“They” said it would be easy! Choose your experts carefully…

image663389557"I stopped taking any nutrition a week ago. It was
the only choice I saw to end my life, the only
thing I can control. The literature I read said
it wouldn't be hard, and it isn't -- it's brutal.
My loved ones support me, but this is as difficult
on them to watch as it is for me to execute.

The experts told Charles Selsberg that refusal of food and liquid as a means of ending his life would not be painful. They were wrong. “But I know someone who did it and they died very peacefully,” you say. Indeed. But it is a method with many factors and what works for one person will not necessary work for someone else. Be very careful which experts you listen to and which literature you trust.

Starvation/dehydration is such a complex subject that The Exit Path spends no less than 50 pages examining and analysing the evidence and presenting guidelines based on collating data from more than 100 published sources from academic studies and the mainstream press. Yet each month we hear of some well-meaning source suggesting that it is ‘painless’ or that it is the ‘ideal’ way to go; and the same month we hear of another prolonged and painful death where someone took that advice at face value. In this short article, it is only possible to give the briefest of outlines, but we say, don’t take our word for it, look at the evidence.

How is what we tell different to the advice from other sources, some of them eminent doctors or even some right-to-die groups? The answer is metadata. We don’t just look at a few examples and add on some convenient theory. We search and search again, paying particular attention to failures and their causes. We look at the medical hypotheses and see if they stand up to the most difficult examples. We are probably one of the very few organisations that can devote full-time investigation to get to the bottom of controversial self-deliverance issues. We ask other experts to criticise our findings just as we criticise our own. When it comes to someone’s life and death, we think they deserve more than a belief, a ‘wish-and-a-prayer.’

So what are the basics on starvation-dehydration as a means of self-deliverance?

1. Firstly, you need to be in the category of persons for whom it is possible (but not inevitable) that it will work well in ensuring a peaceful and painless death.

2. If that is satisfied, you need to prepare. Once you have embarked on your terminal fast, it is too late to put the necessary things in place.

3. You need to be familiar with the probable course of your terminal fast, what to expect, the potential obstacles that may require urgent attention.

4. Your friends and family need to be aware also, how your appearance will change and your physical capacities become less. You will need to know how you can exert some control over your progress to interact with them.

5. You need the willing back-up of a medical person able to prescribe such (legal) drugs as may become necessary to relieve symptoms that arise, as well as some basic day-to day nursing care.

6. The process is voluntary. In theory, you can stop at any time; but there is also a point of no return. Calling it, “voluntary refusal of food and liquids” is a fuller way of describing it to cover the moral issues. There must be no question of relatives or carers refusing liquids or nourishment. “Starvation-dehydration” simply identifies the physical process causing death.

Let’s not beat about the bush: there are many people who die peacefully by this method and many that don’t. Tony Nicklinson (see previous blog) was severely debilitated. He was also in touch with many sympathetic doctors. Charles Selsberg was less fortunate.

Many terminally-ill cancer patients experience a bodily “shut down” and no longer feel a desire for food or drink. Many of them also have excellent hospice care to manage any conditions that arise. Many of the studies on death by starvation-dehydration have been in similarly well-managed clinical settings. Yet Jane Gross’s mother, paralysed and desperate to die, had medical back-up in her nursing home and still suffered. “The first three days were so-so,” says her daughter, adding that, on a scale of 0 to 9 where 9 is “a very good death” her mother’s condition would have been a 6. “The last three days were peaceful, an undisputed 9. It was the week in the middle that was harrowing, at best a 3.”

Finally they got an outside pain consultant to persuade the staff physicians that they could raise the dosage without risking legal liability. “Only then did my mother stop pumping one arm frantically, clenching her jaw and staring wide-eyed at the ceiling.”

Excited by the findings of a Dutch psychiatrist, one right-to-die group led by a doctor had even started recommending refusal-of-food-and-liquid as the best way to go, failing a change in the law. Horrific newspaper reports of bad deaths followed, and the group quickly played down their advice.

