deep narcotic sleep. And after about three minutes, the heart stops beating. You only need this one medication and because of this one medication needed, the people can do it themselves. If we would need several medications like it is in other countries, then the doctor would have to inject several different medications and this would not be accepted in Switzerland.

So on the next slide, you see that this is the big problem, that doctors in Switzerland are taking a risk when they accept assisted dying. After every assisted dying, we have to report a unnatural death to the police. The public prosecutors and the coroner are coming to check whether it suits the Swiss regulations. And if the public prosecutors have the impression that, for example, the person had suffered from a depression before, then they might open a court case against the doctor, because they can say maybe this patient was not of sound mind. So it is always a big problem for the doctor and this is why in Switzerland, we have far too few doctors who accept assisted dying and even less who do assisted dying. It’s also possible that if your colleagues, doctor colleagues know that you promote, that you accept assisted dying, that you can be offended by other doctors. That’s a problem and this makes doctors be very careful whether they would want to accept.

On the next slide, you see, I’m asking myself sometimes, why do I go on? Because I’m having a court case running against me, myself. In 2016, I gave assisted dying to a lady who was very ill, but a year before she had tried to do a suicide unaccompanied, a suicide without help. And when you try to do a suicide in Switzerland, the doctor will put you to a psychiatric ward and you will have to diagnose of depression. She wasn’t depressed at all.

The only thing is that she wanted to die. And because she couldn’t find a doctor, she wanted to do it herself. But as she had depression in her list of diagnosis, the public prosecutors opened of course a court case against me, even though two different doctors had wrote a report that she was of sound mind, that she met all the conditions of the medical association. At that time, we didn’t have a psychiatrist to judge the people. That was the big, big problem. Now we have a psychiatrist and when we have somebody who has a reactive or any other depression, we can send them to a psychiatrist and they can have assisted dying anyway.

I want to stop the suicide tourism. This is the most important thing for me. I think everybody should have choice. Everybody should have the right to die in his country, in his house, in his bed by assisted dying if he wants to do this. So we all have to stand up and try to get legalization all over the world. This suicide tourism won’t stop, as long as people can’t do it in their home country, and I’m sure as abortion is legalized almost all over the world. With abortion, you kill a healthy unborn child. If most countries accept abortion, I can’t understand why they don’t accept assisted dying or medical aid in dying, euthanasia. So that’s what I say, I hope and I’m convinced that we will get assisted dying legalized in every country, so everybody will have the choice to die the way they want to.

Good. This is the most important part that I wanted to tell you about my work. I’m still working with palliative care. That’s amazing, most of my patients die with palliative care and the patients that I’m looking after in Switzerland, they can choose right until the end. They can go the palliative way. And if they say, “Look, now suffering is too bad for me. I don’t want to go the palliative way anymore. I want to have assisted dying now,” then I can give them assisted dying. That’s a big, big advantage. And what I can also do as a doctor, looking after my own patients is to do a terminal sedation, if they don’t want to have assisted dying.

Terminal sedation means that if pain, suffering, fear, breathing problems are not to be reduced by morphine, I can put them into a artificial coma with morphine and sleeping medication, mostly something like Valium. And when they are in a artificial coma, they don’t eat, they don’t drink and in the end they die within three or five, seven days by renal failure. And this is something that is legalized in most countries and is one good thing, but also not an easy way of dying. Good. So I think let’s go to the questions if you like.

Thanks, Erica. Let me just pull up the questions here. Just give me one sec. Thank you so much for going through all of that. It’s so interesting to know what’s going on, especially in Switzerland, where we always get questions about that here in Canada as well. So it’s great to have that information.

Okay. So we have a few questions that have come in. So you’ve gone over a few of these in your presentation, but maybe there’s some that you can just expand on. One here that I think is really interesting is, “Has there been a decrease in the number of assisted deaths in Switzerland since other countries have begun legislating made? Have you seen a decrease at all?”

