Life in dying

indian-funeralNo-one can really feel the pain of another when a loved one dies. Or the the moment that another experiences and feels in the minutes and seconds before that person dies. But does it have to be such a bad thing?

London’s famous Southbank is launching a new event, How Do We Live With Death from 22nd February to 25th March, it asks, “Does modern society distance us from our own mortality? And how are we able to live with the death of a loved one without the promise of seeing them in an afterlife? Death and taxes unite us all, so join us for an exploration of the way that death affects our life, an issue with which thinkers, artists and composers have long struggled.”

Exit approaches the question in many ways, and with our motto, taking away the fear of death. We believe there are both physical and emotional challenges to be surmounted, as well as that area that some call spiritual, some call philosophical, or some would simply say, “getting my head round it”.

Physical questions that can be covered include how best to approach one’s illness realistically in terms of treatments, making what is left of life worthwhile for as long as that is possible. Knowing what symptoms can be treated successfully, and which ones mostly can not. Knowing how to get the best out of terminal care. And the aspect we are most associated with (though not our only concern), how to draw things to a close a bit sooner rather than a bit later. Even that knowledge can be empowering. We don’t make grandiose claims about a magic pill, or that it will be easier or harder than it sounds: we just research and publish the science.

The emotional aspects are just as important, how we cope, how our loved ones will cope, how we should tell people. (We deal with these too!) But the question most people will discuss is, “How do I live when it sinks in that I am going to die?” – a question that becomes ever more pertinent as we enter later years, as serious illness looms, and as friends or family members die before us. It is something we can only put off for so long. Facing the inevitable prospect is probably better than avoidance, but is it possible not simply to make it a negative but to make it an inspirational positive?

In coming months we hope to share with our Exit Euthanasia Blog readers some excerpts from our print magazine on this very subject (please note that we do not publish precise instructions on self-euthanasia on the Blog, but provide updates within the awareness that the Blog goes to a general audience of all ages).

The Southbank Centre is correct in that Western society distances us from mortality, it distances us from death. A little while ago, I interviewed a member who had embraced the lifestyle of Nepal. One of the main features she spoke of was how death was so much a fact of life. Biers were carried in the street, cremations performed on an open pyre. Death was never far away, but not in a bad sense. Ancient Egyptian Pharaohs commenced work on their tombs the minute they had ascended to the royal throne: the idea that the “heart was weighed” after death was a guiding principle in life, each action to be performed with Maat, an idea of justice and balance, so that one might set an example in all things. A much publicized tale from Bhutan recently by travel writer Eric Weiner explained the habit of the Bhutanese in thinking about death “for five minutes every day” as a cure for panic, psychosomatic problems, or simply lack of contentment with life. Socrates and the Platonists of Ancient Greece found that much fear of death was rooted in personal relationships that would not be continued. To counter this, one can dissociate from relationships and then re-enter them as part of the joys of life, yet with an attitude of balance, loving appropriateness (or the Egyptian maat).

The Southbank Event may well have a strong emphasis on Christianity, which is one of the common threads for most people in the U.K., but there will be “talks, panels and debates covering topics such as whether we have the right to die, burial rites, apocalyptic religions and the way to immortality.” Panelists include the Bishop of Leeds and the London Philharmonic Orchestra is showcasing Berg’s Violin Concerto, dedicated to ‘the memory of an angel’, which “conveys a bottomless depth of personal loss.” They also perform Penderecki’s St Luke Passion, a work which “struggles and laments towards redemption.” There is, however, a “Right To Die” debate on assisted dying (1:00 pm, 4th March), a ‘Death Cafe’ (same day) and other talks, discussions and events that increase awareness of mortality. Does it sound like the upbeat, constructive approach for instance of many TED lectures on the subject? Perhaps not at first glance: but given the Southbank’s formidable reputation for great events it will quite possibly be a huge success! Let us know your thoughts.

Read the full line up of events and how to obtain passes at the Southbank website, “We Live With Death” Southbank Centre, Belvedere Road, London SE1 8XX, 22 Feb25 Mar
For EXIT magazine (free with membership), go to and
click “join” on the left hand side.
For TED Lectures on death and dying, visit their website at
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Another year, and for some a final rest

Betsy Davis smiles during her party with family and friends on July 24, 2016, in Ojai, Calif. Davis, diagnosed with ALS, held the party to say goodbye before becoming one of the first California residents to take life-ending drugs under a new law that gave such an option to the terminally ill.