Factors that can eliminate (or severely increase the difficulty) of patients from point (1) include being overweight or having a pre-existing condition that increases the likelihood of organ failure. Nursing needs can include care of the mouth so that it doesn’t dry out completely (and painfully), bed turning to prevent sores, and general observation to anticipate medical needs. Medical needs commonly occurring are the need for ordinary prescription drugs to control things like sleeplessness, anxiety, occasional breathlessness and pain. Emotional needs should be thoroughly addressed by full and open advance discussions. Advance equipment might include a nebulizer or hand-held atomizer, saliva-replacement gel, eye-gel (or ‘artificial tears’) and nasal sprays, plus Vaseline or lip-balm. A soft-toothbrush for oral care, and a gauze soaked in alcohol-free chlorhexidine can be used on the gums and tongue to prevent fungal infections in the mouth.

No-one undertakes raional self-deliverance unless their suffering is unbearable. If they make that final choice, everything should be done to ensure that they do not unwittingly bring even more suffering on themselves.

Exit received an award from the Natural Death Centre in 1996 for its ground-breaking study of death from refusing food and liquids. It has continued to research and publish in this area for almost 20 years.
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No helium, no bags, no information, can’t talk about it, where will it end?

nicklinson  S.CHow much respect does the law really give you for your private life? Your family life? Your private arrangements between you and those you love and who love you? This apparently straightforward question is one that our highest court wants to decide for us. They are still ‘deliberating.’ Perhaps they think we are “just not capable” of deciding how to live and die. Is that really the case?

Slavery(1) was abolished in 1833. You now have the right to live your life as you please, without interference from others, and without interfering with their lives — at least that’s how the theory goes. One day you will die but, while alive, you must have the right to die how, and when, you will, or your status as a human being wil be reduced. The courts, so far, don’t agree. It remains more a case of, if you can get away with it, fine! The Court of Appeal holds that there is no right to commit suicide, since the Suicide Act(2):

“. . . can more accurately be described as conferring an
immunity from the criminal process for those who actually
commit suicide. A fortiori, if there is no right to kill
yourself, there can be no right, fundamental or otherwise,
to require the State to allow others to assist you to die
or to kill you”(3)

Having decided what the law can ridiculously get away with, religious, political, and well-meaning motherliness push lessening your rights further. I can buy a car, a perfectly lethal mechanism to end my life or that of another, and no-one suggests cars should be banned. Yet there are people seriously wanting to ban sales of helium. If we compare helium to cars, there is little doubt in my mind which is the most dangerous and which is the most dignified. In America, ordinary plastic bags and tubing (“Gladd bags”) were banned.(4) Cars and guns aparently are ok, but plastic bags are not (the tubing happened to be the right size for conecting a tank of helium, but these bags and tubing are available from many a highstreet store).

Last year, pressure was put on Exit resulting in the loss of our credit card trading facilities. The main inconvenience is to overseas members, for whom paying their magazine subscription becomes more cumbersome. The silliness was probably aimed at restricting information — information that can be gleaned from newspapers and medical books, hundreds of underground internet sites (not this one) or more responsibly and reliably from Exit publications (which anyone can buy from Amazon). What happens when you make it hard for people to get sensible information is that they resort to bootleg sources. Books or websites with inaccurate instructions, or horrible and undignified methods of suicide. Chemical suicides (a Russian roulette that endangers other people), potpourris of pills or other backstreet methods.

Tony Nicklinson(5) was refused help by the Courts and starved himself to death. Luckily, he died well. Starvation is a particularly risky method for many people and there are many cases of a horrble ddeath when they are unprepared.(6) Indeed, no less an authority than Lord Browne-Wilkinson stated:

"How can it be lawful to allow a patient to die slowly, though
painlessly, over a period of weeks from lack of food but unlawful
to produce his immediate death by a lethal injection, thereby
saving his family from yet another ordeal to add to the
tragedy that has already struck them?"(7) 

A patient that cannot move has less options when it comes to choosing the time and manner of his or her own death. Why do we do it? The likely answer was succinctly put in a recent Law digest:

"Rather than face head on the most difficult fact of life, that it
must end, we force people with severe physical disabilities to
continue their lives despite their express and maintained desires
to the contrary, even though we do not do so to able-bodied people.
In a society striving for equal opportunities in all other areas,
this anomaly cannot be ignored."(8)

The Supreme Court (U.K.) is currently grappling with this question of assisted suicide, since severely paralysed people are disadvantaged and unable to make a simple choice on how and when to die in the same way that able-bodied people can choose. The issue is whether the prohibition on assisted suicide is incompatible with the right to respect for private and family life. If the answer is yes, to comply with such rights, the Suicide Act 1961 should include a defence of necessity, so as to make it not unlawful for a doctor to assist in a person’s suicide when that person has made a voluntary, clear, settled and informed wish to end his or her life (but is unable to do so without medical assistance). Alternatively, if no such defence is available, the Court should declare that, in such circumstances, the Suicide Act 1961 is be incompatible with the rights to private and family life.(9)