I’m afraid there is no decrease. It is a decrease in certain countries. We did have a lot of people from Canada. We did have a lot of people from the US and from Australia. And I think especially, doing this long, long traveling is horrible for these people because they are not in a condition that they would be able to travel. They do it to have a good death. So from Canada, I think the last patient we had from Canada was a very young man from Quebec. He was only 23 years old and he had a heart failure at the age of six. His mother and himself, they wrote a book about what happened with him. And he died with us. He was very badly handicapped within his body. He could hardly speak, but he could express his will.

So this was a very difficult case of assisted dying. And two neurologists of Canada had a look at him, but he was not accepted for MAID in Canada because he was too young and he was not going to die within a reasonable foreseeable time. So he came to die with us. I knew him so well and I went to Quebec to see him. I lived with him and his mother for three days, so we got good friends and this is the moment where it gets very, very emotional when they die and so young people it’s difficult. No, this is right. Since Eduardo, we have none from Canada. We have few from the US, but we have a lot from Europe because in Europe, it is still a very big problem. And the more people know that this solution is possible and open, the more want to come and die abroad.

Thank you for sharing that story. That’s amazing what a bond you created with your patient. So thank you for sharing that. Okay, someone wants to know, “What are the most common medical conditions that people have, who you’ve assisted in dying?” Do you see the same recurring conditions or does it vary a lot in your work?

It doesn’t vary a lot. It’s about 30% cases of cancer, which is very much progressed. It is about 30% of neurological diseases. This is motor neurone disease, multiple sclerosis, dementia, things like that. And about 30% of old age rational suicide. We have quite a lot of couples also who want to die after 60, 65 years of marriage. They want to die hand in hand, and mostly both of the couples are very badly handicapped. And these are very beautiful, assisted dying, especially when the children and the grandchildren are present also. [crosstalk 00:19:22] But they should be able to do it at home, not in Switzerland.

Mm-hmm (affirmative).

That’s the only [crosstalk 00:19:28].

Yeah, for sure. That’s so beautiful though to go together in that way.

Yes.

That’s really nice. Okay, another question is, “In Switzerland, do they allow assisted dying for folks with dementia or Alzheimer’s? Is that allowed?” And then a second part to that is about advanced requests. “So can folks ask for an assisted death well in advance?” So kind of a two-parter there.

This is a bit a problem of the assisted dying. In Switzerland, you’re not allowed to do euthanasia, which means the person who wants to die has to do it as long as he is of sound mind. I have seen so many people with dementia in the clinics, in the nursing homes, that if I get the diagnosis of dementia, I will rather die half a year too early than one day too late. We can accept people with dementia. Dementia doesn’t come from one day to the other. It starts. You have the diagnosis. You have mild cognitive impairment. Then you have beginning dementia. Then you have middle grade dementia and you have to … In Switzerland, you can do checks with your neurologist. And when you are in the middle grade dementia, you are still of sound mind, concerning your wish to die.

Then the neurologist might do tests every week and tell you, “If you want to do it, you need to do it very soon. You might lose your mental capacity, if you wait any longer.” The big problem with dementia is that people tend to forget what’s the most important thing for them, not to run into complete dementia. If they wait too long, they forget about this and then … But this is what I think. If they run into complete dementia, they don’t suffer anymore. They have forgotten everything. The big problem is that then, the family members start to suffer.

That’s a really good point, right? It’s interesting to think about it that way, actually. And what about … Well, I guess you kind of touched on it, advanced requests. I know in Canada, that’s something a lot of Canadians want is to be able to put in writing, “In 20 years, if I have this diagnosis, I want a doctor to be able to assist me.” But that’s not the case in Switzerland, since you have to self administer.

You know in my advanced directions, I have written, “Should ever euthanasia be allowed in Switzerland, I want to be euthanized at the moment when I don’t recognize my family members anymore.” This is not possible now, because I think in Switzerland, we will never, ever have euthanasia. We will always have to go too early. And I, myself as a doctor, I’m so glad that people take the responsibility for their decision. At the moment, I’m still glad that we have only assisted dying. I don’t have to take the last responsibility. It’s the person himself/herself who takes it and who does it. So, you could say, I’m a chicken. I don’t want to kill someone. They have to do it themselves. I help them that they don’t fail, but I don’t want to do it myself. [crosstalk 00:23:31].

