A small site update (we’ve added a few FAQ’s)

Screen Shot 2015-08-21 at 19.36.00Just a quick post to let regular readers know we have updated the reference pages on the top menu to include an FAQ.

These Frequently Asked Questions will be updated or added to occasionally. If you have a question that you think a lot of people might ask, feel free to suggest it. We’ll answer time permitting if we feel it will be both helpful and appropriate.

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One cannot escape death

The thought of dying is one that most people push aside, at least until it seems imminent (to ourselves or someone close to us). The mission of Exit can be described as taking away the fear of death. A large part of that, and since Exit was formed in 1980, is to research the reliable means of taking things into one’s own hands if all else fails. It is an area where our research, quietly, still leads the world. It can provide the most peaceful of available exits to those that need to use it one day, or reassurance and courage for an unknown future for those with many years still to live. Stop, and think about it for a minute…

(Merely thinking about death is not harmful, in spite of superstition.) Take a calm look at the issues and how you feel about them, might handle them; then stand up, do something else, put the radio on or clap your hands: thinking about for a few minutes is not the same as dwelling on it.

Control of pain and symptoms
There are various other fears associated with death. Most can be dealt with simply with knowledge. Most (but not all) terminal pain can be relieved. This does not mean that in every (or in your case) case it will be relieved, and it is worth bearing in mind that making a loud fuss (if you pain is not being controlled) may be the best way of getting the attention you urgently require. I have a friend who explains very calmly, with a typical English stiff upper lip, that the pain he is in is “really rather considerable.” I advised him instead to let it show in his face a bit that he is in excruciating pain (it produced a more satisfactory and immediate answer).

Then there are symptoms that might occur in the time leading up to death and which people can fear. Perhaps you have seen someone struggling for breath for instance? Breathing difficulties can in most cases be lessened these days with careful medication (such as benzodiazepines) and good nursing care to ensure fresh air and a posture that makes breathing easier. If you are looking after someone at home, these things can be researched easily or advice obtained from such experts as (in the UK), Macmillan Nurses. These people are expert in the most modern methods of pain and symptom control but not sympathetic towards euthanasia or self-euthanasia, so one has to be careful to respect that. Different experts for different challenges. If you try to discuss euthanasia with a medical person in a country where it is illegal for a doctor to help you then you put him or her in a very difficult position and quite unfairly. It is probably be worse for you and for the doctor to do so (they have legal obligations, after all, and “quietly giving someone some pills” is much harder these days due to the paperwork and checks on almost every move a doctor makes).

Self-euthanasia and assisted suicide
Exit is the source of expertise for self-deliverance, or self-euthanasia. Many people think, “Oh, that’s good, I’ll just phone up if I am near to death.” As many readers of this Blog will know, it doesn’t work quite like that. Self-euthanasia is fairly straightforward but mostly when it is researched in advance so the person, while reasonably fit and mentally competent, can absorb the necessary knowledge in advance of the time, if and when that time comes, and one decides for oneself that is needed. The law does not allow an emergency ‘help line’. We provide the best knowledge available worldwide in our books, our members’ magazine, and in our very occasional workshops. Until the law is changed and you can approach your doctor for the help you need, there is no perfect solution: we simply look at this area as responsibly as humanly possible. (For those considering Dignitas, Switzerland, again, do not think that it is just a case of a phone call: get in touch with them well before such emergencies arise.) There is no ‘on demand’ service anywhere in the world at this time.

Think about tomorrow today
The key to all of this is planning. Planning for your future, planning for a good death, whether that good death will be a ‘natural’ one, aided by doctors, sudden, or by your own hand. The strange thing about this is that the grief and fears associated with death are a challenge, quite literally, for every single person on this planet. If you lose a loved one, or if your own death is approaching, it seems like the most momentous thing (and in a way, it is), and yet it is a more commonplace and universal event than anything else consciously encountered in this life. There is no “if” one is close to death. One day you and I will will be close to death. No-one has ever escaped that. So a little planning can go away.

“I have everything under control, but I am still uneasy.”
A few years ago, we realised that, even if pain and symptoms are controlled, and even if you are capable and confident of making a self-euthanasia, some people still feel worried or afraid of the final moment, that second and the seconds and minutes leading up to it where everything, consciousness, outside world, ability to do things, say things, experience through the senses, and even to have any thoughts, all will cease, finally and forever. (We are not denying or affirming any life-after-death scenarios but that is generally a slightly different matter to the ending of the here-and-now.)

Having a calm state of mind is a good start to most challenges: but how to achieve it? Fear is a neurochemical reaction that plays an important role in some circumstances but is redundant in others. When an animal or human feels threatened, fear or anxiety may stimulate appropriate and largely automatic responses such as fight or flight. It can occur whether the fear is reasonable or not (We have all probably known a child fearing the bogey-man, or a bullied child being more fearful generally.) Some fear responses are learned and can be unlearned. (An alternative psychological view is that fear at the moment of death is natural and one should just accept it.)