Some people hope that our so-called “right-to-die” will seventually just go away. If only it would die, and its ashes swept under a table! But it doesn’t go away. While life goes on, the prospect of our eath, and of dying well or dying badly, continues to be a live issue.(10)
(1) The Slavery Abolition Act 1833 (citation 3 & 4 Will. IV c. 73)
(2) The Suicide Act [1961]
(3) R (Nicklinson) v A Primary Care Trust [2013] EWCA Civ 961 (para 55)(4) “A less than Gladd end” (ExitEuthanasiaBlog)
(5) Mail Online  The Independent (newspaper reports on Tony Nicklinson)
(6) Overview of rational suicide methods, including starvation
(7) Airedale Hospital Trustees v Bland [1992] UKHL 5
(8) Elaine Freer, Halsbury’s Law Exchange
(9) Current Supreme Court Cases, R (on the application of Nicklinson and another) (AP) (Appellants) v Ministry of Justice (Respondent)
(10) See also, Rosalind English, “Is there a right to die in English law?”

Regular readers interested in legal nuts & bolts: please find links to cases & statutes in the right-hand column.

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What would you do? Let the individual decide.

HeliumAtomIn the first week of the new year came the news of an elderly ill couple that had ended their lives together. As people read these words, their responses may be of many different kinds.

There are those who are, quite simply, grieving. We miss a person’s passing. We mprobably hope that they did not suffer. Other emotions are common with any bereavement, such as sadness, shock, anger, wanting to blame someone or wondering if something else could have been done. Some people immediately feel that suicide in any shape or form is wrong. Others want to know more details. How old were they? Were their illnesses terminal? Or, could I do it in their situation?

My own first reactions are usually, “I hope the person did not suffer. I hope they had a good death.” Is death ever good, you ask? Some deaths are clearly better than others – as you will know if you have ever watched someone suffer terribly before the moment of death. It is true that, with advances in technology, most pain (but not all) can (at least theoretically) be treated. Yet it is also true that a large proportion of pain is not successfully treated in practice. In addition, there are often other factors making life sometimes less than bearable. Catheters, drips, side effects of chemotherapy, or being so doped out by morphine that any meaningful interaction with the world and one’s loved ones is very significantly reduced. It can get to the point where the patient’s possibility of any good experience is virtually nil.

This does not discount the value of last-minute exchanges with loved ones, and the crisis of impending death can reveal new bonds. There is also a practicality when death does not come too quickly. My old doctor, right up to his last year of life, had always expressed the hope that he would die of cancer. When asked why, he said that palliative care is more advanced for cancer than many diseases but most importantly it gives you time to put your affairs in order.

Mr and Mrs Phillips clearly had time to plan. They even posted a letter of intent to their lawyers so their bodies would be found at the appropriate time afterwards. They were discovered sitting calmly on their sofa. They had died within seconds of making the final decision. The means (reported in the newspapers) was helium. Safe, effective, painless, odourless.

The bedrock consideration must be the amount of suffering the person is experiencing in the last phase of life and whether they are the sort of personality that decides, Sooner rather than later: With dignity, rather than dragged screaming. It is up to that person to decide what amount of suffering is ‘unbearable.’

In the case of newborn babies, clear guidelines exist to allow a baby to die, for instance, when a baby had been born very prematurely, suffering brain damage, epileptic, and the evidence is that the child would be blind, deaf, dumb and quadriplegic but fully capable of experiencing pain, then the law allows that child to die. (This was the case of Baby J). Similarly, a person with an advance medical directive (living will) can legally refuse treatment and choose to die from an underlying condition. But these examples refer to people kept alive with life support or medical treatment and who will die swiftly without it. The law makes no provision for those who will simply die a slow, often agonizing death.

