The cost of dying overseas
The cost of an assisted death in Switzerland is, for many, prohibitively expensive. Based on our calculations it costs anywhere between £6,500 to over £15,000 to have an assisted death in Zurich, where Dignitas is based.
The average cost for those interviewed was approximately £10,000.
Some costs might be surprising. For example, many interviewees booked a return ticket for the dying person, to ensure they knew they had the option to change their minds if they wanted to and to reduce the chance of suspicion by authorities.
The cost of obtaining an assisted death in Switzerland denies the option to the majority of people in the UK.
A 2017 report by The Money Charity showed that 68 per cent of households in the UK have less than £10,000 in savings. According to NMG Consulting and the Bank of England approximately 80 per cent of private renters and 87 per cent of social renters have less than £10,000 in savings.
Despite the cost of an assisted death being a significant issue in debates about the current law, for the majority of interviewees in our research it did not impact on their decision to seek an assisted death overseas.
Many said how they felt privileged to be able to afford to make the arrangements, acknowledging that it was not an opportunity that every dying person has available to them.
A logistical challenge
The logistical hurdles that need to be overcome to arrange an assisted death means only some people are capable of doing it. Interviewees recognised that obtaining paperwork and navigating bureaucratic systems requires knowledge and skills that favour the “sharp-elbowed” middle class.
The lack of clarity in the law for healthcare professionals means obtaining medical records and reports can prove challenging. But there are other documents that are also required.
Interviewees commented that, as a consequence of the lack of support available due to the illicit nature of what they were doing, they experienced loneliness during the process of obtaining paperwork. They also spoke of the anxiety caused by not knowing if they would be able to get the necessary documentation before their loved one died.
The most common concern that resulted from this process was the loss of valuable time at the end of life. There was anger and frustration that much of the final months and weeks, that could be spent enjoying life, were spent engaged in bureaucracy.
It was clear that arranging an assisted death had a negative impact on the mental and physical health of those involved. It is telling that this was considered the preferable choice. Having the control and peace of mind of an assisted death was considered by all interviewees to be worth the pains of making it happen.
A cruel trade-off
To arrange an assisted death overseas, dying people have to negotiate a complex trade-off.
Being able to make the journey to Switzerland requires a certain level of health.
However, this can create pressure to make the journey before becoming too ill to do so, which in turn often means sacrificing quality time that people could enjoy if they were able to remain in the UK.
The journey home
Following an assisted death, Swiss authorities must confirm that there has been no breach of Swiss law. This means that police, a public attorney and an independent doctor inspect the body of the person who has died, review the evidence provided by the organisation and, if necessary, interview the professionals and the loved ones who witnessed the death.
While interviewees acknowledged that Dignitas and Eternal Spirit (another Swiss right-to-die organisation) must allow for these procedures, it was clear that the curtailing of time spent with the body of their loved one, the presence of officials and the implication that their loved one’s deathbed had become a suspected crime scene was distressing.
The experience of watching a loved one die, in any circumstance, requires time, space and support to process. Many interviewees said that the organisations in Switzerland that facilitated the assisted death of their loved one provided emotional support after the death. But this is the limit of support that was available.
Our research found evidence that, while there is comfort in knowing someone has ended their suffering, grief is made more complicated by the death happening in a foreign country.
If a person dies overseas, bringing the body home for burial or cremation in the UK leads to the involvement of a coroner (or medical reviewer in Scotland). In the unique circumstance of a person being assisted to die in Switzerland, it is likely that this would lead to a criminal investigation into the actions of those who helped.
As a result, all interviewees whose loved one had an assisted death said that a cremation took place in Switzerland, with their loved one’s ashes collected at a later date or couriered back to the UK.
The reality of having little choice but to have a cremation in Switzerland means that people are denied a traditional funeral service in the UK. This limits the funeral choices available and prevents people donating their bodies to medical science.
It can also have severe consequences for people with religious beliefs that forbid cremation, another example of inequity created by the current law.
Threat of prosecution
It is currently illegal in the UK to assist someone to die.
With the prohibition of assisted dying in the UK and the difficulties in arranging an assisted death abroad, our research has found that dying people often need the help of friends and family to make the arrangements for an assisted death, yet any assistance provided is against the law.