Some years ago I was camping solo in the desert for several days and nights. I had arranged with my guide that he would come back at a certain time, on a certain day, to fish me out. I was already very dehydrated, having slightly misjudged the water I would require, and when he didn’t arrive, my first reaction was slight panic. I decided to test some of the meditative techniques I had long researched, several of which have been used in peer-reviewed studies in hospitals and elsewhere. It was all pretty logical (once I reminded myself to be logical!) First, sitting quite still, I slow my breathing, focussing my mind on my higher aspirations (rather than the external ’emergency’ outside). I listen to the sound of my breath, enjoying the purity of the air as it enters and fills my lungs, the movement of my diaphragm, up, down, not thinking of anything else, my attention solely on the rise and fall, my breathing deeper, slower.

That first stage is very simple. Our thought patterns are closely linked to our breathing and usually agitation, excitement and so on will cause a change in breathing patterns. This simply reverses the process. Sitting very still also minimises outside distractions.

The next (but not the last) stage is to actively produce a positive state of mind. To do this, I first think of someone who loves me unconditionally (if you cannot think of someone who loves you unconditionally, then you imagine someone). I imagine I am sitting in bright room, warm and comfortable, with a chair and table. In front of me is a diary and I have been writing my life story. Then I imagine that the person that loves me unconditionally is looking in, watching me through a small window. Part of me then moves and imagines I am standing next to them, looking at me writing the diary, and I can hear them gently saying all the many wonderful things they feel and know about me. Returning to the desk, I write these things in my diary.

The purpose of the above stage is to feel good about yourself, to feel conscious of yourself as a wonderful individual, and to feel loved. It is not difficult: but is best done methodically, as just described. It should not be rushed. It has the effect of a good conversation, and releases oxytocin, making one feel good about oneself and ready to feel good about others.

The next step is to produce a feeling of being centred. So far, it has all been about oneself, not the distractions or tendencies of the mind to be swept up by that which is external to the mind, whether one’s physical state, the people around us, or the myriad cares of the world. The following stage allows us to take a pro-active stance and expand the positivity now felt to all things whatsoever.

In the desert, I chose north, east, west and south and performed the exercise four times, concentrating on one direction at a time.* Some people might prefer to think of an expanding circle. I focussed on the positive feeling of love produced from the last stage. I imagined this expanding and embracing others. (If this is difficult for you, imagine it as a warm, golden light which you radiate from the heart.) Firstly, I expand it to the people with whom I have a good emotional bond, the people I love; then to people who are simply colleagues or people I don’t have strong feelings towards one way or the other, and also then people I have never met; finally I expand it to embrace enemies, people I maybe don’t like for some reason or who maybe have some issues with me.

Conflicting emotions can reignite fear, anxiousness, feelings of ‘things left undone’ and so on; the final stage described above takes control of the process to counter all external input with a sense of non-conditional goodwill. It stops one being pulled in one particular direction while at the same time feeling expansive towards all living persons. It associates the positive emotion and neurochemicals in a continuum towards all possible sensory input.

These basic methods of controlling one’s own mind were first brought to the West by a gentleman called Allan Bennett, an analytic chemist and scientist who applied his scientific mind to the meditative practices of Buddhism; today they can be found in many palliative care programs. In essence they are neither religious nor non-religious and can be adapted to personal preference. There are versions for Christians and Atheists, Buddhists and Agnostics. In essence it is simply the application of certain psychological principles to direct one’s mind to a state of inner calm (neuroscientists describe it in fancier terms of course). It has also been used effectively for carers.

I have included a few references of related interest for those maybe inclined to investigate further how all this works. There are many more in the Epilogue to Five Last Acts – The Exit Path where the subject is treated more broadly and a variety of approaches examined. Having recognised that the fear response is redundant and inappropriate at a time when death is inevitable, we simply reprogramme our mind’s outlook, step by step, producing the neurotransmitters that enable a more productive management. Many of the sensory inputs near death may not be the most conducive to a peaceful moment (hospital wards, emotional relatives) but cannot in all situations be avoided. The process is one to allow us to take control of one’s outlook. As Viktor Frank pointed in his famous book, there is always choice, and the last choice is to choose one’s state of mind.


(The author got out of the desert. The calmness produced by the practice lead to a new ‘Plan B’ that would enable a successful exit from the wilderness. As he was about to execute it, his guide eventually arrived, rather late, but nevertheless very welcome.)

Five Last Acts – The Exit Path (this is the new, considerably expanded edition, just released: for reviews of the earlier edition please see here)
Viktor Frankl’s Man’s Search for Meaning (famed neurologist, psychologist and Holocaust survivor)
Dignitas (Swiss assisted suicide group)
The biology of fear- and anxiety-related behaviors (by Thierry Steimer, complete text)
Neuroanatomical and neurochemical basis of conditioned fear (M Fendt & M Fanselow)
Neurochemistry of Positive Conversations (lay article, full text)
Loving-kindness meditation: a tool to improve healthcare provider compassion, resilience, and patient care (Seppala et al.)
Loving-Kindness Meditation for Chronic Low Back Pain Results From a Pilot Trial (Carson et al.)
Mindfulness for Cancer and Terminal Illness (Carlson, L. Note: mindfulness meditation is more closely related to the first stage described above.)
When it All comes to an end (a free download from this Blog)

* The four directions can also be expanded for completeness using Einstein’s coordinates, the necessary way of defining anything: any noumena must be a) so far east-west, b) so far north-south, c) so far up-down, so far before or after a moment in time. Many meditators will at least add (c) to the four directions.
Note for members of Exit: the processes described above will be included as an optional free, additional session with the next workshop. See the next magazine for details.
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A nitrogen workshop and a special invitation!