Except for the lucky few living in a country where you can ask a doctor to assist legally, or who can afford the large sums necessary to go to Dignitas for an assisted death in Switzerland, the only other option is doing it yourself. The methods of peaceful death using helium (the method chosen by Mr and Mrs Phillips) are now so well-known that there is little or no question of being able to stop someone who has made up their mind. Yet the emails to Exit show some marked differences. Members of organisations such as ours (Exit), or Final Exit Network (in America), or Exit International (in Australia, no connection with Exit), almost always choose inert gas as a safe and reliable means of self-deliverance (rational suicide), if and when things get too bad. Whereas persons feeling suicidal due to a psychiatric condition or psychological trauma tend to go for more dangerous methods. We wouldn’t like to see anyone choose death unnecessarily, for reason of something that could be put right. Yet if death cannot be avoided and the suffering is unbearable and unrelievable, any human being would wish that the last moments of another, whether natural or by their own hand, are as peaceful and dignified as possible.

When couples end their lives together, it can have a romantic sense to it . . . yet only if both are old, both suffering from a disease that is likely to be fatal. We should never glamorize to the extent that one half of a couple feels influenced by a ‘trend;’ but at the sort of ages that we are talking about, surely most people are old enough to make up their own minds.

At the far end of the end-of-life spectrum, some people have simply had enough, thank you very much, and wish to bow out gracefully. For some, disease or injury precipitates the decision or hastens the choice. Others want to let the doctors do their best and see what happens (bearing in mind that there may come a point, possibly in hospital or through incapacity, that you no longer have that choice). Nothing, no-one, should persuade someone else. Let each individual investigate the options and so be prepared. Understand the disease and its likely progression. When you get a diagnosis, wait a few days at least until the shock has worn off and you can think about it with a clear head. Above all, it is your life, your decision. We have a tendency not only to cling to our own lives but to cling to those of others, sometimes to the point of taking away a person’s choice. Yet the motto of life in relation to others should ultimately be: let the individual decide! With a proper assisted suicide law, there would be little, if any, call for self-deliverance. A person could consider their options, what they would want in different stages of a disease, how much and what sort of palliative care, and know that they would be listened to without prejudice. The transparency would not increase early death. It would allow doctors to share their expertise more openly, and without patients ‘keeping mum’ to avoid putting doctors in an impossible position. There are enough doctors that would be willing to help. The courts have on more than one occasion deemed it would be appropriate to pass a law. The only ones that still need to decide are heads of government. Will they continue to support personal agendas? Or will they allow the possibility that the individual could decide?

Further reading:
Husband’s cancer led to couple’s helium suicide pact
Prostate cancer symptoms
Prostate Cancer Support Helpline
Prostate Cancer UK (management of advanced symptoms)
Medical review of prostate cancer palliation
Prevalence of pain in cancer patients
Management of death in severely premature neonates (book)
The Exit template for a new Assisted Suicide Act

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Liberté for France??

lutetiaRomantic suicide fever has gripped the French media in the past week after an 86-year-old couple, described as brilliant intellectuals, ended their lives together last Friday. Three days later, a second Parisian couple, aged 84 and 81, were found dead in their apartment in the city’s upmarket 7th district.

France is a country of contradictions when it comes to the question of assisted suicide and euthanasia, with a massive 92% of the population supporting legal change for it. Yet this is the country that has also tried to ban books on rational suicide, including its own historic volume, Le droit à la mort : Suicide, mode d’emploi (“The right to death: Suicide, user manual”). Propaganda or advertising for products, objects or methods advocated as a means of committing suicide, though rarely enforced, is punishable by three years’ imprisonment and a 45,000 euro fine.

Yet although anything resembling euthanasia is horriblement illégal, the current French socialist president, François Hollande, made changing the law one of his 2012 election campaign pledges.

The story surrounding the 86-year-old couple adds enormous fuel to fire. They died holding hands at Lutetia, one of Paris’ most romantic hotels on the Left Bank, and once a favourite haunt of Pablo Picasso, Samuel Beckett and James Joyce, who loved its romantic setting and architecture.

Friends and family of Bernard and Georgette Cazes, said there was no doubt the pair were still very much in love after more than 60 years of marriage; and in the name of that loving unity, they decided to end their lives together at a time and place of their choosing. A member of staff walked in with the breakfast tray to find the pair hand in hand on their bed with plastic bags over their faces. A letter was also found, in which Georgette vented her fury at not being able to enjoy a more dignified, comfortable departure.

“The law forbids access to any lethal pills that would enable a soft death,” the typed note said. “Should my freedom be only limited by that of others?

They had been active until recently; Mr Cazes was an eminent economist-philosopher and author of a series of books including The History of Futures, which charted how the future was predicted throughout the ages. His wife was an author and Classics teacher, and later a volunteer social worker.

