(Chris Haws is a British-born psychologist and certified Grief Counselor, based in Washington, DC. He specializes in grief, loss, and bereavement recovery working with individual clients – both face to face and virtually. He also advises multinational corporations, grief support organizations, and bereavement affinity groups locally and internationally. His work has appeared in print, radio, and TV in the UK, the US, Australia and Europe.)
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The wording in the letter to Laura from the clinic in Switzerland was clinically precise, even a little cold – “Dear Member. This to confirm the date of December 19th for your Voluntary Assisted Death.”
For Laura, it was the culmination of over six months of lengthy form filling, personal document copying, and international telephone conversations. But today, what had been a vaguely imagined future possibility had now snapped into sharp focus as a scheduled calendar reality.
According to the letter, on December 19 – just two months away – Laura had been approved to die by her own hand in a Swiss clinic specializing in “Death with Dignity,” also known as Medical Aid in Dying (MAID), Physician Assisted Death, Voluntary Euthanasia, Self-deliverance, and Voluntary Assisted Death. The proliferation of names for what effectively is the same procedure is an indication of the ambivalence societies still feel about it.
Even so, there are now a growing number of jurisdictions around the world where MAID is legal, but very few that don’t require that the client/patient is a) terminally ill, with less than six months to live, and b) resides in the state or country offering the service. For Laura, who was not terminally ill and lived in Australia, where MAID was still not legal, only one jurisdiction met her specific needs. That was Switzerland.
Receiving that letter represented a tipping point for Laura and her family and friends. Now approaching her 90th birthday, her last year had been very challenging. Falls and illnesses, including a near fatal bout of pneumonia that hospitalized her for a month, had left her disabled, depressed, and demoralized, unable to be as active and independent as she had been all her life.
She had also always been an avid reader and current affairs consumer, and so – now involuntarily housebound – she began to take note of the occasional media stories about suicide and voluntary euthanasia. Stories that seemed to be getting increasingly frequent.
True, she’d previously given some thought to death by suicide, but wasn’t persuaded that any of the techniques were either foolproof or wouldn’t leave a distressing scene for her family to encounter and clean up. What she was also determined to ensure, however, was that she would not go into a home to deteriorate and waste away – which is how she saw her options.
Unsurprisingly, when she raised the topic of Voluntary Assisted Death with her daughter and granddaughter, both of whom lived thousands of miles away, they strenuously attempted to dissuade her. But Laura was a fiercely independent and strong-willed lady, and the more they tried to change her mind, the more she stuck her heels in. Meanwhile, she was entering into ever more detailed correspondence with one of the clinics in Switzerland who offered such a service to non-residents who were not terminally ill.
For a while, it seemed as if the international, multi-lingual bureaucracy might defeat her, but she persisted. She was even able to finally enlist the reluctant help of her daughter and granddaughter, who were eventually on the phone to Switzerland almost as often as she was.
So it was that, one morning when Laura’s granddaughter was making a routine call for an update on the status of her grandmother’s application, the manager at the clinic confirmed that “Yes, your grandmother has been given the ‘green light’ and will be receiving a confirmatory letter within the next day or two.”
The effect of receiving that long-awaited verdict – the “green light” – was a mixture of relief and shock. Suddenly, Laura’s ambition for a peaceful, controlled death could become a reality. She now knew when her life could end – she had a date, and it was just weeks away.
The clock was ticking, and there was much to be done to put all her affairs in order. Her daughter shouldered most of those responsibilities, while her granddaughter began to arrange a “send-off” party – a sort of “living wake.” It was to be a simple affair – a few close friends, some speeches, a little wine, and many tears. Together, Laura, her family and friends were experiencing a mixture of “Anticipatory Grief” and “Preparatory Grief.” The difference in this case was that everyone concerned knew when Laura’s death would occur, and how, and why.
Day by day, her appointment in Switzerland drew closer, and on some days Laura was subdued and clearly a little afraid of what she had undertaken. On other days, she seemed to be relishing her decision to assert control over her future.
The doctors at the clinic in Switzerland were frequently keen to point out that she could change her mind at any time, and even when she and her daughter and granddaughter finally made it to Basel, where the clinic was located, there were repeated interviews to gently confirm that this was indeed the course of action she wished to pursue. Clear-minded and determined intentionality is a core feature of all MAID services around the world.
But on December 19, after the doctor had asked for one final time whether Laura knew where she was, why she was here, and what would happen when she thumbed the valve wheel in the intravenous line to the bottle that contained the lethal medication, Laura made her last-ever decision, and within seconds was gone – quietly, and peacefully as she had intended.
Her death had been at the time and in the manner of her choosing, surrounded by her loved ones. And as she said to her daughter and granddaughter who were lying on the clinic bed with her, just before she died, “This is perfect.”
(Please scroll down to comment.)
Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
Payments and donations are tax deductible to the full extent allowed by law. Final Exit Network is a 501(c)3 nonprofit organization.
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I’m so glad for Laura but what an ordeal for her and daughter and granddaughter. It’s sad to have to leave one’s home and travel so far to make this happen, never mind the effort required at 90. It’s nice that Switzerland provides this service but it’s still not right that this is not more widely available for all capable adults in their own homes.
Very nicely reported, Chris. Thank you. As to the “proliferation of names”, that is a recurring subject on this forum, e.g., https://www.thegooddeathsocietyblog.net/2023/05/14/medical-aid-in-dying-is-still-called-assisted-suicide-an-anthropologist-explains-the-problem-with-that/
and https://www.thegooddeathsocietyblog.net/2022/07/31/terminology-for-ending-ones-life-at-the-end-of-ones-life/.
I’m a healthy 86-year-old with a loving family, good friends, and a zest for life, but I desire for myself the same as Laura. I do regret that I and other fellow-travelers will have to leave my home and state to avail myself of such a humane service. I hope that will no longer be the case when my time comes and I’ll have to rely upon VSED.
The most interesting…and disheartening….paragraph for me was:
“For a while, it seemed as if the international, multi-lingual bureaucracy might defeat her. (Her daughter and granddaughter) were eventually on the phone to Switzerland almost as often as she was.”
So it seems we’ll be up against bureauracy wherever we choose do die, unless we’re willing and able to die by our own hand. And not all of us have a daughter or granddaughter who are willing and able to help us.
I guess dealing with bureaucracy is our last big trial to deal with when we decide to go this route. And having a loved one with us is challenging too. I’m sure my ex-husband would be willing to accompany me!