Choosing Switzerland: Learn From Those Who Have Been There

Hello everybody out there in cyberspace. Welcome to tonight's fabulous conversation. We have our conversations on choice and dying, choosing Switzerland. Learn from those who've been there, and we are so grateful for tonight's wonderful master panel. And our featured guests include Nicole Nuttall, the chair of the Completed Life Initiative; Dan Zembroff, author of his new fabulous book, *Wingman: Escorting My Father to a Death with Dignity*; Kristy Gollum, she's on the boards of directors for the Hemlock Society of San Diego and a Better Exit; and Randy Laken, our Final Exit Network coordinator and Swiss advisor.

Um, and also Laurie Brown will be with us tonight, who is our Exit Program Guide Director, and I will be facilitating our session tonight. So, uh, we have um a Q&A section. The big opportunity for you all tonight is to use this lovely Q&A section that I hope you will all find on your bottom toolbar. Your way of getting questions out to the panel is through that Q&A section. So, it's either going to be on the bottom of your Zoom toolbar, or a lot of people are saying there's a little circle with three dots that says "More." Your Q&A might be under the "More." Um, so, use that tonight. The chat is not enabled. Everything will go through Q&A. We will try to answer questions during um during the beginning as well, or throughout the show as well, but we likely will not get everyone's questions answered. We have over 900 people registered with us tonight, but we are committed to answering your questions all in written format after the webinar. So, know that after the webinar tonight, we will send you an email with links to all the resources you hear and see that we reference, to the recording of the webinar, and also to all of the great resources that we talk about, as well as a transcript if you need a written transcript. Some people have asked for that, as well as answers to all the questions. So, you're going to get a lot of good information.

Okay, for those of you who might be new to Final Exit Network, I just want to give a real, really brief overview of who we are. Um, Final Exit Network, our mission is to educate and support those who want choice in dying. And our vision, really, is that any competent person who is suffering an intractable medical condition has the opportunity to die legally and peacefully. So, that will shape a lot of what we talk about tonight. Um, we have three big programs: all all of our education on end-of-life options, support for individuals, and our Exit Guide program. And there's a lot more of this on our website, but I did want to sort of show you again why we're talking a little bit about Switzerland tonight, because we do education on all the end-of-life options out there. We try to help people with information about medical aid in dying that is connection to state-specific resources, voluntary stopping of eating and drinking, assisted dying in Switzerland, and FEN's Exit Guide program, and providing one-on-one support for people who need individual questions answered. So, we are very unique in that space.

And I wanted to take just a second to learn a little bit about our history, because I think it matters um in the space of why we're talking about Switzerland as well. Our beginnings really come from the Hemlock Society, which still has a thriving chapter in San Diego, and Derek Humphry's best-selling book, *Final Exit*. Derek wrote this book and helped found the Hemlock Society after helping his wife with her end her own life in their home after suffering uh for years with breast cancer and seeing the great need in our society to normalize the discussion of death and access choices that provide peace and dignity. So, we, what happened [clears throat], now all this great stuff was going on, but in 2004, the Hemlock Society kind of evolved into two distinct organizations. You've probably heard of Compassion & Choices. We all come from the same space of our commitment. And that they focus on legislation, advancing legislation to legalize medical aid in dying, as you'll hear, which is now available in 13 states plus the District of Columbia. But Final Exit Network focuses on providing direct education and compassionate support for individuals seeking end-of-life options. So, today, while MAID laws exist in several states, Final Exit Network plays a very critical role in serving individuals who do not meet the legal criteria um of MAID or live in in areas without access, ensuring that more people can make informed choices about their end of life, and continuing the Caring Friends tradition that was part of Hemlock Society. So, I think it's helpful to kind of know where where we're coming from. And um, I really encourage you to go on our website and watch this fabulous five-minute video there with our former executive director and many people in our organization to learn more about all the services we provide. All right. Now, I'm going to hand it off to Laurie Brown, our Exit Program Direct Exit Guide Program Director, who will tell you more about assisted option dying options in Switzerland. Hit it, Laurie.