Georgette and Bernard, from the Paris suburb of Issy-les-Moulineaux, had asked staff to bring them breakfast in bed, ensuring their bodies would be found quickly. All their affairs were in order, including documents containing their final wishes. When found, the couple’s room was perfectly made up, just as they had found it when checking in. Mrs Casez had first visited the hotel in the 1940s when she met her father there when he was released from a prison camp after the Second World War.

It would appear they died peacefully. The second couple also managed a gentle death, but using prescription drugs. Most rational suicides in France are not so lucky. With the restrictions on literature, most persons seeking an end to intolerable and violent means, which also traumatises relatives who find the body.

A history

Since the Middle Ages, Western society has used first canon law and later criminal law to combat suicide. Changes in the legal status of suicide, however, have had little influence on the suicide rate. Beginning after the French Revolution of 1789, criminal penalties for attempting suicide were abolished in European countries; England was the last to follow suit, in 1961. But many of those countries and numerous U.S. states also adopted laws against helping someone to commit suicide.

A French physician, called Dr.E.Forgue. published an article, named “Easy death of incurable patients” in La Revue de Paris, in 1925, and pointed out that killing an incurable patient wasn’t a legal condition. But, Liege Bar said that killing an incurable patient with his free consent had to be forgiven.

The 2005 Leonetti End-of-Life Act, was a significant turning point. This Act was voted into law as a response in part to public outcry over cases like that of Vincent Humbert, a young man suffering post-traumatic locked-in syndrome. He voiced his desire to “die legally” but his appeal was denied, and his mother assisted in killing him by injecting him with an overdose of barbiturates that put him into a coma, killing him 2 days later. Although she was arrested for aiding in her son’s death and later acquitted, the case jumpstart the new legislation which states that when medicine serves “no other purpose than the artificial support of life” it can be “suspended or not undertaken”.

It covered the sort of ground of refusal of treatment and and advance directives now common in many other countries. Although a legal landmark, many people involved in end of life situations claim that the approach used in hospitals has not really changed since the introduction of the law. Many people want to see the law extended to cover physician assisted suicide and also ensure measures to upgrade the country’s palliative care procedures.

Last year, award winning director Michael Haneke’s film Amour tackled elderly assisted suicide and picked up a swathe of prestigious awards at the Cannes Film Festival. This year, President Francois Hollande said that France should hold a national debate on the issue and stated his intention to introduce a bill to parliament before the end of the year. Opinion polls in France show that the majority of the public are in favour of an assisted suicide law, but so far France’s national ethics committee has advised against any change in the law.

I too shall cease and be as when I was not yet, only all over instead of in store. That makes me happy, often now my murmur falters and dies and I weep for happiness as I go along and for love of this old earth
that has carried me so long and whose uncomplainingness will soon be mine. Just under the surface I shall be, all together at first, then separate, and drift through all the earth and perhaps in the end through a cliff into the sea, something of me.
A ton of worms in an acre, that is a wonderful thought,
a ton of worms, I believe it.
                                                            — Samuel Beckett

French law on assisted suicide
(in French: use Google translate for an English version)
Ethics review: End of life legislation – the French model (medical journal article)
Euthanasia, assisted suicide and palliative care (review by the Ethics Committee of the French Society of Anaesthesia and Intensive Care
Acceptability for French people of physician-assisted suicide (abstract of article)
French hospital nurses’ opinion about euthanasia and physician-assisted suicide (phone survey)
A report in The Telegraph newspaper

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Download the new trifold leaflet

FLA-TEP flyer photoNew: download and print the new tri-fold leaflet with information about Five Last Acts – The Exit Path.


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Facing the moment of death

DSC03962Whether a person is interested in the reassurances that Exit’s literature can offer or not, each of us has to face the moment of death one day. “When it all comes to an end” examines what we can do to face the last moments of life with equanimity, whatever our situation. We offer it to our supportive readers for personal use (It may not be published elsewhere or modified without permission. We ask you to please respect this. Webmasters may feel free to offer a link direct to this site.)

The article does not include details of self-deliverance (rational suicide) techniques. Much of the information is equally applicable to a self-deliverance, a hospice, or a natural death at home. The psychological methods have also been featured in peer-reviewed journals.

Click here: When it all comes to an end
(This article has also been published in Exit Newsletter and Five Last Acts – The Exit Path. The version here is from the Special Feature in the Exit Newsletter.)

