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”

Just before a member turns on the valve to feed the sodium pentobarbital through the cannula and into the member’s bloodstream, the leader of the team at Lifecircle switches on a film camera in order that the following event can be recorded accurately.   The member is then asked, on camera,

• ​What is your name ?
• ​What is your date of birth ?
• ​Do you know where you are ? and
• ​Do you know what will happen if you open that valve ?

If all the answers are correct, then the member is told “you may now end your life.”

In other words, they are considered to have sufficient mental capacity if, having been through the application process, they can answer those straightforward questions.   People in the early stages of dementia can certainly do so.   In later stages even such simple tasks will have become impossible.   They will have left it too late.

Dementia

As a result, many people who have been diagnosed with some form of dementia have a difficult balance to reach.   As their powers of memory and reasoning decline, they must choose the moment when they have retained just sufficient discernment to satisfy the “mental capacity” test.   They will need to be “considered capable of taking a self-determined decision to end their life and to act accordingly”. Faced with this task, many choose to take the safer route of coming to Switzerland a bit too early – meaning that they have missed the opportunity to live for a few more rewarding months.

This is also where the role of the psychiatrists becomes very important. When you make your initial application to one of the Swiss AVD providers you will need an assurance from a psychiatrist that you still have sufficient mental capacity to make the decision to end your life. This is the “sound mind” test. The Swiss centres can usually take for granted that you are of sound mind but if there is any hint in your medical records that you may be suffering from mental impairment then they will require a psychiatrist to say so.

At this initial application stage, the psychiatrist will need to have been from your own country. For British people this poses a particular problem because UK psychiatrists are almost universally worried that any opinion concerning a visit to Switzerland might nullify their professional indemnity insurance. The different AVD providers handle this issue in different ways. Dignitas insist upon the agreement of a domestic psychiatrist but point out that he or she does not need to know the purpose for which the opinion is being given. Also, it doesn’t have to be a psychiatrist as such – the opinion of a neurologist or geriatrician would count just as well. Pegasos have their own in-house retained British psychologist who can give his opinion, via a Zoom call if necessary. Athanasios are happy for one of their own Swiss psychiatrists to give their opinion, again via Zoom if necessary.

At the final stage, just before the AVD itself, the two physicians who confirm the prescription to the pharmacist will also need to cover the question of mental capacity but it is rare for a patient to fail at that point in the process.

Parkinsons

For sufferers of Parkinson’s Disease, the problem is more straightforward.   Can they, unaided, drink the drink or turn on the valve ?   They can use a straw if they cannot lift the glass.   But the actual, physical act of ending their life must be carried out by themselves.   That’s the law. Additionally, because Parkinsons in its later stages leads to a form of dementia, they might need to go through that same process as for dementia patients.

People who have any sort of neurological illness are likely to need the facilities available in Switzerland, even if the UK law changes. In Oregon, for example, 72% of assisted suicides are for people with cancer. The proportion with a neurological problem represent only 11%. Of UK people travelling to Switzerland, by contrast, almost 50% do so for neurological reasons.

Medication for Depression

Just because you have been diagnosed as suffering from Depression, it doesn’t mean you are no longer capable of taking a sound decision about whether to end your life or not. It does mean you’ll have difficulty in finding a Psychiatrist who’s prepared to say so, as indicated above. This problem is particularly prevalent for patients who are taking a medication called Mirtazapine. The psychiatrist or psychologist will need to be convinced that its use has not been interfering with any “sound mind” judgement.