We salute some of the beautiful friends-in-spirit who decide about their Exit this year.

Betsy Davis threw a farewell party with friends and family in July. It was her way to say goodbye before becoming one of the first California residents to take life-ending drugs under a new law.

Betsy, a 41-year-old artist with ALS (Lou Gehrig’s disease) emailed the invites with a special message: “These circumstances are unlike any party you have attended before, requiring emotional stamina, centeredness and openness.” And she added just one rule: No crying in front of her.

Ms Davis Davis planned a detailed schedule for the gathering, including the precise hour she planned to slip into a coma, sharing her plans with guests in the invitation.
One woman brought a cello. Someone else played a harmonica. There were cocktails, pizzas, and a screening in her room of one of her favourite films, “The Dance of Reality,” based on the life of a Chilean film director.

See the trailer for The Dance of Reality here:
Watch the news review of Betsy Davis’ farewell party: news clip
See the news announcement on California new law: 5th U.S. State to legalise

Related image
Paralympian Marieke Vervoort says planing her own euthanasia is enabling her to live longer. The power to take her own life, she says, is really what’s keeping her alive. A silver and bronze medalist, Vervoort says that knowledge, that she can have a safe and easy death, gives her the strength to keep going.

Her silver medal in the T52 400m in Rio de Janeiro came after 30 hours of violent sickness and a day on a rehydrating drip in the Paralympic village. Her bronze in the 100 metres came after a bladder infection had sent her temperature soaring. 37-years-old, the Belgian wheelchair racer suffers so much pain she wakes up her neighbours by screaming in the night. Marieke Vervoort has a progressive, incurable spinal condition, diagnosed when she was 21, that ravages her body. Her fiercely defended independence dwindles. She has visits from nurses four times a day, and also an assitance labrador, Zenn, who fetches items for her, helps her dress and supports her during epileptic attacks or when she is crying.

“When I’m happy, she’s happy,” says Vervoort. “When I’m mad, she’s scared, and she goes to sit in another part of the house so she’s not bothering me. When I’m crying, she’ll come to lie down with me, lick my face, hug me. When I’m going to have an epileptic attack, she pushes her head between my knees. She is saying to me, ‘Marieke, you have to lay down. Go to a safe spot because something is going to happen to you.'”

Triathlon had become her passion when the disease made her reliant on a wheelchair. She was world champion twice, but in 2008 her condition deteriorated so much she had to give up the sport. It was the lowest point in her life. The pain was agonising, the loss of independence insupportable. She told her friend she wanted to kill herself. “She said, ‘there’s no point in living, no point in going on because it’s too hard, it’s too bad.'” It was Marieke’s coach and therapist that recommended she speak with Dr Wim Distelmans, a leading palliative care expert, and who suggested another option: that of euthanasia. She decided to sign the papers.

“If I didn’t have those papers, I wouldn’t have been able to go into the Paralympics. I was a very depressed person – I was thinking about how I was going to kill myself,” she explains.”To me, death is peaceful, something that gives me a good feeling.”

“All those people who get those papers here in Belgium – they have a good feeling. They don’t have to die in pain. They can choose a moment, and be with the people they want to be with. With euthanasia you’re sure that you will have a soft, beautiful death.”

“I prepared everything. I wrote to every person who’s in my heart. I wrote to every person a letter when I could still do it with my hands,” she says. “I wrote texts that they have to read. I want that everybody takes a glass of Cava, [and toasts me] because she had a really good life. She had a really bad disease, but thanks to that disease, she was able to do things that people can only dream about, because I was mentally so strong. “I want people to remember that Marieke was somebody living day by day and enjoying every little moment.”

See Marieke’s speech in Rio de Janeiro: Euronews feature and video

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Our first all colour issue

for-blog-front-pagePrint subscribers were treated to our first all-colour issue last month and feedback so far has been great!