Fair enough.

But it would be nice to have this possibility and I can understand the possibility. It’s written in my advanced directives, but I know I can’t use it at the moment.

Okay, thank you. We have a lot of questions coming in, so I’ll try and get through as many as we can. And I just want to say to those watching, if you do have a question, please put it in the Q&A function at the bottom of your screen, and I will read it out for you. So another question we have here is, Do Swiss hospitals allow assisted dying on site? Or do most people choose to die at home?”

The funny thing is that, almost all nursing homes accept assisted dying in the nursing home. So you are allowed to do it there in your room. But there’s only one hospital in Switzerland who allows it, but it has never done it up to now. It has so complicated rules that it wasn’t practiced up to now. And except to that one hospital, all other hospitals do not accept, which is a pity. You know, people are so very ill and they need an ambulance to go to our apartment and have the assisted dying there. It’s crazy. And palliative care is no problem. In Switzerland, you can put somebody into an artificial coma in a hospital and he will die of renal failure. You know it, but assisted dying is not accepted.

Thank you. Okay, another question here we have. This is about the general attitudes about death and dying in Switzerland. Can you speak to kind of what the vibe is on death and dying in Switzerland? Are people comfortable with it? Is it talked about a lot?

It depends whom you ask. There was a vote on whether assisted dying should be forbidden in the state of Zurich in 2011 and 84% of the population of the Canton of Zurich, of State Zurich said, “We want it. We do not want it to be forbidden. We want it for us.” And even 78% of the voting people said they also wanted for foreigners to be allowed to do it in the State of Zurich, which is amazing. Now it is more than 90%. So, it’s going up, up, up, but the 10% who are against it are mostly religious people and they’re very, very intensively against it. They have very loud voices and they are very much against it. And many of those are priests, public prosecutors, lawyers and doctors, which makes it be quite a bit of a problem.

Absolutely.

Especially, the doctors.

Mm-hmm (affirmative). Oh, for sure, yeah. Okay, next question is, someone wants to know, “How many people have you helped, in terms, when it comes to dying? How many people have you yourself helped?” I mean, you don’t have to have the exact number off hand, but I think they’re just interested in your story a little bit.

Yes. With Lifecircle, I have helped with assisted dying over 500 people. And then again, I thought, “And how many people did I help to die with palliative care? Within the time that I have been working as a doctor now, it’s about 800 that I helped to die with palliative care. And with Lifecircle, with all the foreigners coming from other countries, it’s more than 500. We have to look at it like this a little bit. It seems a lot.

Yeah. I mean, when you say it like that, and you’re just one doctor, right.

Yes. Yes.

Wow. That’s amazing. We have so many questions. This is great. Some really nice comments coming in as well. So I just want to read out this comment. So, “Thank you Dr. Erica for providing this valuable info today.” I know there were a lot of people really excited for this session, and I can just tell by the amount of questions coming in. So I just wanted to read that out to you, to thank you again. So we have a question here. So in Canada, to access an assisted death, you have to be covered by government funded health insurance. So, “Is assisted dying in Switzerland covered under the country’s healthcare system? Or do people have to pay out of pocket?”

People have to pay out of pocket and it’s extremely expensive. For Swiss people, it costs 4,500 Francs. This is everything included. And for foreigners, it’s even more complicated and more expensive because there we have to do also all the work with the international death certificate, birth certificate and so on. We also have to do the funeral, which is coffin, cremation, transport of the body, put the ashes into an urn and send the urn back. And this is all included for a foreigner and they have to pay 10,000 Euros, which is an awful lot of money. The foundation sometimes gets payments, gets donations. And so, if somebody has no money, the foundation can pay for people who have no money. That’s very good. We are lucky.

It’s amazing that … You should be able to do it with the health insurance. If you imagine how much money the health insurance earns by every assisted dying, they would have to pay for it. And in Switzerland, we have to pay ourselves, giving them so much money because they don’t have to go on paying the chemotherapy and the hospitalization and everything. But, you know, if in Switzerland you would try to make health insurances pay for assisted dying, I think everybody would say, “This is unethical.” But I think it’s unethical that they don’t have to pay. That’s my opinion.