Great. Thanks, Michelle. Um, good afternoon or evening, depending on where you are. It is great to have so many of you joining us for this deep dive into the option of traveling to Switzerland for a chosen death. Before we get into the heart of the program and hear from people who are familiar with or have accompanied a loved one on their journey to Switzerland, I want to briefly answer the question: Why Switzerland? Um, so, to explain why someone would pack their bags and travel across the pond to conclude their life, I need to explain what the laws in the United States do and don't do. Um, putting aside Montana, which authorized medical aid in dying through a judicial decision, the other United States states with medical aid in dying all have legislation that very explicitly describe the who, what, when, and how of the medical aid in dying process. For those in the US who want choice in dying outside of the medical system, which is where Final Exit Network's Exit Guide program operates, it is legal to end your own life, but it is illegal for anyone to provide any kind of physical assistance in a chosen death, which is a suicide in legal terminology. And that includes providing the equipment, which is why we operate with a strict hands-off policy in the Exit Guide program. So, these two legal frameworks in the US make choice in dying quite difficult for a lot of people. US medical aid in dying laws do not serve people who want to qualify with a dementia diagnosis. They don't serve people who are debilitated with advanced old age, but who don't have a specific diagnosis. And they don't serve people whose prognosis is more than 6 months. Now, those individuals might be interested in a non-medical path to a chosen death, but laws prohibiting assistance in a chosen death in this country mean that a person must be physically able to do everything without anyone else's assistance. For someone who is physically debilitated or disabled, that might be painful, difficult, or frankly impossible. Enter Switzerland. The Swiss organizations currently supporting non-Swiss citizens in a chosen death all provide medical assistance in dying. But interestingly, Switzerland does not have a law specifically authorizing medical aid in dying the way US states do. Instead, Swiss law allows for assistance in a chosen death by whatever pathway, provided four constraints are met. The person choosing to die must be at least 18 years old. They must have decision-making capacity. And they must perform the final action that will bring about death. In addition, anyone assisting in a chosen death must have non-selfish motives. So, medical aid in dying is legal in Switzerland because assistance in a chosen death is legal, and medical assistance is just one kind of assistance under that broader umbrella. Importantly, there's nothing that prohibits non-Swiss citizens from accessing the Swiss healthcare system in order to receive medical aid in dying. So, with that overview of the legal framework, I want to briefly introduce the four organizations that are currently set up to support foreigners who want to come to Switzerland for an assisted death. First, there is Dignitas, which was founded in 1998 and it is located southeast of Zurich. Dignitas is the oldest of the organizations by a full two decades. And being the oldest, it probably knows a thing or two about weathering changing economic and political conditions. Um, and it is a bit more conservative than the newer organizations. It administers medication orally. Then there's Pegasus Swiss Association. Pegasus was founded in 2019. It's located in Basel, but it has a residence in the Solothurn countryside. Um, for those who want a more pastoral feel for their death location. Um, and Pegasus has also uh made an arrangement with the local authorities in Solothurn such that the police do not need to come to certify each death. Now, Pegasus will administer the medication intravenously. The other two organizations were just founded in the last year or less. Um, but their founders all have experience from having worked with other Swiss voluntary assisted dying organizations, so they aren't newbies. Um, Athanasios was founded early in 2025, and it's located in Basel. And they will administer medication intravenously. And then there's Phoenix Care, which was founded a little later in 2025. It's located a bit south of Basel, and they too administer medication intravenously. There is one organization, The Last Resort, which was formed to provide non-medical assistance in dying in Switzerland. But they are currently in a legal battle with the Swiss authorities, and it really isn't clear when or if they'll be able to open their doors again. So, with that like lightning background, um, let's get to the stories. Michelle.

Great. Thank you, Laurie. Well, we will now move to Nicole Natal, who is the chair of the Completed Life Initiative. And we also asked her to share information about this, uh, wonderful, vibrant organization, as well as her personal story. Welcome, Nicole.