We have to balance costs carefully so every penny we spend has t0 be justified under the benefits it brings to our members. A colour magazine is more expensive than a black and white one, but when we took it as a proportion of overall costs including postage the difference turned out to be miniscule.For legal reasons, we can put far more explicit information in the magazine than we can in the online Blog, but here’s a round up of the latest one (Volume 36 No.1) for those who are interested –

Helium climbs back  The current situation analysed and the likelihood of helium tanks being ‘diluted’ with air. USA vs Europe.
Quote/unquote A round up of moving, inspiring or eye-opening quotations from the best in literature, the medical press and philosophy
Advancing discussion (by David Donnison) The illustrious social science professor from Glasgow looks at some options for real progress
Standing firm   (by Ken Jones) examines meditation techniques clinically proven that can help in facing inevitable death in the best possible way
Off the bookshelf  Our round-up of some books of interest
Unsung birth of the helium method  Helium brought a new era to self-euthanasia, but who brought us helium?
Rising costs of death  You’ve worked out your insurance policy and how to take things into your own hands should the need ever arise: but have you factored in the cost?
Eavesdropping on your decisions?  Emailing someone about your end of life decisions? When government invasions of privacy can mean you door can be forced open.
The good news on helium  A run down of what’s what, and a simplified approach to nitrogen euthanasia
The Carloway decision  Technical analysis of the Scottish legal decision and what it really means
Death as inspiration  A famous motivational speech on why we shouldn’t fear death
Living wills 7-step scenario  A compact reference guide to approaching this important document, condensed from our new membership pack
An organic burial suit  Really? where art meets dying well
Nitro USA  Some statistics on the American take-up on the ‘new nitrogen method’
Private dying & staying safe  How to protect yourself from prying eyes
AGM report  It’s feels quite informal, but follows a strict methodology to ensure that all cost undertakings are measured in terms of benefits to our paid-up print  members
Heart of Darkness  wrestling with death through one of the most powerful novels of all time
Needless inconvenience (H28)  They make it sound so simple (yes it can be – except when it goes horribly wrong!)
Self-deliverance costs compared  A rough answer to financial aspects

The print magazine is aimed at mature adults who want more specific, practical information to look at the long term of having a safety strategy, a “key to the door marked ‘Exit.'” If it is news and updates you are looking for, those are available free from many sources, including this Blog (please scroll down the right-hand side for links to online news information from professional bodies and sister organisations). You will also find a search box to look for specific blogs on particular subjects and some links to various laws around the world.

A big thank you again, both to out Blog and Print subscribers, for all your feedback and support!

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Carloway: clarity or confusion?

carlowayExitEuthanasia Blog has been receiving emails about eleven short words spoken by this man on 19 February this year.

“It is not a crime ‘to assist’ another to commit suicide.”


61-year-old Colin Sutherland was a graduate of Edinburgh University and was admitted to the Faculty of Advocates in 1977. His appointment as Lord President and Lord Justice General was announced on 18 December 2015. That makes him Scotland’s most senior judge.

Rather less eye-catching were the next few words which were:

“However, if a person does something which he knows will cause the death of another person, he will be guilty of homicide if his act is the immediate and direct cause of the person’s death.”

He then goes on to say that the crime may be treated as murder or culpable homicide depending on the individual circumstances of the case.

Lord Carloway is not only repeating the assertion of the Procurator Fiscal in the consultations over the failed Assisted Suicide bills brought by Margo Macdonald that “the law in Scotland is perfectly clear”: he is upholding the opinion of a previous court last year.

This was another “what if” question, trying to work out in advance if someone would be prosecuted if assisting a suicide in Scotland. A similar attempt in England resulted in the Director of Public Prosecutions issuing helpful guidelines on factors that would tend towards – or against – prosecution of cases.

But is the judgement helpful? On the face of it, yes. It seems a lot more clear-cut than in England and Wales. But it is only a formal opinion. It is not a judgment on a particular case, either actual or in the future. More than that, the opinion was basically to say whether the failure by the Lord Advocate to adopt and publish a policy identifying the facts and circumstances which he will take into account in deciding whether or not to authorise the prosecution in Scotland of a person who assists another to commit suicide breaches human rights law. The appeal judges, headed by Lord Carloway, decided it did not.

So that is the position: the Lord Advocate is not forced to publish guidance (as the Director of Public Prosecutions did in England). The law in Scotland is “perfectly clear.” (It could actually be argued that the  law in England & Wales was “perfectly clear” without the Guidelines, but now England & Wales has guidelines and Scotland still does not.