Martin Amis’ stance on euthanasia hardened after the deaths of his stepfather, Lord Kilmarnock, and his friend and novelist Dame Iris Murdoch.

Martin Amis is famous not just for his hard-hitting novels but for his outspoken stance on euthanasia. His position, however, is a personal one, arrived at not for the sake of exercising his vast skill as a writer but as a result of a deeply held conviction, arrived at partly from witnessing the suffering of those close to him. He is clear about what he would want: yet every person’s story is different.

This year we are inviting people to contribute to our project, EXIT: The Self-Euthanasia Movie. (The film examines the immersive empowerment people experience in EXIT’s unique workshops.) What we also need is short ‘headshots’ (typically up to three minutes long) from people with their own feelings, story, reasons for wanting to be in control of their own dying moments. If you have a point to make, we do not want you to act: simply to express your own personal, genuine convictions or position with intensity.

Filming for this is expected to take place in August or September (2015), probably in Edinburgh, Scotland. If you think you could contribute, you are invited to email us at exit@euthanasia.cc within the next three weeks (if you are not a member of Exit, please include a little about yourself). You might be included in a film that is released to the public on DVD or entered at a film festival.

The other item in relation to EXIT: The Self-Euthanasia Movie is a special workshop to consider the use of nitrogen in self-euthanasia. This is a relatively new development. Exit, together with other organisations, has been presenting its research on this at an international symposium (sponsored by NuTech, in San Francisco) and in its latest work, Five Last Acts – The Exit Path (2015 edition). The workshop is for members only and is filmed (standard release forms). Exit members are invited to apply.

(Please note, participation in workshops is only open to Exit Members. Headshot contributions are open to anyone. Exit reserves the right to refuse admission to workshops or headshop auditions without giving reasons.)

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Choices are individual

jean daviesJean Davies was 86 when she died. She had devoted most of her life to the “right-to-die” movement and died both in a time and manner of her own choosing. Why, one must ask, did she starve herself to death?

Jean was surrounded by loving friends, including any number of doctors who could (and probably would) have found a way to give her some easy medications. She had been in the movement long enough, both as a leader  of the London campaign organisation and as an international speaker on voluntary euthanasia, to know how to end her own life quickly and painlessly. But she chose starvation (or more accurately, refusing food and liquids, since refusing only food makes a difficult death longer and even more intolerable).

How we make choices is a very personal thing. Choosing apples over oranges is a matter of taste, of associations of pleasure and pain, associations based on which is good for us, or associations concerned with cost if one is much more expensive than the other. Maybe one was a gift. Associations, to a certain extent, are or can be brought under our conscious control.

In a famous experiment many years ago, psychologists recruited some volunteers and monitored them while they were given unpleasant and unwanted stimuli – in the experiment, this was achieved by subjecting them to a mildly unpleasant and distracting noise. Then in a second set, the experiment was the same except participants were told they could stop the noise at any time by pressing a button. In the second group, the participants were far less bothered by the noise. Many didn’t even press the button. Something that was under their control, their choice, was less of a trouble.

Jean knew that dying by refusing food and drink was likely to be horrible, even if you had enough medications to control most symptoms pretty well. But for her, there were different associations. She was a campaigner, and intended to die as she had lived, by making a statement. The statement Jean Davies was making, roughly paraphrased, was that was in the absence of proper legislation to allow voluntary euthanasia, the average person had little recourse except to starve themself to death, refusing food and liquids. She chose that, even as a mountaineer chooses a difficult ascent involving (for a mountaineer) cold and blisters and tests of endurance. Jean Davies was a hero in her own life story.

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Nitrogen & helium: airing differences

Nitrogen cylinder headAs noted in our earlier Blog, the ‘right-to-die’ movement went into a bit of a tailspin over the news that Balloon Time, a manufacturer of helium party-balloon kits, was henceforth diluting their product. This was because helium had offered a cheap and convenient fail-safe, generally speaking, should someone decide enough was enough.

Faced with an alternative of throwing oneself under a train, hanging oneself from the rafters or blowing one’s brains out with a gun, it was little wonder that a desperate search for a peaceful alternative ensued.

It was in 1995, when I was collaborating on  a book of  New Research in Self-deliverance for the Terminally Ill,1 that one our collaborators, a remarkable biochemist from Vancouver called Bruce Dunn, came up with the idea of using inert gases (of which helium and nitrogen are two. In his chapter entitled, Nitrogen and other Inert Gases, Dr Dunn wrote: “Potentially any non-oxygen gas could be used for physician assisted suicide. However, the most suitable gases appear to be nitrogen, argon and helium. Other gases may present moderate to severe hazards to bystanders, may be disagreeable to breathe (carbon dioxide) or pose other difficulties.” After describing in detail necessary conditions regarding the application, Dr Dunn concluded, “Using inert gases requires acquisition of a compressed gas cylinder, an appropriate pressure reducing regulator, and suitable administration equipment. These materials are not inaccessible to a determined individual, but they are relatively difficult for a member of the public to acquire casually or quickly. This tends to prevent the method from being used by suicidal individuals without aid from an outside agency of individual with the requisite equipment and supplies.”

