Assisted deaths: Making a quick exit

Barnaby Bayswater

Arena Health

Assisted dying has always been controversial. The UK has just voted against legalising it, while Switzerland’s Dignitas clinic continues to attract clients from far beyond its borders

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Jeffrey Spector made UK national news in May when he took his own life at a Dignitas clinic in Switzerland six years after being diagnosed with an inoperable tumour growing near his spinal column.

A husband and father of three, Spector did not want to die but felt that he did not have another option. He said that the tumour made him feel like a ticking time bomb as he could have been struck with neck-down paralysis at any moment. Unwilling to give up his autonomy and become a burden to his family, Spector made the choice to travel to Zurich when his condition began to deteriorate.

“I was going downhill and was finding it hard to use my hands. I had no pressure in my fingers,” explained Spector in an interview with Dignitas hours before his death. “I felt the illness had crossed the red line and I was getting worse. Rather than go late, I am jumping the gun. I call it the least worst option, which is best for my family in the long term.”

Spector had been a successful businessman, working as the director of several advertising firms in Blackpool. Friends and family members urged him not to go through with the plan, but his resolve was unwavering.

“I know I am going too early but I had consistent thoughts without peer pressure. It had to be a settled decision by a sound mind. If I am paralysed and cannot speak, then what hope is there? I am a proud person – a dignified person, independent and self motivated. It is me who is doing this.”

Spector had to travel abroad in search of an assisted death because of the prohibitive laws currently in place in the UK, which ban assisted dying. The case provoked renewed discussion on the issue, with many claiming that the husband and father could have had months left with his family, but had been forced to cut his time short, knowing that if his condition deteriorated further he would be trapped. “Assisted suicide is illegal in the UK so it had to be Switzerland,” Spector said.

Speaking to The Guardian in the wake of Spector’s death, Sarah Wootton, chief executive officer of British assisted dying pressure group Dignity in Dying, disclosed that one Briton travels to Dignitas every fortnight in search of a self-directed death. “We know that for every one [British] person that goes overseas to have an assisted death, ten Britons are taking matters into their own hands in this country to control their deaths,” she added.

While Switzerland has allowed assisted suicide since 1942, it was the Netherlands in 2002 that opened the doorway to legalised euthanasia, and other countries soon followed. Belgium made the shift to decriminalise euthanasia in the same year, followed by Luxembourg in 2009 and later by Canada and Colombia. Certain states in the USA – Oregon blazing the trail in 1997 with its Death with Dignity Act, followed by Washington in 2008, Montana the year after, Vermont in 2013, New Mexico 2014 and California in October this year – have joined the ranks since the 1997 United States Supreme Court ruling that each state should be responsible for resolving its own stance on assisted dying.

Now the debate on the right to die is again gaining momentum as the population of the developed world grows greyer and greyer: according to figures from the World Bank, low-income countries have an over-65 population averaging 3.4 per cent, while in middle-income countries this figure is at 8.1 and in high-income countries it’s 16 per cent, and growing rapidly. In the UK over-65s represent almost a fifth of the population and in the USA this figure is 14 per cent. Perhaps surprisingly, Switzerland, Belgium and the Netherlands are all on a par with the UK in this regard, having some of the highest numbers of elderly people in the world, with the Netherlands having increased by three per cent in just four years. Japan tops the chart at 25.8 per cent while simultaneously boasting the steepest ageing trajectory in the world.

No wonder we’re all anxious about what the future holds. But it isn’t the ageing population that’s championing the right to die; it’s largely the on-looking worried well that are terrified of losing their autonomy. Similarly, it’s largely the onlookers who are admonishing it.

In his open letter to The Guardian earlier this year, the UK’s Archbishop of Canterbury equated assisted dying with suicide and otherwise took the view, naturally, of an observer. He talks about how hard it has been for him to sit at someone’s bedside when they have been unwell; he talks about how important it is that “we can show that we love even when people have given up on caring for themselves”. Critics have pointed out that the archbishop’s concerns seem to be less for the suffering of those on the brink of death and more for those who will be left behind and want a clear conscience.

“[Archbishop] Justin Welby’s cri de coeur about the evils of the assisted dying bill is cloaked in social concern, but at its core is standard religious authoritarianism,” writes Dr Christopher Burke in a letter printed in The Observer. “Enacting the bill would not have restrained the archbishop from following his deeply held moral beliefs about his own life. It would have just granted me the right to do the same.”

Whichever side you look at, the majority voice is that of the healthy. But both sides need to listen more to the terminally ill, who will be most affected by assisted dying laws.

A 2015 Dignity in Dying Populus poll of 5,000 people in the UK – the largest ever poll conducted on assisted dying in the country – showed that 86 per cent of people with a disability and 79 per cent of religious people would support a law that allowed assisted dying. Dignitas has disclosed that, in its first 16 years of operation, 920 Germans had travelled to Switzerland to end their lives with them, 273 Britons and 194 French citizens.

“I am not suicidal. I do not want to die. But I am dying. And I want to die on my own terms,” said 29-year-old Brittany Maynard, who had an assisted death under Oregon’s Death with Dignity Act in November 2014. Since the law allowing lethal prescriptions was passed in Oregon in 1997, fewer than 900 people have used it and, as Rachel Aviv points out in The New Yorker, those who did were overwhelmingly white, educated and well-off – the demographic least likely to be pressured into asking for a death they don’t want.