Thank you, Michelle. Really appreciate it. So, my story actually probably integrates part of the beginnings of our organization, the Completed Life Initiative. Um, we took my mother, or I should technically she's my stepmother, but very much like a mother to me. And, uh, and my brother. Uh, we, the three of us actually started the organization back in, uh, 2019. Uh, not too long after her mother had passed, and, um, my father had passed. So, um, I think once all of that happened, uh, there was definitely a change in my mom, and realizing that she wanted to have a criteria of when is it going when should she choose to end her life? And that was part of what inspired the organization's start. Was that if somebody could decide when they could live a completed life. Uh, as a little girl, Faith, uh, so Faith Summerfield is our founder. And my mother. And she, as a little girl, had a friend, or I think it was her sister's friend, who had a very terminal illness. She, um, suffered tremendously, and it began Faith's, uh, in, you know, contemplation as to why should we suffer and not be able to have a peaceful death. Uh, she's, she was one of the original members of the Hemlock Society. She loved saying that all the time. And, um, but when she, you know, at the time that she started the Completed Life Initiative, she was so, probably just before 80. And so, cuz we started in about 2019. She was a spitfire of a woman. Uh, probably less than 100 lb. Um, mentally like very with it, sharp as a whip, right? Uh, English major. Had, uh, really almost philosophical ways of thinking and discussion. She really wanted to start this organization because no other organization seemed to fit. Which is, she wanted to push the boundaries on everything past medical aid in dying, which is the only thing available in uh, the states. Like you said earlier, Michelle, 13 states and the District of Columbia. Uh, what she believes is that everybody should have their own autonomy as to decide when their life is complete, and should then, and if they so choose, die when they want to. And so, I believe that when she started this, she started out with thinking, how would I like to die? Um, she, um, a couple of things probably led up to her decision. Uh, we we went to Switzerland actually in '22. So, a couple of things led up to that. Obviously, we had the pandemic. Uh, where everything kind of shut down in 2020. And probably a year after that, she had, she was quite active. She, walked to the grocery store, walked to it. We We live in Connecticut. She, you know, was in Greenwich, was able to just, you know, get out of her apartment, or her condo, and then walk to the, anywhere she wanted to go. She loved that. So, one day, uh, about a year into COVID, she had a huge fall. Uh, just accidental fall. At this point, she was 80, probably 81. She had a huge fall, had a big gash around on her face, broke her nose, um, bruising, all of that. Everything was thankfully intact. Like didn't break a hip or any other bones. Cuz of course at, uh, 80 plus that becomes a big issue. I, in my opinion, I think this scared her quite a bit because I believe this began her journey to say, even though she knew she wanted to complete her life at some point, she then decided, maybe I'm going to do this sooner than rather than later. And I say that because we would have conversations about the fact that it would only take one big fall, and she would be either in a nursing home, or, you know, and have, or have 24-hour care, and not really have a way of being able to complete her life to what she wanted. Uh, I will preface a little bit by saying she watched her mother, uh, decline. Again, sharp as a whip. Uh, up until like 101, right? But didn't have really any friends. All of her friends had died. She'd watched all of this happen. She watched my father die of, uh, metastasized prostate cancer. Uh, was not a great death, although we did have home care for him. So, I think all of these were factors kind of rolled into how how am I going to complete my life? And she she sought out Pegasus in, uh, 2022. We basically, she and I, uh, I helped her with the paperwork. I will have to say mentally and emotionally, um, I, you know, I this was a difficult thing for me, but because of course I wanted her to stay, for as long as as she could, or was willing to. But how could I deny what she was so hard and fast fighting for, which was her own autonomy and her own decision? But so, I helped her. I helped her by starting the paperwork for the D 80, uh, going through the process, helped her to coordinate, uh, the logistics, and maybe some phone calls with Pegasus. Uh, they, at that time, they were not in their pastoral environment. So, when we did end up flying out to Basel, um, we flew out, I should say we flew out on a I don't know what day it was. Maybe it was a Sunday. We flew out on a Sunday, arrived the next morning. Got to the hotel, a hotel that they recommended cuz we knew nothing. And basically had some lunch, and then had the visit from the doctor. Which was great. And actually, um, the president, Rudy, came as well. So, uh, I think this is just an assessment to go through, and make sure that they are still of sound mind, to even though they'd gone through the interview calls be previously. To make sure that she was very sure and certain in what