At the very moment Britain decides whether to make an assisted suicide easier for its citizens, the only country with a medical clinic prepared to receive them is considering how to make the process more difficult.
Helping terminally ill or incurably disabled people to commit suicide is a crime in Britain and will remain so, the Director of Public Prosecutions, Keir Starmer, said yesterday. But new guidance, to be published on Wednesday, will "list the factors that are likely to lead to a prosecution and list those that aren't," he said, effectively explaining how the law may be circumvented without consequence.
The Swiss clinic Dignitas is the only clinic in the world that helps foreigners to end their lives. About 115 people from the UK have died at Dignitas, but none of those who assisted them has been prosecuted. Support for Britons who have chosen to travel to the clinic has grown in the UK, but in Switzerland there is growing embarrassment about what has become known as "suicide tourism".
Switzerland's justice minister, Eveline Widmer Schlumpf, is known to believe that the law on assisted suicide should be tightened. At least two of her colleagues in the Swiss cabinet believe it should be outlawed altogether.
Two government papers are on their way to Switzerland's parliament, one suggesting restrictions to the present law, and another proposing a ban on assisted suicide organisations. The latter is highly unlikely to find support, but a revision restricting assisted suicide to Swiss citizens and those permanently resident in Switzerland is possible. These moves reflect the growing desire in Switzerland to bring some clarity to the grey and largely unregulated area of assisted suicide.
Helping someone to die is legal in Switzerland, as long as the patient has repeatedly expressed the wish to die and is able to perform the final act personally. But many Swiss have increasing doubts over the activities of Dignitas, whose foreign clients hail mainly from Britain and Germany.
Dignitas does not have an actual clinic, but instead operates from rented apartments. These have become increasingly difficult for the organisation to find: in 2007 Dignitas had to leave the Zurich apartment it had rented for its patients after local residents complained about coffins entering and leaving the building.
After that, the organisation set up assisted suicides in hotels, prompting at least one hotelier to launch a legal action. And, in 2007, it was revealed that two German citizens had committed suicide, with the help of Dignitas, in cars parked in lay-bys on the outskirts of Zurich. That provoked an outcry in Germany. For several months last year, Dignitas rented rooms on an industrial estate. It is now believed to have found another apartment in the Zurich suburbs.
Many Swiss doctors have serious doubts about the kind of patients Dignitas accepts. The Swiss organisation Exit, which helps patients die, accepts only the terminally ill, and only Swiss citizens or permanent residents of Switzerland, but Dignitas will offer assisted suicide to all nationalities, and to people with chronic, but not terminal illnesses, and – most controversial of all – to the mentally ill. The apparent speed with which Dignitas deals with its patients has also led to questions; they generally arrive in Switzerland, see a doctor, and die all in the same day.
And the organisation's book-keeping has come in for scrutiny: at the start of this year, the Zurich public prosecutor's office called for more transparency from Dignitas, saying it remained unclear exactly what the organisation's 10,000 Swiss franc per patient fee (approximately £6,000) was being spent on.
Dignitas's general secretary (and only long-term employee) Ludwig Minnelli has told French media that some of the money has been used to campaign for assisted suicide in other European countries, and some for lawyers' fees. That could be problematic for Dignitas, in that spending the money that way could be seen to contravene Swiss law, which rules that any person or organisation offering assisted suicide should not be motivated by self-interest.
Canton Zurich, where Dignitas is based, has drafted regulations stipulating that those opting for assisted suicide must have expressed their wish repeatedly over a long period, in discussions with their doctor. This would appear to rule out Dignitas's present practice.
Two initiatives are also on the table in Zurich, one calling for a ban on assisted suicide, the other demanding that it be restricted to those who have been resident in the canton for at least a year.
The guidelines follow a Law Lords ruling in July in support of a call by a multiple sclerosis sufferer Debbie Purdy for a policy statement on whether or not people who helped someone kill themselves should be prosecuted. Ms Purdy, from Bradford, West Yorkshire, wants to know what would happen to her Cuban husband Omar Puente if he helped her travel abroad to end her life. She would like to go to Dignitas when her condition becomes intolerable.