Yeah, yeah. Well, thank you for sharing that. Okay, we have another question here that says, “You mentioned that two doctors must agree. So that’s similar to what we have here in Canada. So in Switzerland, if the two doctors don’t agree, is that patient then allowed to seek a third opinion or even a fourth? Can they continue looking for a doctor who will approve them? Or is it kind of cut off at the first two?”

The big advantage in Switzerland is, that we have several organizations who do assisted dyings. So, if we would have somebody asking and one of the doctors would say he does not accept, this person could go to another organization and not tell that they have been refused by this organization. They would be stupid to tell. There is a reason why a doctor would refuse somebody. I did refuse some people when I was still working for Dignitas. I had one lady from the US. She came with reports of almost complete tetraplegic. And when I saw her, she was walking and she wasn’t ill at all. She had multiple sclerosis and she has sent the reports, the doctor’s reports when she had a very bad spell. Then she was treated with cortisone and other medication and she was completely well after that.

She came from California. That’s a very long way to Switzerland. But I said, “Look, I can’t give you assisted dying. You don’t know when you have the next bad spell. It might be in 10 years and you have a good life.” Oh, she was about 45. She wasn’t old and I can’t do that. I can’t give her assisted dying when I’m not convinced that she should do it. I stayed in touch with her for three years and she didn’t have another spell for the three years. Then, we were not in touch anymore and she was so happy that she didn’t do it.

The only reason that one doctor would say no … There’s two reasons. One reason would be that the patient is not ill enough or that the wish to die is not stable. And the main reason that somebody could be refused is that, he’s not of sound mind. But we try to be in touch with the people on Zoom, by Facebook, FaceTime, by telephone, so we really know how they are and we try not to make people come to Switzerland that we have to refuse or cannot accept. That would be horrible.

Yeah, because you’re right. It’s a long way to go, [crosstalk 00:33:57].

Yes, yes.

To be told that you have to turn around and go back home, especially if you are suffering, right.

That shouldn’t happen.

Yeah, exactly. So I have a question here. So in Canada, folks whose sole underlying condition is a mental illness will not be eligible for assisted dying until 2023, so next year. So we have a question here about, “If folks with a mental illness or mental health conditions are eligible for assisted dying in Switzerland.”

The big problem is that we need to have good medical reports from psychiatrists. If they can bring medical reports from psychiatrists, if they can talk to their psychiatrist in Canada openly about assisted dying, which might be the case in Canada. In all other countries, they will be put into a psychiatric ward, if they tell that they want to die. So from Canada, it might be put possible. From all other countries, it’s completely impossible because our psychiatrists do not want to see them only once, which means we need reports from psychiatrists, treating psychiatrists. And in all other countries, it’s too dangerous to tell psychiatrist. They will immediately set you to a clinic, because of person in danger.

Yeah. And I mean, we still don’t know what that will look like in Canada. So although it will become legal next year, we don’t know the parameters around it, the eligibility criteria. So it’ll be interesting to see what happens here. [crosstalk 00:35:46].

And you know what-

Yeah.

You know what? I feel so sorry for these people. A mental illness can be a uncurable illness, as well as a cancer. Somebody said, who was … She suffered from schizophrenia and she said, “It’s like cancer of the soul.” And I was so impressed by her open-minded way and she was so right. It was like cancer of her soul and she didn’t want to go on living like this. And in the end, she killed herself. She had a suicide and was successful. But, it’s not fair towards the mental illness because they have the suicide that they can do anytime, and then they fail and are even worse. That can’t be the solution.

Yeah, exactly. I mean, I love the way that patient put it. What an interesting way to look at it, “Cancer of the soul.” Wow. So you mentioned during your presentation, terminal sedation as another route, opposed to assisted dying. So folks are just wanting to know a little bit more about terminal sedation, and whether patients are asking for that more than assisted dying, kind of when that determination is made. Can you just speak to that a little bit more?