she wanted to do. And the next day, we were picked up, and we were taken to the facility, which was a strip mall like looking place, and had a tire, used tire place next door, and had a kindergarten down the way. But what was interesting is because Rudy actually knew of our organization, and everything that we were already starting and promoting, we actually talked a lot of I guess we talked shop in a way, right? >> [laughter] >> He showed us and shared with us the design plans for the new property where they were building the the new facility. Uh, which looked fantastic. And so, what I can say about how all of that went was they, even though we were in the strip mall looking area, the inside of this this one room, the first room you walk into, was very bright and very comfortable. And then they had a second room with the hospital bed and the equipment set up for the IV, um, process. We were given instructions how it would all work. My brother and I both were there. Um, and then once she signed all the paperwork, we were able to have like just our own family discussions, uh, one-on-ones, lots of tears, lots of laughter. Um, I can tell you that even up to that point I was like, you know, we can change our mind anytime because she did not have a terminal illness. She was in a lot of pain because she had I called her the Bionic Woman because she had like re- shoulder replacements and hip replacements and back surgery and she needed another back surgery and she said, "I'm not doing it." And I think that also facilitated the timeline. So, when she felt ready, we went to the second room which was a hospital bed. Actually, uh, I think Rudy had told me that it was, uh, 1 and 1/2 so that if people brought their pets or if a loved one wanted to lay with her, with their the the patient, that was available which I thought was a fantastic thing to do to make that comfortable. Uh, she got very comfortable. The doctor hooked up the IV. Uh, and once everything it was all in a saline solution bag at the moment, but I I believe, although I wasn't really paying attention, that he had already mixed up the other bag. I'm I'm not exactly sure how that works, but then once they did that, they left and and left us with the instructions of "Take your time. When she's ready, poke your head out the door and tell us you're ready." We had, um, more conversations. She was very much at peace, I will say. Very resolved in her decision and happy about that. She had a playlist. We started playing the playlist. We had more conversations. And then when she asked to to for us to play Pachelbel Canon, that was kind of our signal for she wanted that that she was ready. So, I went out and I told them that she was ready. They switched the bag. And it it as I said, it was filled it was, um, connected with an IV and I should say it had a like a roller valve or tap. I'm not exactly sure what you call that. Um, and then they, uh, switched out the bags and said, "As soon as you're ready, you just need to roll this this way." And uh, and she said, "Okay." They left the room and pretty immediately she decided to do that. And she was still talking to us. We were still listening to the music. And her last breath was, "I love you." And I'm getting teary-eyed now just thinking about it again. It always makes me cry because obviously I miss her horribly, but um, I know she's with me and I am so amazed is that she lived her truth and did that. So, just to briefly back up a little bit, I will say that with the plans that Rudy had for going to this beautiful location and we were looking at those before we went to the hospital room. One of the things that she said to my brother and I were, "We should have this." Meaning here in the US. And part of what we are working on today, the Completed Life Initiative or CLE as we like to call it, is that we bought property in Vermont. 23 acres, beautiful setting, old farmhouse. We're having it retrofitted so that we can allow a guest to come to ingest. And if people don't know, I know this isn't about the US, but if people don't know, Vermont is one of the states that allows for a non-resident to come and go through the process of MAID. And not obviously not everybody qualifies for that, but that is one of our biggest objectives this year is to, uh, have a place for people who are not from Vermont, who do not own a home or an apartment or a place where they could come and ingest if they need to, um, at our location. So, having said that, that's sort of the integration of that. We, uh, I was amazed at how much we sat and waited for the coroner and the police officer. And we left not long after her body was taken away. Um, and, uh, my brother was the recipient of her ashes. And I think my brother and I went back to the hotel and we stayed we stayed until the next day and flew home. I it it sort of felt weird to make it a vacation, so >> [laughter] >> I'd still like to visit Switzerland on another time and visit Switzerland on its own, but it was, uh, it was a beautiful moment and I came back, uh, with more >> [snorts] >> um, with more conviction that we need that people should die with dignity and compassion and when they so choose. So, there, I was trying to keep within my time limit. I'll keep that back I'll kick that back to Michelle, um, and try to answer questions, uh, for anything if I can.

