Mental Illness and DIGNITAS: Are You Still Eligible?

Mental illness alone does not automatically rule you out of an accompanied suicide with DIGNITAS, even though our own FAQ lists "severe mental illness" among the standard exclusions. The Swiss Federal Supreme Court has confirmed that a mentally competent person retains the right to decide the timing and manner of their own end of life, and this position was upheld by the European Court of Human Rights. What actually decides a psychiatric case is not the diagnosis itself, but whether decisional capacity can be independently established.

The exclusion is about capacity, not diagnosis

DIGNITAS is not asking whether someone has a psychiatric history. It is asking whether the wish to die reflects a settled, rational, well-considered decision, as opposed to a symptom of a treatable episode. This distinction matters because a curable depressive episode and a stable, long-term, therapy-resistant psychiatric illness can look similar from the outside, but they lead to opposite conclusions. Only the second can support a formal request.

What an in-depth psychiatric appraisal actually involves

A request on psychiatric grounds requires a detailed, independent medical appraisal by a psychiatrist, separate from the applicant's regular treating doctor. This assessment needs to establish a clear diagnosis, document every therapy already attempted, and confirm whether further treatment options genuinely exist or the illness is treatment-resistant. It is generally advisable to seek out a psychiatrist with a forensic or analytical background, since an independent professional without a prior therapeutic relationship is more likely to assess the case without bias.

Why "new therapy" often comes first

Before an appraisal is finalized, new treatment options may still be suggested and should genuinely be tried. This is not a delay tactic - it is part of establishing that the illness is truly resistant to available therapies. If a new therapy does not produce the desired effect, the request for an accompanied suicide can still move forward from that point.

What the formal request needs to include

Once the assessment stage is complete, a full request typically includes a personal, signed letter explaining the reasons for the request and the applicant's current situation; a detailed life report covering childhood, early adulthood, the onset of the illness, and the current family and social situation; one recent medical certificate plus two to three older ones from treating psychiatrists or clinics; and the in-depth psychiatric appraisal itself, confirming both decisional capacity and that the wish to die is not a symptom of the underlying illness. Only complete, well-documented requests move forward to review by a Swiss psychiatrist.

Handling pushback from a treating psychiatrist

Requesting an independent appraisal can meet resistance, especially from a doctor who has treated the applicant for years. It generally helps to avoid presenting the wish to die as the primary reason for the request, and to approach a psychiatrist with a forensic or scientifically oriented outlook rather than the current treating physician. Checking a psychiatrist's general attitude toward these assessments before making a formal request can also prevent an outright refusal.

Frequently asked questions about mental illness and DIGNITAS

Does a diagnosis like depression automatically disqualify someone?

No. What matters is whether the condition is established as severe, long-term, and resistant to therapy, and whether an independent psychiatrist confirms full decisional capacity regarding the wish to end life.

Can the regular treating psychiatrist write the in-depth appraisal?

It is possible, but an independent psychiatrist without an existing treatment relationship is generally preferred, since they are less likely to be influenced by years of prior clinical involvement with the applicant.

Is requesting this kind of appraisal legal?

Yes. Requesting and obtaining an in-depth psychiatric appraisal for this purpose is neither illegal nor unethical in itself.

What if a family disagrees with the decision?

Family opposition can complicate the practical side of a request, even when it does not change the medical assessment itself. Working through this with the family early, rather than at the last stage, tends to make the whole process considerably smoother.

If you or a family member are considering this path on psychiatric grounds, understanding the real requirements before approaching a doctor makes a significant difference. Our accompaniment service is built around exactly this kind of preparation - helping you understand the full picture, connecting you with the right independent professionals, and managing the DIGNITAS correspondence itself. For the general eligibility criteria beyond psychiatric cases, see our frequently asked questions, or contact us directly to discuss your specific situation in confidence.