In Switzerland, we do a lot of terminal sedation. We have very good hospices. We have very good mobile palliative care teams, who can come to your home and do a terminal sedation. They have these little casks where they put medication in, which is morphium and Valium. Morphium makes you have wonderful thoughts, wonderful dreams and the Valium makes you sleep.

So if pain, fear or breathing gives you unbearable pain and we can’t manage it with morphine only, we are allowed to do terminal sedation. But then in Switzerland, always the patient is asked, “Do you want terminal sedation? Do you want to sleep? We give you medication to put you into a coma. It might take three days. It might take five or seven days. We don’t know.” They say goodbye to their family members. And then we start the terminal sedation. This little machine is giving them the medication to keep them in the coma. And as they don’t drink, don’t eat. In the coma, they are not hungry. They are not thirsty. They just sleep. And in the end, they will die of renal failure because your body cannot get rid of the rubbish of your blood anymore.

So you mentioned with that, the medications and we also actually just … It’s a good tie into this next question. Someone wants to know about the medications used for an assisted death. Can you speak to that?

In Switzerland, we only use sodium pentobarbital. This is a medication that has been used for years as an anesthetic. With half a gram of sodium pentobarbital, you can do a surgery for about four hours and for assisted dying, we use 15 grams. That would kill an elephant. We are very happy that we can use a medication which has been used for anesthetics, because like this, we know the heart failure will come within a very, very deep sleep, deep anesthetic sleep. And what we actually all want, I want this for myself. I want to die at night during my sleep. I want to go to bed and not wake up the next morning, but this happens extremely rarely. It has happened, within 36 years of my medical work, three times. So this is very little. And what you do with the sodium pentobarbital is, you give an anesthetic sleep which causes heart failure, which means actually you die in your sleep and it’s always the same.

I love this intravenous application. Most organizations in Switzerland make you drink it and then it’s not the same. It takes two to three minutes to fall asleep, and it takes about half an hour to die, but it can also take 20 or 26 hours to die, and that’s a big problem for the family members who are present. When we have intravenous application, sometimes we also have children present when the dying takes place. It’s always the same, 30 seconds to fall asleep and about three minutes, heart failure. And it’s no railing, no problem at all.

And do the patients choose which option they want to go with?

Yes. Yes, they choose and within … What is it now? 11 years that we are working, we had four people who chose to drink it, because they wanted … Three wanted not to have a needle, the pain of the needle. They said, “I rather drink it.” And one was a psychiatrist who said, she wanted it to be a little bit slower. She thought it’s too quick with the intravenous application.

Interesting.

But they can choose.

Yeah, that’s the same as in Canada. Although, similar to what you mentioned, the oral option is very rarely chosen.

Yes.

Speaking of assisted dying in Switzerland and Canada, someone wants to know, “What your opinion is on the assisted dying laws in Canada, if you even have one.”

I think it’s a very … Well, if you manage to accept also mental illnesses and if there’s reasonable foreseeable death, I think they changed this not a long time ago. And I think now the law is very good. And if you manage to accept also mental illnesses, that would be wonderful. The only sad thing about it is that you have to inject several medications, that you can’t use sodium pentobarbital. I can’t understand. Every country should be able to produce sodium pentobarbital and that’s the best medication you can … What do you use for animals in Canada?

You’re asking the wrong person. I don’t know.

Okay.

But you’re right, that it is the three medications here.

Yes, because most countries use sodium pentobarbital for animals.

Well, if someone who’s watching knows, feel free to put it in the chat or the Q&A, and we can read it out. Okay. Well, thank you for giving your opinion on that. It’s very interesting to hear. It’s just so interesting to see the contrast and the similarities between Switzerland and Canada. So, one question here, we have time for a few more is, which I don’t know if you’ve mentioned it, but someone just wants to know how long assisted dying has been legal in Switzerland.

It was officially legalized as a human right in 1948. And the first organization was founded 40 years ago in 1982. EXIT was founded and that’s the biggest organization. They have 130,000 members in a country with eight million people, huh? That’s good.

Wow. That’s amazing. Sorry, I just got word here that, in Canada, they do use what you were saying, the phenobarbital sodium for animals in Canada [crosstalk 00:44:47]

For animals.