Great. Thank you so much for sharing your story. And we will [clears throat] get to those questions, so keep them coming in. I know Laurie's working on them and, um, we will now hear from Dan Zimroth, who, um, is a new author. His fabulous new book, *Wingman: Escorting My Father to a Death with Dignity*. Welcome, Dan.

Thank you very much, Michelle. Thank you everyone for for joining. I'm going to start just with a very brief excerpt from the book that gives some context, um, to what I'll be talking about and what we're all talking about. So, chapter one. My father's hunched body lurched forward, his hands trembling as he let go of the metal walker and dropped to his side. He straightened as best he could and reached awkwardly toward the aircraft doorframe for support. I tenderly gripped his shoulder to provide further assistance. "Pop, take your time. There's no rush," I reassured him as he slowly and shakily stepped onto the United Airlines 787 bound for Frankfurt. "I've got you." "Can I help you to your seat?" asked a kindly flight attendant. "No," my dad bellowed as he reached for one of the plane seat backs to help steady himself before continuing to shuffle forward. I turned to the flight attendant and smiled as best I could. "Thank you so much. I think we have this." She returned my smile and gently patted my 86-year-old father on the shoulder as he passed her. "You let me know if you need anything, dear." "Thank you," he muttered in a conciliatory tone while continuing to look straight ahead. My father plotted forward as we made our way to his business class seat. I carried his backpack, remaining vigilant for any trip hazards that may lie ahead. As he trudged along, my mind wandered to a distant time. I was probably 13 years old and my father somewhere around 40. He and I were playing tennis at the Newport Beach Tennis Club in Southern California. I was a decent athlete, but Dad schooled me that day as he often did on the tennis court. I remember believing in that point in my life that my father was bulletproof, a physical and mental warrior. Now, I look down to see an unrecognizable old man straining to walk a few feet toward his airline seat. Once acute, laser-focused eyes were watery and blurred. What had become a muscular body tottered feebly. The right hand, strengthened like a vise after 50 years gripping a tennis racket, could scarcely grasp seat backs. Close-cropped white hair lingered at the fringes of a freckled, mostly bald scalp. Legs, formerly sinewy and firm athletic stance, now barely supported a hobbled frame racked with tremors from a despicable disease. The strange figure shuffled forward with my hand holding steady on his shoulder. Was this really my dad? How did he get here? How did my father go from invincible hero to frail, irritable man flying halfway across the globe to end his life? It's probably best to start at the beginning. That's the end of the excerpt. Uh, my father, David Zimroth, suffered from Parkinson's disease. For the first few years, he hardly knew he had it, but then as the disease progressed, so did his anxiety about, uh, a prolonged death. My father's primary concern was not becoming a a burden on his family, on my two sisters and myself. So, due to constraints, uh, this evening I'm not going to go into the background of of my father, um, but I do I would be remiss if I didn't tell you he was an uncompromising man who loved life. He did not take this decision lightly by any means. His decision to go to Switzerland was not in fear, I think in spite of it. Uh, it was an act of extraordinary courage as I think many of the people that that end up doing that. Um, regarding the logistics of traveling to Switzerland, I named the the book *Wingman* because I was a former, uh, Navy pilot and the wingman is the person that accompanies the lead pilot from takeoff to touchdown. There's plenty of people that support a mission, this case with my father, loved ones, medical providers, friends, but I alone was the one that accompanied him from start to finish. My dad lived in Chicago. I lived in Toronto. A few days before we left for Switzerland, I flew down, we spent the last few days together, and then we made the the trip across. And similar to Nicole's experience, we flew all night. We got into, uh, Frankfurt and then we caught a commuter flight to the airport in near Um it was not easy. I think one of the questions that I think I saw and in in speaking to others is timing. It's a little bit of a catch-22. Obviously, you don't want to leave too early, think that you've given up on life, but if you wait too long, if you're suffering from a debilitating disease like my father did with Parkinson's, um it could be very difficult, if not impossible, to make that trip. If you're coming from the United States and flying across the pond, um I mean, I'm in pretty good shape. My father was not wheelchair-bound. He had a walker. Physically, he certainly had difficulty from the Parkinson's, but he was still mobile. Uh but it was not easy getting the flight uh the flights and then getting around. So, I know that's that's an issue that that people have to face on on the timing of it. Um when we left for Switzerland, I really didn't know what to expect. My father had had arranged everything ahead of time. He told my sisters and I about about a year before he ended up doing it that he had arranged um this voluntary assisted death, explained he was going to go to Switzerland, but he thought of it more characterized it as an insurance policy. Um hopefully not needed it, but if so, he had it. So, we didn't know anything about the particulars and even uh as I mentioned, I'd flown down to Chicago and we spent the last couple days just making sure all of his estate planning and and all his personal affairs were in order. We didn't talk about the actual procedure and what it was going to be like in Switzerland. I I didn't know. We didn't have any contact. It wasn't until we landed in Switzerland and got to the hotel and similar to Nicole's story, the time this was 2022 and Pegasus uh is not where they currently are and I I understand now they have lodging there. You can actually go to Pegasus uh and and stay there and do the procedure. We ended up going to a hotel at the time, similar to Nicole's story. Rudy came there, the doctor came there and explained everything and just made us feel so at ease. Uh explained the process, actually gave my father the sample of the valve because in Switzerland, as as Nicole mentioned, the actual patient is the only one that can actually administer the the drug. I mean, the doctor obviously sets it up, sets up the IV, but the patient is the one that that actually flips the valve. So, gave my father an opportunity to look at it, uh make sure he answer any questions, had just a wonderful bedside manner, and then later in the afternoon, the psychiatrist came and just gave made sure my father was of sound mind and and and knew and consent, and then Rudy also answered any questions, made us really feel at ease. And I remember my father um, you know, said, uh "I can do 20 push-ups, you know, at the end of this." We're talking for for a couple hours near the end and he he goes down to the floor and he he does 20 push-ups. He says, "I want people to understand it's not the body, it's it's my mind that that goes away, and I still have strength. I still have strength in my body." Um, you know, we we laughed at at at my dad uh and a very similar experience at Pegasus. Went there and they finished up some paperwork, had some snacks. My sister, who had was in Europe during the during the time, so she flew and so she was there, met us there with her husband, my brother-in-law. And we uh we just talked at the at the end. We had our our iPhones and uh recorded some of some of the last thoughts that my dad had. And boy, was he resolute though when Rudy and the doctor said, "Well, we can go to the next room when we're ready." My dad just stood up and I started to lose it a bit. We we went to the the more benign setting. They had everything set up at the the bed. Uh the IV was was placed and we were saying our goodbyes, crying, and then the doctor said, "Okay, David, when when you're ready." And my dad said, "Let's do it." And it was just an an amazingly peaceful passing in in our arms, my my sister and myself and my father. Uh at the end, Rudy and the doctor gave us all the time we needed with our father and then uh we had joined to the next room. The policeman and the coroner came and signed off and then one of the questions I saw and something I didn't plan for, you know, I thought I had everything covered beforehand with my dad's personal affairs, was transportation of the body. I just I didn't think of it. I just assumed, well, he'd come back with me. Well, it took about 5 days for the paperwork to clear between the Swiss authorities and then uh you don't actually get a death certificate. You get what's called a US a death report of a death of a US citizen abroad. That's done through the US consulate or or embassy. So, I ended up flying back home and then 5 days later, I got the email that uh with the attached cert and the body was released. Um there was a nursing or a funeral home in Switzerland that coordinated with a funeral home in Chicago. All that was done. I didn't have to do uh much of anything. And that's uh the the the quick story of uh of my father and our experience in Switzerland.

