Will you qualify? What if you’ve got Parkinsons, Dementia or are taking medication for Depression?

“You need to know who you are, where you are and what you’re there for. You must also be able to drink or twiddle a valve”

There is nothing in Swiss law that says a candidate for a Voluntary Assisted  Death must be terminally ill or must be likely to die within six months.   They must, however, be “of sound mind”.

When you submit your application for a “green light” for a VAD it will need to contain a full recent copy of your medical records.   If these make no mention of any mental or neurodegenerative illness (such as Parkinsons or Dementia) then your chosen VAD provider can assume that you are likely to pass the “sound mind” test.   The test itself will still be necessary – but only after you have arrived in Switzerland.   Two Switzerland-based doctors will check that you understand what you are intending to do and are fully aware of its consequences.   Also, at Pegasos and at Lifecircle you will be asked, just before opening the valve on the cannula in your arm, to state that you know your name, know where you are, know why you are there and that you know what will happen if you open the valve.

That is the situation if there is no reason for your VAD provider to believe that any form of mental impairment might be involved.

If your medical record or any of the other personal documents you have submitted with your application have provided any hint that mental impairment might be involved then the providers have to be much more cautious.   If, for example, you have been diagnosed with any form of depression, then the provider will need to take additional steps to ensure that you pass the “sound mind” test.   This will certainly be the case if you have been taking any medication for mental or neurological issues within the past few years.

This does not mean that you will automatically fail the sound mind test – just that it will be more difficult to pass.   People with Parkinson’s or those in the early stages of Alzheimer’s can certainly pass the test and frequently do. But the process itself will have been a bit more complicated.   The consequence is that when people are initially diagnosed they have a very difficult choice to make.   If they leave it too late, they may fail the test and the option of going to Switzerland will no longer be available to them.   If they go straightaway, they will probably have missed out on several months or even years of a rewarding life.   Faced with that difficult decision, most people do actually seem to choose to go a bit too early.

So what are the extra difficulties ?   Well, you will simply need to provide an additional professional opinion to the effect that, in spite of your recent diagnosis, you still possess the awareness and discernment to know the consequences of what a VAD actually means.   In the words of one psychologist (whose command of English may not have been the finest) you will need to understand “that you will be dead for the rest of your life”.

The four providers in Switzerland that are currently open for new applications vary in their interpretation of this additional requirement.

Athanasios and Phoenix Care prefer the specific “sound mind” opinion to be given by a doctor (in all cases a psychiatrist, a neurologist or a geriatrician) who is resident in the applicant’s own country.   If this is not possible, they will accept the opinion from a Swiss doctor after the consultation has taken place on a video call.   They will, themselves, make the necessary arrangements for that.

Pegasos are happy for the specific consultation to take place physically in Switzerland after your arrival there for your VAD.   This is obviously preferable for most people but runs the real risk that you might not actually pass – in which case you will have to return home.

Dignitas is the most insistent upon the need for an opinion from a doctor who is local to the applicant.   This presents particular problems for applicants in the USA and in the UK where it is notoriously difficult to get doctors in those circumstances.  

The position of the British and American doctors is understandable. They may be worried about the reaction of their professional body or concerned about their professional indemnity insurance policies. In any event, they are likely to be very busy with other tasks and will not want voluntarily to take on anything extra which could prove problematic.

Dignitas will normally suggest that the doctor who had carried out the additional diagnosis should be persuaded also to add an extra assessment covering mental competence.   This will need to express a view upon the immediate state of the patient and also, if possible, some forecast of any likely deterioration in the near future.

You will need to remember that the standard fees charged by all the current VAD providers do include the costs of the basic “sound mind” tests for patients with no record of mental or neurological issues.   Those standard fees do not include the additional costs of any further tests that may be necessary because of Dementia or Parkinsons.   These will, inevitably, need to be charged extra.