Of course, when people working in the field mulled it over with the sort of obsessiveness for which we are generally known, it soon became clear that all the materials were indeed very accessible. Thousands of people ordered balloon kits as an insurance against an unknown future, and an elderly lady in America even began making and selling a delivery system (in the form of a plastic bag with a bit of tubing attached).2 It never quite got to being like “a suicide booth on every corner,” as Martin Amis so grimly predicted and even advocated,3 but there was a big enough incidence of student deaths for several organisations to train a renewed attack on right-to-die groups such as Exit and Final Exit Network.

Amis, of course, was intending that euthanasia should be available to the exceedingly old if the person wanted it, at a time when medical science had kept them alive long enough to suffer years of debilitating disease in a slow death. Dunn had a similar market in mind – people who desperately wanted it but also had such undeniably good reasons to want it, such as living into extreme old age (at which point we might surely grant them to have lived long enough to make well-intended decisions about their own life) or else such horrific illness that any doctor in a bygone age would have “given them a little something” as a standby if they really and truly needed it.

But enough of reasoning the need! If we can educate youngsters not to drive recklessly in fast sports cars it should not be beyond human capacity to to attend to their emotional well-being and growth, so that they do not turn to the latest ‘suicide fad’ in moments of exam crisis.  A grown and competent adult, on the other hand, should really not have to prove a “need” in order to make choices about his or her life.

Helium is suddenly in disfavour. For many people, it is as if, having gone to great pains to ensure a peaceful death (one day in the not so foreseeable future), society and the market has turned round with a bitter grin, saying, “Thought it would be easy, did you? Well just you suffer like everyone else, because we say that deciding the time and manner of your own death is “bad” and not your business at all!”

So let’s dispel some panic. There are no guarantees when crossing the relatively unknown territory of life but we have some pretty good maps. Our members, by and large, managed very well before helium and will continue to do so, even if the goalposts change.  Problems with other methods mostly yielded to scientific examination (check our books if you are interested).4 Good helium supplies have not suddenly ceased and nitrogen or argon are not that difficult to obtain: they are just a bit more difficult than buying a balloon kit. This is not an entirely bad thing.

Let’s look at some differences . . .

Helium is still available. Only Balloon Time (manufactured by Worthington) have said they are selling balloon gas that they now openly describe as ‘helium mix‘.5 But for such an important item, it pays to be vigilant. Products have to be fit for purpose so the only legal constraint is that the stuff will float a balloon. Balloon Time canisters are easily recognised since they are usually bright pink in colour and the words “Balloon Time” on them. The other party balloon kits, known as Balloon Occasions are usually a dull beige colour and are manufactured by BOC. BOC’s data sheets still specify their balloon gas at the original, unmixed purity.6 (In North America, BOC trades under the Linde Group. In both continents, both manufacturers have outlets under local names, as do many of the other big gas wholesalers.)

There are some good legitimate reasons why you might want, and have a reasonable right to believe, that you are being sold pure helium (i.e. about 98 per cent pure, not 60 or 80). The two main ones are to use as a diving mix  or in welding. It is only when bought as ‘balloon gas’ that you should not assume it is necessarily helium gas and nothing else. Twenty per cent air, by the way, is probably not enough to keep you alive, as a Canadian colleague, Paul Zollman, kindly pointed out to me. (Do the maths: oxygen being 20 per cent of 20 per cent, and refer to standard tables on effects of oxygen deprivation.)7 Yet it is borderline. It could make you very ill for a day or two. Some American dealers are fond of adding “Hi-Float”, a sticky substance that adheres to the inside of a balloon and makes it float for longer with less helium. I hate to imagine what it would do to someone’s lungs! but it again stresses the need for vigilance when purchasing.

Of course, BOC could change their mind next week and say their balloon gas is also just balloon gas, like Worthington’s, and not necessarily helium: but it would be strange if they did so while claiming in print that is was indeed helium.

If you buy an industrial cylinder rather than a balloon canister, you have every reasonable expectation for it to be helium gas (and BOC, unlike Worthington, are a gas company.) The pressure inside such a cylinder can be six times that of a balloon gas canister. So a regulator, largely superfluous before, would be highly recommended. The pressure in industrial tanks is sufficient to do some serious damage!

In the U.K. a regulator, hose and small tank of nitrogen will come to about £80 in total. (No, we don’t give out addresses on the Internet or by email: that bit of work a responsible person will do themself, with or without our book.) Typical costs: We paid £18 for the gas, £25 as a one-off deposit on the cylinder itself, £20 for a regulator and £17 for a hose with the right connectors on it. There is wide variation in prices and and also a big variation from country to country. We’ve covered it in a large new Section of Five Last Acts – The Exit Path, which is selling rather well on Amazon at the moment. (Not cheap as it is over 800 pages and was costly to produce, but that alone should deter casual enquiries.)