Thank you, Dan, and I really encourage people to check out your book because it is a very powerful story and um thank you so much for sharing. Um we're going to end our story telling a little bit today here with Kristy Golem, who's going to go next with us and then we will also get more into the questions. But thank you so much for being with us tonight, Kristy.

Thank you. My father's death shaped everything that came later. In 2005, my father's prostate cancer returned. His doctor told him it was terminal and that he likely had a year to live. This was before California had an end-of-life option act. I learned that my father's plan was to shoot himself when the time came. I would not accept that ending. We talked through alternatives. Eventually, he was advised on how to overdose on his prescribed medications. Over time, he quietly accumulated enough. On the day, he took my mother to dinner to say goodbye. She checked into a nearby hotel so no one could accuse her of assisting him. Alone, he sat at the dining room table with his pills and a bottle of Courvoisier. The next morning, my mother and I found him lying on the floor under the table where he had fallen. In 2017, my mother, Molly, was diagnosed with Alzheimer's, but for years, she remained remarkably stable, walking 6 miles a day and living independently in her retirement community. Everything changed in February of 2021 when she fell and broke her collarbone. After a brief stay in skilled nursing, we were told she could not return to independent living. She would have to move into memory care, even though she still clearly had decision-making capacity. Because of that skilled nursing stay, Alzheimer's was now part of her permanent medical record, and the community required anyone with a dementia diagnosis to be placed in their lockdown memory care unit. The problem was she wasn't ready for that. She was still in the early to mid-stage of Alzheimer's. A few weeks later, I received a jarring call. My mother was on suicide watch. I later learned that she had summoned the courage to approach her favorite nurse and ask where she might find the little white pills that could end her life, referring to the pills my father had taken. She was calm and unmistakably clear that she did not want to continue down the trajectory of Alzheimer's. I had to find a way to help her, but what? She did not qualify for California's end-of-life option act. I was told her only legal option was voluntary stopping eating and drinking, which she firmly rejected. I stumbled upon a reference to Pegasus in Switzerland, where she had met my father decades earlier. In Switzerland, voluntary assisted death or VAD is legal as long as the person has decision-making capacity and can carry out the final act themselves. For someone with Alzheimer's, that means going at 15 minutes to midnight while they still can because once that ability is gone, so is the option. That reference changed everything. I joined Pegasus and began researching obsessively. VAD appeared to be so straightforward, painless, and quick. My mother was resolute. Together, we answered all our questions. We had to gather updated documents, birth certificate, marriage license, my father's death certificate, and her medical records. Because I was her medical proxy, I could do that for her, which made the process much easier than if she had been trying to do it herself. I was working in a void as I didn't know anyone who had even considered this option. I didn't tell many people what we were planning as I didn't want anyone to try to stop us. It was equally important that if for some reason she was unable to complete her VAD and had to return to San Diego that she could do this without anyone judging her for what she had attempted. Obviously, my siblings knew, my adult children and their partners knew as well as a very few close friends. I had stressed to my mom not to mention what she was doing to anyone as I didn't want her retirement community to try to stop her. On May 1st, I wired the first deposit, approximately $6,000 to Pegasus. Was this for real? Was it a scam? I questioned everything. Were our hopes about to be dashed? Molly's requested date for VAD was sometime the end of October as she wanted to enjoy a last summer in San Diego. In early June, my sisters flew in. They needed to hear directly from mom that this was her decision. They recorded the conversation. I was deliberately not present so there could be no question that this was her choice. They were stunned at how much she had declined and feared her window close before her October date. I reached out to Pegasus to request an earlier VAD date anytime after July 15th. I told them I only needed time to arrange flights. On July 8th, I received an email from Pegasus telling me that her VAD date had been moved up to July 20th. We had 12 days. On July 14th, I brought Molly to my house so she could meet via Zoom with a psychiatrist who would verify that she had capacity, the ability to understand the consequences of her actions. She also spoke with Rudy, the founder of Pegasus. Rudy explained that they would work with Molly for as long as it took for her to answer the required questions and physically turn the knob that would end her life. I was incredibly relieved after that conversation. Perhaps this is really going to happen after all. She was going to have to answer the following questions on the day of VAD. What is your name? What is your date of birth? Why are you here? And do you know what will happen? We practiced those questions repeatedly making sure she could say she was going to die. On July 16th, one of my sisters flew to San Diego to accompany us to the flight to Zurich. That evening we had a small family dinner at Molly's favorite restaurant. No one spoke about what was coming but everyone knew it was goodbye. The next morning, my mom was unable to walk and I had to arrange a wheelchair at the airport. Because she was in a wheelchair, we were escorted through private customs at the Zurich airport and taken directly to baggage claim where we met my other sister and the driver who took us to Liestal, a picturesque town outside of Basel, to the hotel Pegasus had recommended. The next day, my worst nightmare happened. Molly woke up looking for her mother. She thought it was her wedding day. My sisters and I were paralyzed. Had we come all this way only for her to lose her clarity? That is how narrow the window can be and how quickly it can close. We took her for a walk through town hoping it would return. Slowly, it did. It had been a few years since the four of us had traveled anywhere new together. We spent the day strolling on the pedestrian only streets. Late that afternoon, the doctor who would prescribe her lethal dose came to our hotel room and in and the interview felt more like a casual conversation. At her final dinner, Molly celebrated with two desserts. After breakfast on July 20th, we met Rudy when he arrived to drive us to the warehouse where the VAD would take place. While I handed over all the original paperwork, my sisters and mom played Go Fish. When everything was ready, we entered an adjoining room where my mom lay on a bed and had the IV inserted. She had to answer the questions and everything was videoed so Pegasus could show the authorities that it was mom who had turned the knob to start the flow of drugs that would end her life. She didn't answer the questions correctly the first time around but on her second attempt, her voice was strong, determined, and very confident ending with, "I am going to die." We had been told it would be immediate. It wasn't. A minute or two passed. It felt like an eternity. My sisters and I were incredibly nervous. One of them cracked a joke. We were all laughing when the drugs took over and my mom died suddenly mid-laugh with her [snorts] three daughters at her side. The relief was overwhelming. She had done it. We scurried from the room and waited for the authorities to arrive and document her death. Afterwards, we took a train to Wengen to hike in the Swiss Alps for a couple of days. We spent that time doing what my mother loved most, hiking and being outdoors. We told stories, we cried, we laughed again. It was a sacred time to grieve together before returning to our separate lives. When I got home, it was my responsibility to inform our extended family and her retirement community about her death. I was honest. This had been her decision. Even our most religious relatives recognized that she had exercised the last autonomy available to her. About a week after I returned home, I received Molly's ashes. They were in a beautiful urn. My mother did not die from Alzheimer's. She died from choice and that choice, though it required crossing an ocean, gave her back her dignity at the very end. She was able to die peacefully surrounded by her children instead of alone and worrying about those she loved. Back to you, Michelle.