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Is Falconer’s bill a folly?

lord falconerThe ‘Right-to-Die‘ campaign, while supported by the vast majority of the public, is heavily outgunned and outfunded by vested interests in the Government and Church. So most supporters feel we should be grateful for anything we can get, right?

This sad state of affairs is reflected in much of the effort to achieve legislation. Lord Falconer’s Assisted Dying Bill – at least in any of the available drafts and probable final version – is a beautifully polished example. Legally precise and crafted with all the razzmatazz one might expect from the Secretary of State for Justice, the bill looks like a ‘least worst attempt.’ The examples of Oregon and the Netherlands have clearly been considered and the questions asked, Which is the ‘safest’? Which is the least likely to be rejected by parliament?

Although the bill has a number of clauses that make use of sophisticated niceties of English law (such as provision for additional future regulations), Exit feels this attempt, like so many bills before, is the wrong way to go about things.

To demonstrate this, let us look at some more effective, more ethical, and more acceptable approaches.

Claudia Carr, from the University of Hertfordshire‘s School of Law, has proposed a tribunal system which is closer to Exit’s model by way of being able to examine individual cases. This would involve independent persons from both the medical and legal professions. Such a review body provides a more open, accountable and transparent system than merely having two doctors agreeing (as provided by Falconer’s bill).

But unfortunately even Carr’s proposals are an attempt to address the debate rather than the real concerns of patients. She rightly concludes that her system could avoid the inconsistencies and apparent abuses associated with the UK law on abortion; but by limiting her answer to those who are terminally ill (as does Falconer) she avoids the most noticeable group of people who fight for the right to die at a time of their own choosing.

For example:

It is unlikely that any of these high-profile cases would have been “assisted” by either Falconer or Carr’s proposals. Both legislative frameworks are asking the wrong question. They want to “do something” but without going so far as to really help someone who is unrelievably, unbearably (and often desperately) ill and wanting to choose the time of his or her own death. They are cowardly attempts. They pass the buck to Dignitas, to Exit, or to backstreet arrangements. Furthermore, by making blanket qualifications on who shall have ‘assistance’ they fail to provide any real safeguard, either for doctors or patients.

In days gone by, the good sense of a doctor could prevail. A doctor would assess whether his or her patient was indeed suffering unbearably and whether nothing else could be done to relieve that suffering acceptably. Today, that model needs to be expanded to include proper safeguards. The default position is, quite rightly, that a doctor should be under no obligation to help: but that a doctor should be able to advocate for his or her patient to ensure lawful treatment, including aid-in-dying, provided that patient is a competent adult reasonably and persistently requesting aid-in-dying. ‘Being terminally ill’ is clearly, from the above case examples, not the issue. Relieving suffering is.

Exit’s position has a number of other differences. We agree with Carr that a legal practitioner as well as a medical person should be involved in judging whether the person is competent; we agree that one of the medical persons assessing the person’s medical condition can be the person’s physician and that the other one should be independent; we propose a qualified assumption of competence for persons over 16 years of age; we provide for the possibility of a failed, authorised assisted suicide attempt and both cover and oblige the doctor to assist; and we address the possibility of residual legal matters and how to treat actions for negligence. We also incorporate the possible use of advance directives.

But we recognise that politicians, for a variety of reasons, will not always seek and follow the best academically sound advice (and here we humbly include Exit’s position, which is based on in-depth cross-disciplinary studies conducted by Glasgow University). The pressures to “do something” or “prevent something” may be very real. There is not always the option to support an ideal position.

Many proponents of the Falconer bill, as with Oregon, doubtless feel that it is a “step in the right direction.” Surely it could do some good for some people? This is a fairly persuasive argument. In the Netherlands, legislation has progressed in gradual stages. But in other countries, the temptation, having taken the first successful step, may be to regard the issue as having been “dealt with.” Only history will be the final judge. So in the meantime, our kindest wishes go to all those who are sincerely making efforts to address the concerns of people suffering unbearably and unrelievably. Whether their attempts at this stage seem to us in this article to fall short or not. Exit is only one voice among many.


The Assisted Dying Bill by Lord Falconer (pdf)
Claudia Carr abstract at an Athens conference session on assisted dying
The death of philosopher Michèle Causse at Dignitas
(from Swiss TV)
Draft legislative framework supported by Exit

(Note: you can find links to laws in various countries by scrolling down the right-hand column)

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Volume 33(2)

Nov 2013ev 33(2) FRONT PAGE

For those readers who might be thinking about joining Exit, here is an idea of what the latest edition of our print magazine contains.

