The last stop A biographical approach to a chosen death in Switzerland

Within contemporary debates over the ‘right-to-die’ notions of individual choice and respect for personal autonomy –fitting Western values of self-rule and freedom from coercion— have stood as primary arguments. Since the turn of the century Switzerland has occupied a central role in these debates, being one of the only countries worldwide to allow assisted dying for non-nationals as a result of its uniquely permissive law. The often highly mediatized stories of individuals undertaking this final journey to Switzerland have been co-opted to serve the aims of right-to-die advocates and their opponents, where they act to support the idea of greater choice-in-dying as an ‘incontestable good’
While their stories have been highly mediatized, very little is known about these ‘suicide tourists’ outside of their choice: their lived experiences, histories, relations, motivations, and identities. In this work, I introduce a biographical approach to what it means for individuals to choose an assisted death in Switzerland. Through this lens, I examine the temporally and historically-embedded manner in which individuals’ stories about their choice – spanning past histories, present lived realities, and anticipated futures – reveal the variety of meanings which they attribute to this highly personal decision. By adopting a narrative stance, I challenge normative ascriptions of this decision as being ‘simply a matter of choice’. I demonstrate how, rather than grounded on an appeal to rationality and personal autonomy, ‘choosing’ to enact a hastened death abroad is a fundamental means by which individuals strive to protect their identities, to story their end-of-life, and to ‘keep a narrative going’ despite the physical, social, existential, and biographical losses they experience.
Two emerging concepts: ‘biographical contraction’ and ‘biographical closure’ are proposed to describe biographical processes associated with the end-of-life as individuals plan for death. The implications of this research reveal the often isolating and uncertain conditions in which individuals choosing an assisted death in Switzerland find themselves in, and points to a broad yet vital need to (re)integrate individual biography into the management of a request for a hastened death in end-of-life care, and the development of a greater sensitivity to individual difference and life history in respecting autonomy in this context.