Very powerful. Thank you. Thank you so much. Well, lots coming out today and now we're going to get to some of the questions. Again, thank you for for sharing so many of your great stories and we're going to turn now to Randy Laken, who is a volunteer with Final Exit Network, a coordinator who answers a lot a lot of questions um on a regular basis uh that people can just call us or email us and get information about and serves as our Swiss options advisor. We'll probably also open it up to some of our other panelists. We know Kristy through the Hemlock Society answers a lot of questions. But Randy, we're going to start off with a few of the big ones and and just building on what Kristy had to say about dementia. You know, that's a big question people ask is and seem to use Switzerland a lot for is is you know, people who have dementia, what are those how open are they with that diagnosis in Switzerland?

This is a question we get weekly, if not more. Uh maybe it's our generation, whatever, but it it's a major question. And uh the the Swiss the four Swiss organizations are are very aware of this issue. Uh their responses are varied. One of the organizations requires psychiatric eval by a US doctor on letterhead signed by the doctor regarding the capacity and this has been a major problem because as everybody knows, finding a psychiatrist number one, getting an appointment number two, and then asking them what you're going to be asking them about capacity is really tough and uh people call me. I just had a call yesterday from someone with this problem. Uh a few of the other organizations provide uh a psychiatric capacity assessment through a psychiatrist in Switzerland and they do it via Zoom as some of our moderators have said and um that seems to work really well and take the stress off of a lot of people. Uh they will uh also have a medical doctor if needed to do a Zoom with the person to help establish that capacity question. So uh it varies but it's a big one.

Thanks, Randy. The other big issue that often comes out of Switzerland is costs. So, can you talk a little bit about what the ranges are? I know there's different situations but can you shed a little light?

Sure. Uh yeah, as our speakers have said, you start out by becoming a supporter or a member of each of the organizations and uh I think that it was Kristy or Dan who said, you know, the overall cost roughly is around $12,000 US, more or less. Uh that does not include the airfare, which I looked at today because prices have gone up. People need to be aware of that. A flight from New York to Zurich as of earlier today was around $900 round trip. I have no idea if it's going to go up or down and then there's the hotel. So, I just give people a rough idea that it's going to be around $15,000 more or less, in that ballpark.

And building on that, about time, does it take a long time once you start the process? Is there a general sense of how long it takes?

There is a general sense. You know, they they would appreciate a 6-month time frame and that is also tied into the records that Kristy had mentioned. You know, you're going to have to get birth certificates, death certificates, divorce papers, you name it, and they have to be within 6 months of your VAT date. Some people just want the security that they've been accepted and given the provisional green light, as they say, uh knowing that they're going to have to redo all their papers within 6 months of their exit date. And that's okay with them, but uh 6 months is is pretty much, you know, what would work without having to redo your paperwork.

Great. Another common question is is being accompanied. What if you don't have anyone to go with you? Could Can people go alone? Are there special arrangements for that?

That's come up recently and I you know, I started this well, Brian Ruder said, just do it for a month, you know, just find out stuff. And now it's almost 4 years and things have changed. Uh and there are people that have no one to go with them. Uh recently I worked with someone and they brought their dental records and that was good enough for the authority. You know, so uh and and the four organizations, if you're alone and like uh some of our speakers said, they'll come, they'll meet you at the airport. They'll, you know, take you to the hotel. Uh so, it is possible to do it alone. Some people would prefer that. So, yeah. Mhm.

I'm going to open it up um now to all of our speakers and we'll get to

Some of the other questions that are here. Um, see if anyone wants to jump in. I know Kristy, you had talked earlier or sent me information about someone going alone, the dental records. Um, do you want to build on that at all?

Uh, well, they just need to be able to have the dental records for the authorities. Uh, and it also costs about $1,500 US more, but this person, she went last week and she didn't have anybody to go with her and it, you know, except for that extra step of getting the dental records, it wasn't an issue. Mhm.

And another one of the questions I see kind of commonly here, um, is the issue we talked a little bit about afterwards, like arranging for ashes or the body itself. Are those all things that you can arrange ahead of time with the organizations? How does that seem to go?

They'll automatically defer to ashes unless you're like Dan's dad and and want it differently. Um, and they make all the arrangements with the funeral homes and everything else. You just give them the address where you would like the ashes to be delivered to and that's the extent of how much you have to think about it. Mhm.

Yeah, if I can just speak on the on the body part, um, if not cremation, as I mentioned with my father, he'd already set up it purchase a plot next to my mom in in Illinois. Uh, and right before we left, I reached out to to them and and they were aware of what was going to happen. And then, you know, Rudy and Pegasus had referred me to and they were all set up the uh funeral home in Switzerland. And so, it really only took a a phone call or two and then they coordinated amongst themselves. And then when I got the release date for the body, uh, and then the funeral home even coordinated the the flight and such. So, I I was just given a a time uh when the body was coming, the funeral home in Illinois, you know, picked it up. So, it was all seamless and coordinated uh outside of what having to get involved personally.