Yes.

Why don’t we have the same right as animals?

That’s the number one thing I hear from folks who reach out is, why can this be for my pets, but not me. I mean, it can be, but there’s a lot of rules. I just want to read this comment out, Erica. So, this person says, “I don’t have a question. I’m the mother of the young Canadian she helped with assisted voluntary death in 2019. And I wanted to send a big and warm hug to Erica.” She’s in Quebec and enjoying the webinar a lot.

Oh okay.

So I thought that was [crosstalk 00:45:29]. That’s so sweet. So thank you for being here and watching, and I’m sure hopefully you two can connect again. That’s amazing. [crosstalk 00:45:39] Okay. So someone’s just asking, sorry, because you mentioned EXIT. Can you just quickly explain what EXIT is?

EXIT is the biggest organization in Switzerland and they only accept Swiss people. So, they only have Swiss members and they only do assisted dying for Swiss people. As they are very big and they are doing about 1000 assisted dying every year, they have big lack of doctors also. And with EXIT, you have to drink the medication because when you drink the medication, there is no doctor needed for the actual procedure of assisted dying. You have to have a doctor to do the medical assessment and to write the prescription, but then EXIT can get the medication from the pharmacy and somebody who is taught how to do that, take the anti-vomitive, the Metoclopramide before, and then after some few minutes, take the sodium pentobarbital. That’s a good way to do it when you don’t have enough doctors.

Thank you for explaining that. I also didn’t know. So probably because it’s for Swiss folks only. So people in Canada aren’t asking about that.

Yes.

Okay. We just have time for a couple more. So someone here is asking about, “Does Switzerland have their suicide approach enshrined in the criminal code like Canada does? Or is it left to the medical practitioner to determine based on clinical eligibility?” So in our criminal code, it is set out what the criteria is for an assisted death. Is it the same in Switzerland?

No, the criminal code only says that you must be of sound mind and I must not make it for money. So, if you would come to me as a young, healthy person and I would do it because I like you, after the criminal code, this would be okay. I think you wouldn’t find a doctor who gives you the medication, who does a prescription to somebody who is not ill. But I think that is a big problem, I don’t like it. I would like to have better regulations on the criminal code on the jurisdiction, not only on the medical association’s level.

Right, right. Okay, thank you. So if you don’t have the numbers right off the top of your head, that’s okay. I’m sure we can look them up and email folks after, but some people are asking if you know how many people have an assisted death each year in Switzerland. I think you mentioned something earlier. Do you know what the …

EXIT is now on about a 1,000 every year.

Okay.

Dignitas was on a little bit more than 250 last year. We usually have not more than 80, because we want to have time to work for legalization. We don’t want to have a lot of assisted dyings. And there’s another organization called Ex International, not EXIT International, but Ex International. They work very much on the cover. So you don’t really know the numbers, but it’s also about 50. I think it’s around 1000, 1,400, 1,500. But from these 1,500, I would say about 500 are foreigners and about a 1,000 are Swiss people. And there also, you have to think that Switzerland has only 8 million inhabitants and that’s amazing. It’s 40 years that it is legalized and we are still on 1.5% of all death that are assisted dyings. And we are on about 10% of all death that people that can with good palliative care in a hospice and all others, 90% die somehow in hospitals, in nursing homes, but with not good end of life care.

Well, thank you for sharing those numbers. I know people were interested to know. We’re closing up here, so I just want to take this time to thank you again so much. This was the last session in our first conference ever. And I think this was a great way to close it out and you’ve been so wonderful answering all our questions and explaining this law to us in Switzerland. Because I have to tell you, we do get questions about Switzerland all the time. So it’s always good to, even for me, to have some background knowledge.

So I just want to thank you again. And I want to thank everybody who attended today and came out to all of our sessions throughout the conference and especially today. Thank you so much. We were recording, so a recording will be posted on the Dying With Dignity Canada website. The link is in the chat and that should be up hopefully in a few days. So Erica, thank you again so, so much and it was great having you

All the best to you. Thank you for your invitation.

Thanks so much. Goodbye everyone.

Bye.