Exit (no connection to Exit International) was founded in 1980 to research and publish self-deliverance information. The knowledge of how to control the last moments of life, should the situation arise, have given hope and courage to thousands.

The print magazine contains a mix of serious articles on self-deliverance and other aspects of the ‘right-to-die’, plus a selection of lighter reading. Contributors include some of the world’s leading doctors, lawyers and philosophers, as well as experts and regular members writing about their ideas and experiences.

MIND AT WORK –  Ruth von Fuchs
explores new practical variations on self-deliverance methods
blends politics and philosophy in his case for a right to die
IN BRIEF –  editorial and fast guide to this issue
A new manual on self-deliverance is a magnum opus
an Exit member, has some innovative ideas
OFF THE BOOKSHELF – our latest roundup of books for your interest
Full-day sessions to practice the techniques in a safe and exciting environment
A Special Feature on facing the moment of death
RULES OF ENGAGEMENT – the inspirational wisdom of Mahatma Gandhi
HOW AND WHEN IS IT GOOD TO DIE? – Carl Jung has the answer! (from ExitEuthanasia Blog)
LIVING YOUR LEGACY – remembering Exit lasts long after your life & death
Why seeing your medical records might not tell you so much
EXIT AGM 2013 – the details, including an exclusive new film
Odds and ends about self-deliverance
A Member of Parliament gives his views on euthanasia
How heavy is disposable helium? how easy to use? . . . and other light questions
Think again!
Serious, amusing or thought provoking but always (we hope!) insightful
THE FLICKERING LIGHT – RELICS – an uplifting drama with helium
HUMOUR – your ‘near-death smiling experience’

*We are not connected with Exit International
Exit is the Scottish voluntary euthanasia society, founded in 1980. We have members world-wide.

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How and when is it good to die?

jungDeath is generally something to be avoided! Yet for someone suffering unbearably and unrelievably it is sometimes viewed as a release. Hence the ‘right-to-die’ movements and books such as the Five Last Acts series.

Yet focussing on a negative – the non-existence of something – is something that can be mentally challenging if not impossible. Freedom from suffering is a noble and understandable goal: yet what exactly does this ‘freedom’ comprise?

To find the answer, we maybe need to look further than the absence of suffering, to the things that can truly justify and make an end to life one of goodness, a ‘good’ death. The psychologist Carl Jung felt he had found the answer and studied many ancient traditions to support his theory of a ‘celebration’ of death. In Psychology of the Unconscious, he suggests that it is the libido that wills each of us to complete his or her life, likening it to the course of the sun, “to mount from morn to noon, and, passing beyond noon, to hasten towards evening, not at war with itself, but willing the descent and the end.”

Jung goes on to remind us of the words of Friedrich Nietzsche, who wrote: “I praise thee, my death, the free death, which comes to me because I want it. And when shall I want it? He who has a goal and an heir wants death at the proper time for his goal and his heir. And this is the great noonday, when man in the middle of his course stands between man and superman, and celebrates his path towards evening as his highest hope: because it is a path to a new morning. He who is setting will bless his own going down because it is a transition: and the sun of his knowledge will be at high noon.”

Jung C, Psychology of the Unconscious (trans. Hinckle B), Kegan Paul 1933:p.233.
Nietzsche F, Thus Spoke Zarathustra
Fraser JG, The Golden Bough

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Critical creativity

I received a strange (but interestingly pleasant) parcel through the post today. It was from a fellow researcher abroad, showing me some examples of the things she is experimenting with, looking into self-deliverance methods and saying, “what if . . . “.

This often happens at our Exit workshops as well: people come along after reading the book – sometimes several books – quite thoroughly. They’re consequently very well versed in the subject, have made numerous ‘dress-rehearsals’, and refined it to their own particular tastes and circumstances. Sometimes hey have had a glaring insight that all the researchers around the world have missed. One example was the T-connector to combine the tubes from two tanks of helium. Why not just have two tubes? A bit of experimentation, finding the good points and downsides, and it became a great option that was picked up by other right to die societies worldwide.