Apart from good helium, or buying nitrogen, someone will doubtless make a custom kit available at some time, and quite probably at quite a high price to justify the work necessary to organise it (for those that can afford it). If money is not a problem, BOC also offer a very stylish tank called a Genie. The Genie is a new ‘de-luxe’ in gas tanks. Lightweight, it also has a little set of (removable) wheels to move it about easily, and an interactive digital display to say how much gas is left, as well as protective handles to prevent any regulator damage. Unlike an industrial cylinder it actually looks nice. (Note: connections for the Genie are non-standard. It requires attachments designed for the Genie. Argon and nitrogen attachments are more or less interchangeable, but helium needs a different calibration.

Here’s a few points you might need to bear in mind about nitrogen (and argon) . . .

In the U.K. you will probably need to look credible and fill in some registration details at the shop (nothing major, just name and address and so on). If you try to buy it online from one of the bigger companies like BOC or AirGas, they will probably expect you to open an account. In the U.K. generally, companies will generally not fill up an empty cylinder supplied by another company. Cylinders have to be made to certain specifications, but legal regulations make companies responsible for the ongoing condition of the cylinder and they do this by means identifying it exactly as one of their own ones.8

It is an offence to transport these gas cylinders (as opposed to balloon gas cylinders) in an unsafe manner. Small local stores do not always have all sizes in stock. If a person buys anything other than a smallest canister of nitrogen commercially available, it can pose a slight safety hazard if stored in a small room. Helium is very light indeed: nitrogen is not. Someone can pass out form inhaling nitrogen that has leaked from a cylinder before they realise what is happening.

In America, we have also had reports of small local dealers selling nitrogen that is a bit of a mixture rather than pure; much to the annoyance of the local welder, who relies on the qualities of nitrogen for the type of weld finish (like helium, it is used as a shielding gas).

Car fanatics (and some cyclists) also buy nitrogen (or pay the local garage for it) to fill their tyres (done correctly, it prevents rust). Nitrogen is also sold for the purpose of dispensing beer, including home brews. It gives that sort of head that you can see with dark stouts such as Guinness. Yet the most common nitrogen “beer gas” is only 75 per cent nitrogen, so someone wanting pure nitrogen would need to be very specific.

It might sound technically daunting at first, even before I were to explain how to choose and buy a regulator, but as Dunn said, it is, “not inaccessible to a determined individual, but … relatively difficult for a member of the public to acquire casually or quickly.” And that is perhaps the way it should be. It is something to absorb slowly. (About 300 pages of Five Last Acts – The Exit Path’s 822 pages is devoted to inert gas, with numerous illustrations, diagrams, and explanations both scientific (in the footnotes and references to scientific and medical journals) and laid out in a way that is accessible to any intelligent reader. There’s 23 pages specifically about nitrogen and the differences using industrial gas. It’s a large volume with much research. (Read and use it sensibly!)

1. Docker C, Smith C, Dunn B, Hofsess J, Beyond Final Exit: New research in self-deliverance for the terminally ill. 1995.
2. “The Gladd Bags” constructed and sold by Sharlotte Hydorn.
3. http://www.theguardian.com/books/2010/jan/24/martin-amis-euthanasia-booths-alzheimers
4. Five Last Acts II. This a more compact volume (at just over 400 pages) but does not contain all the detail on nitrogen that is contained in The Exit Path.
5. http://www.balloontime.com/contact-us/faqs/ Balloon Time data; and
http://www.worthingtonindustries.com/getmedia/382c642e-7458-4903-8ae7-3181c426be32/WC042-Helium-Blend.pdf Worthington.
6. http://www.boc.com.au/shop/en/au-boc-industrial-store/balloon-gas BOC data.
7. (see Table 1, below).
8. Relevant legal instruments include:
The Pressure Vessels (Verification) Regulations 1988;
The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2009.

oxygen deficiency table

Addendum 28 May: Checking the data sheets for Linde Group in Canada, they are specifying the contents of balloon gas as between 60 and 100 per cent, with 10 to 23 per cent nitrogen. (Material Safety Data Sheet Version 5, printed 11/05/2014).

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The quality of mercy is not strain’d


Cheiron instructs young Achilles. Fresco from Herculaneum (Museo Archeologico Nazionale) Naples

“You wouldn’t let a dog suffer like that” is a phrase that often comes to mind when witnessing the struggles of someone who, despite the best efforts of palliative care, is in a prolonged and unbearable agony: someone who in some cases is desperately seeking assisted suicide. Why do we let a human being suffer such torture and, against their competent, sustained wishes rather than give such a person their wish?

Some trite phrase is usually rolled out. “Only God gives life and only God can take it away,” or, “If we did it for one person, other people would fear being murdered.” The ancients often tackled such seemingly insoluble dilemmas in stories. Cheiron, for instance, was a centaur: half man, half-beast.He also happened to be “immortal.” One day, Cheiron sustained a terrible wound from an arrow. The pain became unbearable but, being ‘immortal” he was unable to die from it.

