Exit’s membership and help is available only to people domiciled in Switzerland. It is not open to anyone from outside Switzerland, not even, for example, to people who live just across the border. This is so that the legal situation is completely clear.
Also, anyone who applies to Exit for help in choosing to end their own life, must see the counsellor of Exit on more than one occasion, to explain their reasoning. Because of this counselling procedure, which can sometimes be quite long, Exit occasionally provides help to persons wanting to end their lives on overall reflection, i.e. for people who decide (even without having cancer or piercing pain, or similar) that on balance, they have had enough and are ready to leave this life behind. Particularly, some elderly people feel this way if they’ve had a good, full life, and then suffer from the loss of independence or self-determination, as they lose their sight or hearing or bladder-control.
If these counsellors can think of a possible solution to the person’s problem, which would not involve dying, they often refer people to other guidance centres. For example, I once heard of a young mother who had beaten her children, and decided that she was harming them and that it would probably be better for them if she were dead. When she applied to Exit for help, they told her about the “Eltern Notruf”, a 24-hour emergency helpline for desperate and overwhelmed parents, and through that service she found immediate comfort, and therapy which helped her to control her anger and face her real issues. Then, she no longer beat her children and learned to be a better mother, and as a result no longer felt the need to end her own life for their sakes.
When an Exit counsellor, having met and listened to the person several times, having perused the medical records he/she supplies, and perhaps after obtaining a medical assessment, deems that the person is serious and the case legitimate, the application is brought before Exit’s internal interdisciplinary ethics council, which seeks to check that the person is of sound mind, has understood the ramifications of the decision, is not being put under pressure by a third party to end his/her life, does not wish to end his/her own life in order deliberately to harm a third party, etc., etc.
Only then can arrangements be made for a date and venue, and the person really be given the lethal medication to end his/her own life. The Exit counsellors repeat, at every step, that the person is always completely free to say “no, I want to stop here,” be it because they decide they want to live a bit longer, because they feel unsure, or because they have changed their minds altogether.
Dignitas provides assistance to people in Switzerland, including to those from abroad. It does not, however, offer any assistance outside of Switzerland. This is so that it does not ever act in any territory where assisted suicide may be illegal. To some people living in such countries in which assisted suicide or even any suicide attempt is illegal, travelling to Switzerland to obtain help from Dignitas can be their only hope.
Some years ago, Dignitas had quite some bad publicity. They were said, then, to be too hasty in providing travellers from abroad the service and chemical, without having taken the trouble to fully check who the people were, and what the applicant’s motivation was, nor indeed, the motivation of those accompanying the person, including, for example, being sure of the accuracy of possible translation and interpretation from foreign languages. How much of that was true, or what was perhaps aimed at discrediting Dignitas? I do not know. I also do not know the current situation about all the steps they take to establish the legitimacy/validity of any application, but in any case their procedure, like that of Exit, necessarily also involves the decision of a registered doctor, since the deadly chemical is a medication for which a prescription is needed from a doctor in Switzerland.
There were also some problems about the facilities Dignitas used, as they had rented a flat in a regular residential area. As far as I know, Dignitas has changed this, and now has a discrete house tucked away in an industrial zone, by which they no longer have any resident neighbours who could be upset with the activities of Dignitas. Exit also provides services in its own building on occasion, but more often in the home of the dying person, since, after all, the person definitely does reside in Switzerland.
Both Exit and Dignitas also provide a range of services that do not lead to a person actively swallowing a lethal medication in order to die. Indeed, both organisations have many members who do not ever make use of the service of assisted dying.
• Both organisations work actively, politically, to campaign for the “right to die”. They negotiate, e.g. with religious leaders or with those who make the rules in old-age and nursing homes.
• In so doing, both also work towards trying to prevent reckless suicide attempts using unreliable or violent methods which, whether or not successful, can provide great heartache and trauma for many, including innocent bystanders.
• Both provide some degree of suicide prevention help (as described in the example of the young mother, above).
• Both provide their members with a “Patientenverfügung” (Living Will) in which a rational person can specify what they would like to be done with them, if ever they became unable to give information, e.g. if they have a stroke, or develop Alzheimer’s, or are injured beyond able to communicate. Such steps could be, e.g. to be given only pain-killers and water, but no longer to be given food, so that death will result. A Living Will can also include what is to done after death, such as clauses about donating organs (but not aspects of a Testament, i.e. issues of money and inheritance). At least Exit (and I imagine, but do not know for sure, also Dignitas) will actively step in to deal with doctors, nurses and family members, to protect their member’s right to have his/her Living Will respected.
Here is Exit, in English. http://www.exit.ch/en/
The Dignitas website was last updated about a week ago (7th April 2015), here also in English:
http://dignitas.ch/index.php?option=...mid=47&lang=en