The concept of assisted dying has been equated by many to that of suicide, but the desire to take control of the manner and timing of one’s death when it is already encroaching is not the same. During the Committee stage of Lord Falconer’s Assisted Dying Bill in the UK, which was hotly debated this year but ultimately rejected by the House of Commons, peers voted two-to-one against an amendment that would insert the word ‘suicide’ into the bill.

One of the main arguments for assisted dying is the autonomy of mentally competent patients. Only the individual can feel the suffering that comes with drawn-out terminal illness, and only they can judge what it means for them to continue living or to die. The question boils down to this: should we have the right to make the ultimate decision when it comes to our own lives? Fundamentally, the debate is between an individual’s right to autonomy and the forfeiting of personal autonomy to the state.

“An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy,” reads Canada’s Supreme Court unanimous ruling of February 2015, which made it legal for a doctor to assist in a patient’s death. “The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”

In a letter to The Guardian this September, a group of senior UK doctors – including the National Health Service’s chief knowledge officer – called the country’s current law on assisted dying “dangerous and cruel” for forcing terminally ill patients to end their lives abroad, and pointed out that the practice of assisted dying is already happening behind closed doors – legalising it would only help to ensure that the practice is safeguarded.

Assisted dying around the world:

The Netherlands

In April 2002 the Netherlands became the first country to legalise assisted dying and euthanasia under the strict conditions that the patient is in unbearable pain and that their demand for death is made in “full consciousness”, and children between the ages of 12 and 16 must require the consent of their parents. In 2010 a lethal cocktail was administered to 3,136 people under medical supervision.

Since 2005 there have been an average 15,000 cases of palliative sedation a year, wherein patients who have less than two weeks left to live are put into a medically induced coma with all nutrition and hydration withdrawn, according to the Royal Dutch Medical Association.


In March of this year France passed legislation that gives doctors the power to put terminally ill patients into a “deep sleep” until they die – a move supported by 96 per cent of French people, according to polls. Again, the law applies to patients who are in “unbearable” pain, as well as those for whom treatment has proved ineffective or who have stopped taking medication. The move – one of President François Hollande’s campaign promises – comes ten years after France legalised “passive euthanasia”, in which the treatment needed to maintain life is withheld or withdrawn; under the new law, doctors are able to combine this with deep and continuous sedation.

The change in legislation was, in part, triggered by the 2014 suicides of two couples who were in their 80s; one couple took to Le Lutetia, a luxury hotel where they dined in their room and were later found lying hand in hand, plastic bags over their heads and nearby, with a note that claimed “the right to die with dignity”.


Passed in 2008, Luxembourg’s Law on the Right to Die with Dignity allows for euthanasia and for a physician to assist in a patient’s death providing that the patient is terminally ill, in unbearable pain and competent of the decision, with those aged 16-18 requiring a parent or guardian’s consent.


While euthanasia remains illegal in the USA, six states – Oregon, Washington, Vermont, Montana, California and New Mexico – permit doctors to prescribe lethal doses of medication, with several of these also allowing assisted dying. The rulings in place tend to protect doctors from facing prosecution for helping a patient die. In 2013 approximately 300 terminally ill Americans were prescribed lethal medication. Of these, 230 died, while others chose not to take the medication.


Switzerland, which allows assisted dying so long as the assistant’s reasons for helping are not ‘selfish’, has not actually legalised active assisted dying. But it has seen an increase in so-called suicide tourists in recent years. In 2009 there were 86 recorded suicide tourists and by 2012 this figure had doubled, with the majority of patients coming from Germany and one-in-five originating from the UK.

Dignitas is the most popular assisted-dying organisation. Founded in 1998 by Ludwig Minelli, a Swiss lawyer, the non-profit organisation has featured in several controversial films on assisted dying, including the heart-rending documentary Terry Pratchett: Choosing to Die. Operating from clinics and rented apartments in Zurich, Dignitas has met with its share of controversy. In a 2011 referendum held in the Canton of Zurich, 85 per cent of voters rejected an initiative to ban assisted dying and 78 per cent voted against outlawing the practice for foreigners.


In Germany, the term ‘euthanasia’ is avoided due to its unsavoury links with the eugenicist policies of the Nazi era, the law instead differentiating between ‘assisted suicide’ and ‘active assisted suicide’. The latter, which would involve a doctor prescribing and supplying a lethal drug, remains illegal. Assisted suicide is, however, allowed so long as the lethal draught is taken by the individual without any external help.

Although recent surveys suggest that around two-thirds of Germans would back legislation supporting assisted-dying, Minister of Health Hermann Gröhe does not support the idea of having assisted-dying organisations such as Dignitas in the country.


In 2002 Belgium became the second country in the world to legalise euthanasia and permits doctors to help patients end their lives as  long as they freely express their wish to die due to unbearable and intractable pain; patients may also be euthanised when in a coma or vegetative state provided that they clearly stated this wish beforehand. They do not necessarily have to be terminally ill.

Curiously, Belgian law does not mention assisted suicide, nor  does it specify a method of euthanasia, although it does state that a physician must be present at the patient’s bedside when the act is carried out. In February of this year, Belgium became the first country in the world to lift the age restriction from its euthanasia policy, allowing terminally ill minors to request a lethal injection.

One of the most high-profile cases of euthanasia in Belgium was that of 44-year-old Nathan Verhelst, whose botched sex-change operation left him feeling “like a monster”. In 2013 there were 1,807 cases of euthanasia in Belgium, up from 1,432 in 2012, and more than half of them concerned people aged over 70.


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