‘Death Comes as a Relief’: Talking to a Professional Who Helps People Die

This article originally appeared on VICE France.

Helping others die is taboo even in the year 2022. Only a few European countries, including Belgium, Luxembourg, the Netherlands and, most famously, Switzerland, currently legally permit self-determined death with the assistance of medical specialists.

The practice is firmly illegal in the UK, leading The Guardian to report that prior to the pandemic, on average one British citizen a week was flying to Switzerland to end their life in one of that country’s specialist clinics. 

A survey carried out in the UK by YouGov in August 2021 found that 73 percent of those polled were in favour of legal changes that would allow doctors to assist in the death of an individual with a terminal illness.

In Italy, over a million people signed an online petition in 2021 calling for a debate around the country’s current laws regarding what is defined as “active euthanasia”, the deliberate, planned administration of life-ending drugs by a doctor or clinician.

In countries where physician-assisted suicide is legal, the procedure is carried out by organisations devoted to the practice. Patients seeking death are assigned a “guide,” someone who is there to take care of their particular needs during their final days, including planning death dates and purchasing the necessary lethal substances.

One such organisation specialising in physician-assisted death is Exit, a Swiss clinic founded in Zurich in 1982. Exit is funded in part by members – there are currently around 135,000 of them – who pay either €40 a year or just under €1,100 for a lifetime membership. (Different providers – like Dignitas – charge a fee for their services.)

Only Swiss citizens or Swiss permanent residents can apply for membership, which covers all costs and gives individuals the chance to discuss their situation with consultants, draw up a so-called “living will” (a legally-binding document which gives you the right to refuse medical intervention in the future) and offers them the possibility of an assisted suicide. This final decision will only be granted in cases where an individual has “fatal illness, subjectively intolerable pains or unsustainable impairments.”

Jean-Jacques Bise is Exit’s co-president. VICE spoke to Bise about the work Exit does and why the right to a self-determined death means so much to so many. 

VICE: What’s the difference between assisted suicide and euthanasia?
Jean-Jacques Bise: Assisted suicide is carried out by the person themselves. They can drink the lethal substance. If the person is no longer able to drink, they’ll be put on a drip and they will begin the lethal infusion themselves. As of yet, we’ve never had a situation where the person was fully unable to move, but if that was the case we would figure out a solution, like, for instance, initiating the process through blinking. Euthanasia, on the other hand, is death administered by another party. 

What happens once someone decides on assisted suicide?
First, one of our doctors determines if the person meets the necessary medical criteria for us to help them. The person has to have a severe medical issue or be in the terminal stage of a disease. If they meet the criteria, we look at our calendars and pick a date. Most people don’t know when they’ll die, but this is an unusual situation. On the morning itself, we ask them one final time if they still want to go through with it. If they have changed their mind, we bring everything to a halt. Our job is to help people, not coerce them.

If they want to move forward with the procedure, we give them an anti-nausea pill because the lethal product that they have to swallow – pentobarbital – is extremely bitter. Once we’ve administered 15 grams of pentobarbital, the patient yawns and peacefully falls asleep. It takes 20 minutes or so before a doctor can pronounce them dead. We then contact the police and the funeral providers.

How many people has Exit helped die?
Last year we helped 369 people. It was 223 women and 146 men [studies show that cis women are more likely to apply for assisted suicide than cis men]. We also helped four couples pass away together, which is a request we’re seeing more and more.

Why do you think more couples want to die together?
We’re talking about elderly people who’ve been married for decades and want to be able to die together. Often, one of the two is suffering from a severe illness, or has a crippling disability. The last couple we guided had been together for 65 years. They could’t imagine life without one another. 

How did you arrive at this line of work?
I had been through two deaths in my family. The first was very painful — the person had no choice in the matter, and they suffered a lot. I had a very hard time with that one. The second one, on the contrary, happened under the care of a very understanding doctor. He didn’t truly administer euthanasia, but he generously helped relieve the person’s suffering with morphine, which made the end quicker and more peaceful. I remember thinking to myself that, when the time came, I’d want a doctor like that taking care of me.

Are there any deaths that stand out in your memory?
I remember one case where there were grandchildren present for their grandmother’s passing. They read some poems before she drank the pentobarbital. Then, her grandson started playing the violin, and she fell asleep to his music. It’s a moment I’ll never forget; it was so peaceful, so moving.

Before dying, do people usually say any last words?
I’d say the most common ones are “at last.” I guarantee you, after you go through so much suffering, life isn’t really life anymore. So death often comes as a relief for these people; they feel freed.