In England and Wales, “many factors are taken into consideration” and are enumerated. In Scotland, “many factors are taken into consideration” but are not enumerated.

As we read their Lordships comments, it would seem that they repeatedly come close to giving guidance only to throw it away again.

Mr Ross, a terminally ill man who has since died, had written to the Lord Advocate to request specific guidance on whether anyone who assisted him to commit suicide would be prosecuted. The Lord Advocate said that any incident involving a person who assisted another to take his own life would be reported to the procurator fiscal as a “deliberate killing” of another.

Said Lord Carloway: “Exactly where the line of causation falls to be drawn is a matter of fact and circumstance for determination in each individual case. That does not, however, produce any uncertainly in the law.” He continued, ““… other acts which do not amount to an immediate and direct cause are not criminal. Such acts, including taking persons to places where they may commit, or seek assistance to commit, suicide, fall firmly on the other side of the line of criminality. They do not, in a legal sense, cause the death, even if that death was predicted as the likely outcome of the visit.”

Lord Drummond: “The statements of policy make it clear that exceptional cases may exist where a prosecution will not be appropriate; in such cases the general discretion of the prosecution authority will be relevant. Nevertheless, it is apparent that the norm is to prosecute. … It is of the nature of exceptional cases that they are hard to predict.  To expect an enumeration of such cases would be wholly unreasonable. For this reason I am of the opinion that the Lord Advocate’s policy clearly meets the standard of reasonable certainty that is implicit in the requirement of legality”.

Some assisted suicide campaigners have hailed the opinion as a ‘victory’ and others as a ‘disappointment.’ Rather like asking if the glass is half full or half empty, Exit believes it is neither. (We have included the legal opinion in full, both in the footnotes to this Blog and in the right hand panel for reference, along with other legal instruments of interest.)


Further reading:
The Court Opinion in full
Report posted in Scottish Legal News
Gordon Ross case: BBC report

A quick note to Exit Members, our print subscribers:
The new magazine is a little late, due to computer problems…
but we are working on it! The new issue hopefully won’t be long!

Addendum. It is perhaps worth pointing out that Exit has never been of the opinion that such challenges were valid challenges in law. The opinion of Lord Carloway was perfectly correct in legal terms. For a fuller explanation, readers are referred to 6th Report, 2015 (Session 4): Stage 1 Report on Assisted Suicide (Scotland) Bill and the points on Assisted suicide and the existing law, paras 23-42 and the conclusions which follow them.

Exit takes the position that a challenge to change existing law should be made on the basis of exceptions to the rule of homicide. (See our draft bill template, prepared in association with Glasgow University.) Such a change would be a matter for Parliament, but the arguments put forward to the Scottish Parliament, in our opinion, have repeatedly been ill-conceived, resting on fallacious criticisms of the law as in the case recently before Lord Carloway and in the bills brought by MSP Margo MacDonald. It has been the case, for many years, that proposers of bills come to Exit after they have drafted their bills instead of beforehand. This puts Exit in a difficult position as we wish to support them in spirit but our advice at that stage would have to be “re-write them completely.”

For further information and resources on how Scotland and the UK handles cases of assisted suicide under existing law, please see the legal sections of our publications.

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The essence of a good death

Waterhouse sleep and his half brother death-

Hypnos and Thanatos: (Sleep, & his Half-brother Death) see below.

At its core, perhaps we can say death is two things: what it means to the person who dies, and what it means to the people who will remember. Two days ago in Austin, Texas, a young student, 20-year-old Richard Truong, died. Not particularly quickly, not particularly painlessly, but by his own hand. He had followed the fad for “chemical suicide” – a method of producing hydrogen sulphide gas by mixing household chemicals. This rather extreme example is used to highlight the often complexity of self-dying, and is not as unrelated to the peaceful exit approach favoured by followers of this website as it might at first seem.

“This is not an uncommon method of chemical suicide,” said the attending fire chief. “You can search on the internet to see some of the different ways this is done.” As he died, Richard also hospitalised six other people injured by the fumes and a further five that needed treatment for exposure to the gas. As he was in the process of cardiac arrest as emergency services arrived, it can reasonably be assumed that he didn’t get the mixture ‘quite right’ or experience the instant ‘knock-down effect’ for which he had hoped. It is likely that he suffered.