The majority of interviewees were clear that they were willing to break the law.
The fact that assisted dying was illegal in the UK did not and would not have prevented them from helping their loved one to have the death they wanted.
One outcome of the threat of prosecution is the resulting anxiety for dying people, because of how their decisions may negatively impact on their family and friends after their deaths.
The current law is incapable of protecting vulnerable people
Under the current law, if someone were a victim of malicious or coercive behaviour during an assisted death overseas, it would unlikely be detected by UK authorities.
Unless someone reports a person considering travelling overseas for an assisted death, or reports a person who is providing assistance to them, there are no legal mechanisms to trigger an upfront investigation.
In addition, only a minority of cases are investigated after the fact.
The criminalisation of assisted dying in the UK means the process of seeking an assisted death overseas happens behind closed doors.
In our interviews, a small number of people were investigated by the police when they returned to the UK. This resulted in anger at the implication of being involved in a crime.
While the guidelines from the Director of Public Prosecutions (DPP) suggest compassionate assistance of suicide will not be prosecuted, the policy is clear that the police are responsible for “investigating all cases of encouraging or assisting suicide”.
Given the majority of interviewees in our research were not investigated by the police when they returned from Switzerland, we can conclude the law has not been implemented as intended.
Since the DPP published the guidelines in 2010, over 250 Britons have died at Dignitas alone. A 2016 Freedom of Information request to police forces and the Crown Prosecution Service (CPS) suggested that less than half this number of offences were recorded and investigated.
Our research has uncovered no evidence of coercion or pressure placed upon people assisted to die in Switzerland. Those accompanying them were not motivated by anything other than compassion. It is also clear that Swiss authorities and the organisations that facilitate assisted deaths have their own safeguards in place to protect people.
However, the circumstances of many UK citizens’ deaths each year, the people involved and the motivations of those who assisted them to end their lives, remain unknown.
Those who claim the current law is safe have no reliable evidence on which to base their claims.
Aside from the issue of safety, it is unjust that most relatives are left alone to grieve for their loved ones, while others are subjected to investigations by the police, which can have traumatic and long-lasting consequences.
Our research found that terminally ill people are taking matters into their own hands by attempting to end their lives in unenviable circumstances.
Even some of those who had, or were arranging, an assisted death overseas were so clear in their view that their suffering had become unbearable that they attempted to end their life before travelling to Switzerland.
In other cases, dying people came to the decision that they would not want to end their life because of the potential for “botched amateurism” as one interviewee put it.
Another factor was the impact that amateur attempts to end life would have on family and friends, particularly when contrasted with the peaceful death that facilities in Switzerland can provide.
In our research many interviewees, including those whose loved ones had chosen to have an assisted death in Switzerland, praised the palliative care provided in the UK. Many said that the decision to arrange an assisted death had not come about through poor care or an absence of care.
Even those campaigning against a change in the law acknowledge that palliative care is not capable of relieving all suffering all the time.
In Switzerland, people who have an assisted death must self-administer the life-ending medication.
All interviewees said that the process was peaceful and reflected how their loved one had wanted to die, comparable with falling asleep.
One thing that was notable when compared with deaths that occurred in the UK, even painless ones achieved through sedation, was the moment of lucidity before death. This enabled people to say goodbye to their loved ones.
How things could be different
Interviewees wanted to share how things could be different if assisted dying were legal in the UK.
People living with a terminal illness said it would give peace of mind and increase quality of life.
People who accompanied someone to Switzerland said that if assisted dying were legal in the UK their loved one would have died with more family and friends around them and with greater support from end-of-life-care professionals.
They also would not have been subjected to the difficulty and stress of travelling overseas and they would have had more time to spend with their loved ones at the end of their life.
We would like to thank all the interviewees who agreed to take part in this research project. We are grateful that they decided to share their personal experiences to highlight how the current law is failing dying people in the UK.
Dignity in Dying campaigns for greater choice, control and access to services at the end of life. It advocates providing terminally ill adults with the option of an assisted death, within strict legal safeguards, and for universal access to high quality end-of-life care
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