Around this time, you will remember that Prometheus had been chained to a rock. His only hope of freedom was if some immortal would give up his immortality. Cheiron, a wise, intelligent and benevolent healer, asked if he could give up his immortality. Hercules pleaded the case to the Zeus, which is the Ancient Greek name for God on High, or “Deus.” Zeus grants Cheiron’s wish and the centaur was thereafter remembered as a beautiful constellation in the night sky (which we now know as Centaurus, the brightest of the southern hemisphere).

There are many interpretations of the story, but you may have already seen the connection to assisted suicide. It was not something Zeus granted lightly, but eventually Zeus did the decent thing. How does it compare with our modern gods? The God of the Christians, at least according to His most vocal priests, would not allow it. Similarly, the God of the Muslims apparently feels that life belongs to God and only God can take it away. No matter how strong a case is made by a modern Hercules, it’s apparently just not on. In spite of the rhetoric, the dominant quality of these modern gods is clearly ownership, not compassion. They “own” the life of mere mortals, not just those of priests who have given their life to God but, by a dictat that seems to say that all men and women do not own their own lives.

The quality of mercy, as Shakespeare so eloquently put it, should not be under duress, and certainly not strained beyond all human endurance.

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The right to change your mind

Screen Shot 2015-05-16 at 02.25.46

State Sen. Mark Leno, co-author of the End of Life Option bill (right), receives support from Debbie Ziegler, whose daughter, Brittany Maynard moved from the East Bay to Oregon to take advantage of the state’s Death With Dignity law. Photo: Max Whittaker

As another American state gets to grips with fielding right-to-die legislation, Joe Mathews, a Californian editor, puts forward some interesting ideas. The new legislation would allow mentally competent California residents with six months or less to live to obtain a prescription for lethal drugs they can give themselves.

But Matthews says that the most important right to protect at life’s end is not the right to die but rather the right to change your mind. He attacks the strident tone of people on both sides of the debate. You cannot demand a “right” to have something that will happen anyway. It recalls the almost equally absurd Monty Python demand in Life of Brian for a man to have the right to have babies (even if he doesn’t have a womb).

So what is this “right to die” all about? Put in a more precise way, it is the right to choose the time and manner of your own death. Nothing more, nothing less. The right of someone else not to be prosecuted if they decide to help you is a totally different right altogether. A law against assisted suicide doesn’t interfere with your rights, even if you are incapable of exercising them. It is a legal structure which can be argued as right or wrong and legislated largely according to how the particular ruling body feels about it.

In most of our waking moments, we simply wish to live. Most of us go through a superficial phase at one time or another where we imagine death. Maybe we even come to terms with the reality of our own mortality and welcome it: which is not the same as choosing it. One day, if our situation is such, perhaps through extreme old age, or unbearable and unrelievable suffering, unpersuaded by the best attempts of palliative care, one might simply change one’s mind. Instead of being a passive victim, waiting for the last trace of life to disappear, one simply decides to make the inevitable an act of will. Sadly California’s bill, like most of the American limited provisions for assisted suicide, makes no provision for the large number of people who seek assisted suicide, minority though they might be. People with motor neurone disease, or other long-term wasting diseases: for them, choice is limited indeed.

For Exit’s template on assisted suicide see here.

reference: How my grandma could solve the ‘end of life’ debate by Joe Mathews

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The Exit Path 2015: The most complete reference published, out now. Fully updated on nitrogen.

Five Last Acts The Exit Path 2015 front coverFive Last Acts: The Exit Path 2015 edition.
§ 822 pages.
§ over 100 illustrations and ‘how-to‘ diagrams.
§ Over 1000 references. § tables & charts .
§ Tips and checklists  § scientific evidence.

  • Over 100 pages on helium, completely up to date, with information on companies whose policies on “balloon gas helium” have changed and those that haven’t. alternative sources.
  • 23 pages devoted to nitrogen and options for obtaining and connecting up the “new” inert gas.
  • Updates chapter on compression (64pp.) with new cases and methods.
  • More than 135 pages on drugs used in self-euthanasia and obtaining them legally.
  • Expanded section with scientific data on ‘fringe’ or ‘borderline’ methods, including refusing food and drink, hydrogen sulphide, charcoal burners, drowning, hypothermia, firearms.
  • Social aspects of self-euthanasia, legalities in depth, consideration of others.
  • Preparing the mind for the moment of death (‘natural’ or otherwise), results of peer-reviewed studies.
  • Self-test: hidden dangers of future scenarios.
  • Self-euthanasia and dementia.
  • And much, much more. Information is explained in lay terms and alternatively in more technical terms. Other books say something else? Check our information and data sources, all contained in the book. Many ‘experts’ change their opinions after reading our in-depth analyses. A mammoth volume covering every aspect.
  • Authored by a full-time researcher with over 30 years experience and one of the world’s few professionals in the field working full-time studying self-deliverance, trained in analysis, with a postgraduate Masters Degree in Law & Ethics in Medicine, the Director of Exit, and experience of running hands-on workshops for ten years.
  • A book you can trust. Click here for reviews and testimonials on Amazon from the previous edition. Click the illustration above to purchase now.
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Keeping in touch

NL Contents Spring 2015 (1)

{click to enlarge)

The Exit Newsletter, a quality magazine that goes to our worldwide membership, is off the press again at last! Our sense of responsibility means that Exit does not publish “how-to” instructions on the Internet although we do cover the subject with important news and analysis within the law, right here on the Blog.