Great. Randy, do you ever find are there reasons that people are not accepted? I mean, what are common reasons that people are not accepted in Switzerland?

>> Well, in the 4 years I've been doing this, I haven't haven't had anybody not get accepted. You know, by the time you go through all the preliminary paperwork and, you know, all that they require, I've never seen it happen. I do know that the doctor who comes and writes the prescription can still reject someone even after they've gone through all that. They they have the authority to do that, but I I've never seen it happen. Mhm.

I would like to also add in terms of paperwork, uh, I worked with someone who was born in a small village. They didn't give birth certificates in that person's village. How are we going to deal with that? So, a lot of what I do is troubleshooting and we were able to the person was in their 80s and we were able to then go back to this village and get a document and that was acceptable to the authority. So, and the question also of people saying, I'm sending all this money, it really scares me, is this really legit, like Kristy said. So, they just want reassurance, you know, that's a big question that that comes up all the time, you know, it's like scary. So, uh, there's all kinds of odd things that come across my desk, communication issues. Oh, I haven't gotten a callback, I'm nervous. What's going on? So, I can reach out to the four program directors and fix that communication gap.

That's great. I want to point out that um in so much of what Randy's saying, one of the things we really do specialize in, I think we're one of the I think only organizations except if Kristy does it through Hemlock, maybe the two of us together that actually answer people's personal questions, but also help them. You know, as you heard Randy, we have relationships, we can call the administrators and and get questions answered, which is a service we're proud to offer. Um and we do um are also want to call out a great resource that we're going to include um in your follow-up materials, uh the switzerlandalternative.com. Did I get that right? I think the switzerlandalternative.com, John Watson, a fabulous man who's been gathering up all the real detailed information about each organization. We know that um which is really great. That's a resource. We have a lot of that on our website as well, but we will put that out there, too. And we know that while there's a lot of in general information, a lot of it becomes very personalized and that's where we try to help with folks. Um Lori, was there anything else as you were going through the questions that stuck stuck out to you um or any other questions Randy or anyone else thinks we want to answer before we sign off tonight?

Can I just say that all these organizations are charities. They're nonprofits is probably better word than charity. Um so, although their prices are very, very similar, uh, if somebody really cannot afford it, uh, they all do accept a certain amount of people every year that cannot afford their services. Mhm. So, if you do happen to fall into that category, I would still reach out to them. Um, obviously, they can't accept everybody that reaches out to them, I'm sure. Uh, but that is one of the Swiss rules. Um, these organizations are not quote-unquote allowed to make money off of this. So, take that for what it's worth, I guess.

>> Yeah. Very good point. Yeah, I would just There's a couple questions and maybe I wasn't clear in my presentation about the difference between medical aid in dying in Switzerland and the US. In the US, the requirements are um very specifically, you have to have a terminal diagnosis and you have to be within 6 months of death. And you have to be competent at the time of um taking the medication. So, in the US, you cannot qualify with a dementia diagnosis because by the time you're within 6 months of death, you will not have decisional capacity. So, the big difference between the US and Switzerland is Switzerland does not require you to be within 6 months of death. You do have to have decisional capacity, but you can apply for assisted death much earlier um and therefore be able to avoid a dementia diagnosis. And there was a question earlier, Switzerland is the only country in the world that will accept foreigners. So, there is no other country you can go to and be a tourist and, you know, get get your VAT. Uh, we can't go to Canada, we can't go anyplace else. It's only Switzerland.

Very good. My apologies for going through all the slides here to get to the end, but um we could keep talking forever. These are great great insights tonight and I just want to again thank you all. I want to thank our panelists for being here taking the time to relive your stories, share information. So grateful to Laurie and Randy for all the the details. Also again panelists links are here. We will give all of those to you in the final email you will get. I'm also putting on here this is also you'll get a link to the suicide tourist on Frontline. This was 2010. Our former executive director Mary Ewart accompanied her husband to Dignitas. It is true tonight the three panelists we have just happened to all use Pegasus, but Dignitas as Randy says has been around a long time. All of these organizations have you know just great forward and we really would encourage people will provide the link to also watch another really powerful story. Of someone with ALS who made a choice and used Dignitas. Again learn more get engaged we'll give you all our information. We hope you'll consider becoming a member. I will say our member magazine is coming out in April which also will focus on even more stories and more specifics. All four of the organizations were invited to contribute and have contributed to the new magazine which will come out in April. So those of you who are members will get a paper copy of it. We'll also have an electronic version for for folks later, but we're excited to keep that information going. Of course we're also nonprofit organization and welcome donations as able from people and you can also just subscribe like follow our blog. We have a lot of things that are free to to anyone. So please do consider staying in touch with Final Exit Network. We will be doing more of these types of educational programs and we're just again so thankful for all of you for learning. This is our primary goal. We know and as you heard tonight everyone who makes a choice that we work with people are learning really hard how to do that. There's a lot of information to take in. No one takes this lightly and we're really happy to be there for people directly supporting them at this special time in their life. So thank you all tonight. We will send that follow-up email according with the link to this program as well within the next few days. So thank you all so much. Good night.