Of course, it’s all to do with critical creativity. The ideas that someone comes up with after in-depth study of known data are usually very different to the flashes of inspiration in an untutored mind. But the idea is to get away from a purely didactic approach, a recipe, a “do it like this” and “one size fits all” approach. Examining the ideas in the workshops with feedback from other members and an experienced facilitator allows many good ideas to be validated (or near-validated) on the spot. Where complex physiology or pharmacology is involved, generally much more research is required. But closing our minds to new input is a surefire way to prevent further progress.

I am reminded of the well-known Zen parable. A blind man goes to supper at a friend’s house. As the man is about to leave, his host, almost automatically, offers him a lantern to find his way home in the dark. The man laughs. “To a blind man, light and dark are the same!”

Of course, he knew the way very well. But he followed his route using entirely different sense-data to you or I. He probably knew things about the path that most people would miss (rather like a car-driver missing the smell of fresh grass).

All the methods of self-deliverance are under constant review at the Exit office. Large files going back nearly thirty-five years for each drug, each method, each bright idea (as well as crazy ones). And all frequently updated as new findings are published in the medical journals or new information comes to light in the field.

Keep sending your news! For experienced readers, familiar with the compression method, can you guess what the researcher would be doing with the everyday items in the picture?

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When all “this” comes to an end . . .

sugar loaf  (2)Dying is all around us, even the leaves on the trees (and leaves die very beautifully!) We think about it, avoid thinking about it or, as Exit members, work out how to end it peacefully and painlessly. And then often stop thinking about it!

But even though we can research and familiarise ourselves with methods of ending one’s own life to avoid a painful, undignified death – and that must be the biggest fear – there is still one more fear for many people: the moment of death itself.

Perhaps years of studying the subject has allowed me to feel at home with it enough to look on it as something good when it comes. Nothing more to say, nothing more to do. My life complete. It’s a little like the feeling of sending a book off to the publishers: the time to change anything has passed. All is set in stone. It’s the time when our life finally stands for what it is. I also find it tremendously motivating. How much can I do constructively while I am still alive? For what do I wish to use this amazing opportunity?

But I know, for others, even if they can be guaranteed a death without pain and indignity, the idea that all our senses suddenly cease, all our input, all our output, all “this” – all that you touch, see, taste, feel, love and experience in any and every way, is (for you) going to stop : that is still a fear for many. The reality of death still looms like some sort of surprise. Do you want to wake up one day, on the last day of your life and realise, “Oh! Surprise! The end!”?

Perhaps the certainty of a peaceful and dignified dying is only half of the story.

We often say, “All good things come to an end” – as if that were something to be regretted rather than accepted and even welcomed. Do we look forward to peace unutterable, rest?

Nelly Furtado, in her music video of the same name (filmed in the beautiful Puerto Rican rainforest), uses the phrase to reminisce about a former love affair. I liked the images of the ocean and the forest, but the words moved me less. Is life a love-affair with existence? The idea is too metaphysical to be of great comfort.

For the final chapter of The Exit Path, I researched the peer-reviewed coping techniques used in palliative care. There is an awful lot of flim-flam and well-meaning ideas, but to reach a general audience I wanted material that had been critically tested. A couple of specific meditation techniques came out tops. I also interviewed at some length people who might have to face it in practice, both for themselves and others, such as a military leader. The results, I found, were life-enhancing. It’s something people also say about our written material (on the physical methods of self-deliverance) – it gives them courage to go on, facing an unknown future with a degree of certainty. It’s a small contribution I hope I’ve made with my life, and one of the things that has given me purpose, though the letters of appreciation are always warmly welcomed!

If you make this decision, to avoid unbearable and unrelievable suffering at the end of life, perhaps that certainty is something you can share. Find a way to let others know that it is your decision and your alone. That it is a fulfilling one. Find the things that have been fulfilling in your life, and death can be a celebration of those very things accomplished.

Did you know? The cover photos from The Exit Path feature the cable car at Sugar Loaf Mountain (Rio de Janeiro) rising above the clouds.  The allegory (on the back cover) relates to the sensation when the trip of a lifetime seems to be about to end badly. Rising above the earth, the cable car can be surrounded by cloud, and it can feel like the ecstasy of the wonderful views from the summit will be denied. But then the car bursts through the clouds. It was even better than expected. (Note: the cover photo has been reversed east to west for artistic reasons.)

May your life, and your dying, be wonderful. 

The Exit Path
(Amazon U.S. link)
Nelly Furtado video (All Good Things)

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