Print materials are a different category. Attention span on printed materials is greater. It is easier to ensure that they only go to an intended audience (not to minors) and also kept for reference and reading leisure even without an internet connection.

Each issue of Exit Newsletter includes a broad spectrum of articles, both academic and light reading, but always with a focus on good life & good death. They include light philosophy, medical and legal articles, books and film reviews, but also, essentially, the latest scientific knowledge on self-deliverance. Exit’s reputation for thoroughness, established back in 1980, aims at empowering mature and responsible adults so they are in control (as far as is humanly possible) of their own destiny, as well as furthering research in the area.spring 2015ev 35(1) PAGE 01 (1)

Joining Exit is not something that can be undertaken rashly or impulsively – as every application is subject to a 12-week waiting period. (We are not an emergency service!) Even then, we never give one-to-one advice on self-deliverance. We work within the law and a strict code of ethics. But for members, we try to be a lifeline: not to opinion, however exalted, but to solid information and explicit updates that supplement the Five Last Acts series (always supported by actual case studies and scientific literature.)

The job has never been easy. This edition arrives rather late as our printers company decided to close shop and move to Spain! It is also on a new glossy white paper instead of the familiar black on yellow as suggested in the pictures, but this may be changed back again (black on yellow is supposedly the easiest to read). To all our print members, we apologise for the recent delays. To any potential members, you might like to browse the front page and contents of the current issue (click to enlarge). If you think you might wish to join Exit, there is a link here (then scroll down the left to find a link for an application form).

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New print publications available on Amazon

FLAII 2015ev cover Self-euthanasia Methods & Dialogues (Chicago) coverFLA-TEP cover promo version

To keep pace with the changes in availability of helium, additional sections have been added to the books Five Last Acts II and Five Last Acts – The Exit Path. At over 400 pages, the first of these is one of the standard works on self-euthanasia (rational suicide for the terminally ill). The Exit Path is the extra large reference version, with hundreds more pages of explanations, comparisons, diagrams and notes. Both are considered authoritative works and used by many organisations, researchers and individuals seeking empowerment over their life and timing the manner of their own dying. After many requests, Exit’s notes from the Chicago NuTech Conference on self-deliverance have also been made available in print as Self-euthanasia Methods & Dialogues (a small booklet mostly of interest to people familiar with the main books.)

The additions to the new version of Five Last Acts II are primarily the extra pages examining nitrogen (pros and cons, in what ways nitrogen differs from helium, purchasing, and debunking myths, and relevant supporting citations from the journals). If you have the existing edition and understand the facts on helium and nitrogen, and have read our previous blog post warning about a certain helium manufacturer, you probably don’t need the new version. New readers can find the new edition on Amazon, or in bookshops given the time taken for ordering. The new version of Five Last Acts – The Exit Path, being a much larger reference volume (with 70 more pages, 822 in total), contains small updates to some chapters, extensive and detailed material on helium and especially nitrogen, expanded sections on other methods, and a section on self-deliverance and dementia. A colossal work that covers practically imaginable question.

Look out for the new books!
(Amazon links to all three books will appear on this page as they become available)

  • Five Last Acts II (2015 edition) Amazon U.S. / U.K.
  • Five Last Acts – The Exit Path (2nd edition, 2015) Amazon U.S. / Amazon U.K.*
  • Self-euthanasia Methods & Dialogues (Conference Notes) Amazon U.S. / U.K.

Note that the older, existing editions may be available on Amazon at a slightly reduced price for a short while. We remind readers that we comply with the law in all respects and ‘how-to’ information on rational suicide is not provided on this website. For Exit’s comments on self-euthanasia literature in the British Medical Journal, see here. This was in response to an article by Colin Brewer, the originator of the idea of self-euthanasia manuals. Brewer’s latest best-selling work, “I’ll See Myself Out Thank You” is also available on Amazon and reviewed in the coming edition of Exit Newsletter.

Free downloads from ExitEuthanasia Blog:

  • When it All Comes to an End A free essay by Exit on ways to look death in the face. Psychological routines that have been proven in clinical practice. These are for anyone, whether facing ‘natural’ death or self-euthanasia, or lawful assisted suicide.
  • Exit’s 7-step Model Scenario for Living Wills The effectiveness of a living will (advance medical directive) varies with the amount of accuracy from the patient. We show you how to steer a middle road according to your circumstances.
  • Living Wills A simple poster that you can download and print, suitable for a doctors’ surgery.
    Extended Values History Form A useful form which recognizes that medical decisions which we make for ourselves are based on those beliefs, preferences and values that matter to us most. (Exit writing in the British Medical Journal on Values Histories can be found here, and on the legally binding nature of living wills, here.)

Note: a living will is best when tailored to your own country, state, and circumstances. It should preferably stand out, on strong paper. For these reasons we do not provide a standard download form. Please ask your nearest society, doctor or hospital. (Exit members are provided with a pack containing a choice of documents on joining.) You can also make your own living will (a very basic outline can be seen here); however it is best designed with expert help and also discussed with your doctor.

