Have you ever contemplated making that final journey for assisted suicide consciously aware that you are never coming back? For good! Like you literally opt to travel out of this world and the universe. You fly one-way with Swiss Air, you tell the immigration officer at the immigration desk that you are never coming back, literally! Unperturbed, she stamps your passport, bids you goodbye, and with a heart-warming smile and wishes you a comfortable and enjoyable stay in Zurich. With a ‘sound mind’, you decide to take that one dreaded, treacherous journey to your death.
This is the reality of so many people who travel to countries or jurisdictions with assisted dying laws for the sole purpose of ending one’s life in a dignified way. A phenomenon dubbed as ‘suicide tourism’. What drives people to engage in this practice remains unclear, but most commonly, victims are usually terminally ill, and they see death as a remedy to end their pain and suffering.
However, people willing to end their lives usually hit legal roadblocks as most world nations don’t agree on the legality of assisted suicide. As a result, those living in regions that prohibit the practice travel many miles to a country where they can die with dignity. For most patients traveling to a region that allows assisted suicide is much easier than changing their country’s law.
Is suicide tourism a mental health issue?
As the idea of assisted suicide becomes acceptable around the world, the decision to opt to die is raising debates as to whether it is a mental health issue. The phenomenon has grown and continues to do so unabated. Despite its growth, the issue has received limited attention in travel medicine research. But, with increased awareness of suicide, the risk of sporadic suicide among international travellers has attained global media attention.
Varied research indicates that suicide is the fourth most common cause of traveler mortality. So, the million-dollar question is if this phenomenon is associated with mental health. People are at a much higher risk of self-harm when the thought that their country will never allow them to end their suffering, becomes a reality.
As the debate on whether the law should permit assisted dying and euthanasia (voluntary or not) rubbles on, and assisted suicide becomes more common, conversations between similarities inhumane (assisted suicide) and the unacceptable (unassisted suicides) is brought to the fore, the latter being caused by mental health issues. However, in assisted suicide, the law requires people to be of sound mind.
Destination death
Remember the conversation with the immigration officer at the airport? The one who wishes the travellers an enjoyable stay in Zurich? Right. Switzerland just happens to be the best country for assisted suicide. It is known for providing a humane service to the terminally ill and their families, one unavailable to them back at their homes.
It’s lenient assisted suicide laws do not require a physician to be involved. Nor does it require the recipient to be a Swiss national and protect the prosecution of physicians if they assist a terminally ill patient end their life. Switzerland has allowed assisted suicide since the 1940s.
According to a team of Swiss researchers, the country has the highest number of suicide travellers in the world. In their research, they found that, between 2008 and 2012, 611 visitors from 31 different countries entered Switzerland for the sole purpose of ending life.
Data from Zurich University’s Institute of Legal Medicine research published in the Journal of Medical Ethics shows a 40 per cent increase among those seeking to end their lives between the years 2008 – 2012. Despite the increase, Swiss nationals want this law to stay. In 2011, pro-life opponents of assisted suicide in the Canton of Zurich held a referendum which was rejected by an overwhelming majority – 85 per cent of the voters.
As if that was not enough, the initiative to outlaw the same provision for foreigners was defeated by another overwhelming majority of 78 per cent.
Joining the bandwagon
Several other countries are joining the destination death bandwagon, increasingly enticing guys to make their final journeys to those countries. Canada, for example, introduced an assisted suicide law but only limiting the practice to citizens and residents, effectively excluding foreigners.
The USA has not been left out with states such as Oregon having laws that allow the practice. Doctors in five USA states are legally permitted to prescribe lethal doses of medicine for patients who intend to end their lives. Notably though, is the state of New Mexico where a new bill that could make suicide tourism a reality was introduced. ‘The Elizabeth Whitefield End of Life Options Act’ would allow non-residents to travel to New Mexico to pursue physician-assisted suicide. The Act, which went into effect on June 18, 2021 authorises medical aid in dying, in which a terminally ill, mentally capable adult with a prognosis of six months or less to live may request from his or her healthcare provider a prescription for medication which they can choose to self-ingest to bring about a peaceful death.
The Netherlands explicitly legalised physician-assisted suicide in certain situations. Belgium has the world’s most liberal suicide laws and even permits euthanasia by lethal injection while shielding physicians against prosecution.
My take
It can be difficult to understand the motive of countries with liberal assisted suicide and voluntary and non-voluntary euthanasia laws but helping someone end their life is morally and ethically complicated. Accepting the premise that death is a legitimate ‘treatment’ for suffering, who qualifies for physician-assisted suicide becomes a moving target. Suicide tourism is a Pandora’s Box with untold cultural evils. Who knows what such provision would do to the most vulnerable in our societies? There is an urgent need for international law to address this issue.