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Lighter than (only some) air . . .

helium nanoblimp

A balloon filled with pure helium is sufficient to lift a very tiny camera. The new diluted helium will be less effective.

The helium debate has reignited. One major manufacturer has announced that all their “balloon helium” will now be supplied as an 80/20 helium-air mixture. As helium has been a principal method of choice in rational self-euthanasia for several years, this will distress many people. Great peace of mind results from knowing that one can eventually, near the end of one’s life, choose the exact time and manner of one’s departure. More and more people want to have control over their last moments. Simply knowing when enough is enough, and that after a wonderful life the final curtain should occur with dignity and a sense of decorum, is a great reassurance.

[readers please note: this article does NOT give instructions on how to commit suicide]

Changes of policy by balloon gas suppliers will not affect persons who have already purchased (older) tanks. Neither should it unduly worry Exit members, who have assimilated material from our books and workshops empowering them with several different methods for handling an unknown future. As fast as intelligent, responsible individuals make provisions for their own self-determination: in life, and at the end of life, so will unexpected circumstances, unexpected mental and physical deterioration, or  changes in governmental and company policies attempt to rob them of that very right to self-determination.

We have noted previously, mostly in reports from other countries, especially India (or in isolated cases in the U.S.A.), unscrupulous retailers tampering with, or refilling canisters to be sold as “balloon helium gas” while cutting corners. (It saves them money, for one thing.) Now, that process has been formalised. It has been given a respectable stamp by Balloon Time, one of the world’s leading suppliers of domestic market helium canisters. Whether they do so out of greed, or to save the planet, or to appease lobbyists, makes little difference. Eighty per cent helium is enough to float a balloon: though not as well as one filled with 100 per cent helium.  Clearly commercial helium users, such as those that mount big public displays, are likely prefer helium that is helium, rather than a diluted substitute.

Helium has a lifting capacity of about .84 ounces per cubic foot. A half-helium 12-inch balloon can lift about .22 ounces. Since a 12-inch balloon weighs less than this amount, a half-helium balloon will still float, though not as well as a completely filled one, and it will deflate faster.

Balloon Time, a major supplier, has issued a statement to say that in the future all of their “balloon gas” will be diluted with 20 per cent air. “Our helium is rated from 98-99.99 percent pure. However, due to global helium supply issues, we are now mixing helium with air. All tanks will have 80 percent or more helium. This allows us to deliver a quality product at an affordable price.” It is not known yet whether companies like BOC, another major gas suppliers, will follow suit. BOC have recently introduced a new style of disposable helium canister. A 2003 BOC safety sheet from the KentGas website lists the contents of their balloon gas as ‘helium and air’ although this is probably to distinguish the contents from medical grade helium (rather than suggest dilution). Certainly many people have successfully used helium, painlessly and peacefully, since 2003! Also, on another gas supplier’s website, we noted that the data sheet lists contents as “100 per cent helium,” adding that “concentration is nominal.” Balloon Time however supplies many UK and USA companies, including the Tesco chain of supermarkets.

Self-euthanasia with a ‘helium hood’ is based on a principle of displacing air with inert gas (developed in the first instance probably by Bruce Dunn in our 1995 collaboration, Beyond Final Exit, on at least one occasion by Dr. Kevorkian, on one or two occasions by Dignitas and Switzerland, and then Derek Humphry and most right-to-die groups as a ‘best method.’). Both scientifically, and by numerous carefully-controlled eye-witness accounts, death by pure helium is peaceful. More peaceful than many ways that some persons may now even resort to as the “helium method” appears to lose some of its standing. Yet almost any inert gas will do: there is very little difference. Nitrogen, a popular alternative, produces exactly the same effect. These gases are inert: they have no chemical reaction with the body. At most there could be a minute biological reaction: but the cause of death in all cases is simple and sudden lack of oxygen to the brain.

Exit members are clear thinking individuals that look to the future. They mostly develop contingency plans  years ahead. They investigate, keep up with information we provide, in books and workshops, and make adequate provision for themselves in a careful, sensible way. They do not expect instructions given out on the Internet to the unwary and neither do we provide such. Dying is a serious business and worth investigating. That some gas companies want to make it harder will hardly deter intelligent people from giving it the calm foresight and attention that it requires. In that knowledge, one can relax and enjoy life more fully. The key to the “door marked Exit” is always always there – and in a safe place for the day it might be needed (if and when that day should come).

Neurochemical data on inert gas narcosis (UHM 2011)
Neurochemical basis of inert gas narcosis (UHM 2006)
Inert gas narcosis (PostGrad Med J 1966)
Biological effects of inert gases (Physiol Res 2007)
Example of a helium purity analysis machine (Analox)
Video of a person testing nitrogen purity (Youtube video)
Suicide By Asphyxiation Due to Helium Inhalation (Am J Forensic Med Pathol 2010)
Asphyxial Suicide with Helium and a Plastic Bag (Am J Forensic Med Pathol 2002)
The new Balloon Time FAQ
BOC safety data sheet
A Patients Rights page with facts about helium (U.S.A.)
Physics of helium lift  (p.14).
What Happens If You Put Half Air & Half Helium in a Balloon?

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