A ‘good death’ is sometimes described under three headings. One is CLINICAL: that the death is swift and relatively pain-free. Another is CLOSURE, which relates to the person’s relationships with others. A third is PERSONAL CONTROL — control of what is happening and maybe also being able to communicate before dying.

Someone who dies as a result of sudden depression, as it seems Richard may indeed have, most likely has not experienced closure. There are many things one might wish would have happened. One cannot imagine the pain now that his family must be experiencing. But Richard’s death is a lesson to all of us in terms of closure. In whatever way one dies, one’s death is a statement of one’s life. It is worth getting things right: the right time and the right way. It will mean something to somebody.

Seeing things ‘with a second pair of eyes’ can also be enlightening. Not just for the memory one creates but to see oneself as if as another person who is looking on. Was he or she getting things ‘right’? Taking care enough to plan properly? To focus enough, in the last statement of life itself, to do one’s best?

Last year, there was a panic over helium supplies. The situation seems now more or less stabilised (we are preparing an update for our print magazine and later for this Blog); yet in the interval we have seen a rush to seek out drugs which the movement had once discarded as dangerous, or a rush to recommend drugs that require great care.

People sometimes write to Exit and say, “You seem to recommend this, but someone else recommends something else: which is right?” All we say is, please examine the evidence. If you genuinely need this information to prepare for an unknown future, to give you courage to face a terminal illness, or have reached extreme old age, then there is time to consider options. There is time to look at evidence.

There is time to be as sure as you can possibly be.



Hydrogen sulphide
Although a painless death is sometimes possible, Exit does not recommend it. A report of a failed hydrogen sulphide attempt is reported here, and the science discussed in our publications and briefly elsewhere on this Blog. 1,2,3.

A good death
Research on the factors considered to be important in a good death are examined in a study that can be found here.

Methods of self-euthanasia
are detailed with extensive analysis and supporting evidence in our publications (see side-bar, Amazon or good bookshops). Exit does not give one-to-one advice on methods of suicide by phone, letter or email, or in any manner outside of its publications, members’ magazine and occasional full-day workshops.

John William Waterhouse [Public domain]. Sleep and his Half-brother Death is a painting by John William Waterhouse completed in 1874.  It was painted after both his younger brothers died of tuberculosis.

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Death becomes human (last chance!)

death bristol museumDeath: the Human Experience is available now and until March 13th 2016 at the Bristol Museum & Art Gallery.

With spectacular artefacts, it asks visitors to consider the science, ethics, attitudes and process of death, as well as the variety of ways human remains are used and the importance of end-of-life choices in contemporary society.

An interesting way to get past the taboo of thinking of death is to confront it in a colourful way. The exhibition includes mummified body parts, coffins from around the world, Japanese watercolours, mourning clothes, grave goods and much more. They show how death has been treated from the earliest human civilisations to modern day societies and pose questions including, when is death; what happens to us after we die; and what symbols do we use to understand death.

Councillor and Assistant Mayor, Simon Cook explained, “Around the world, different cultures have expressed their relationship with death in a myriad of fashions from the visual Mexican Day of the Dead to the audible lament of the Australian Aboriginal death wail. Yet in recent times we have seen a reluctance to engage with the subject, something I hope this exhibition will help to change. death: the human experience will provide visitors with an opportunity to encounter the death practices and beliefs of many world cultures whilst also being encouraged to reflect upon their own thoughts on death and the dead.”

The displays include a re-creation of a room at the Dignitas flat near Zurich. Called death: is it your right to choose? it is intended to encourage debate and discussion around end of life choices during a time when end of life laws and guidance are undergoing scrutiny. The reproduction of the room is surrounded by displays relating to the wider spectrum of opinions on Assisted Dying including personal testimonies.

A variety of experts including palliative care doctors, university medical ethics professors and Dignitas themselves have been consulted during the development of the display, as well as organisations such as Dying Matters, Healthcare Professionals for Assisted Dying, and Society for Old Age Rational Suicide. Visitors to the installation will be encouraged to explore their own feelings on the subject, guided by medical, ethical, philosophical and emotive elements, before giving their response on whether assisted dying be made legal in the UK.

All the knowledge in the world won’t help if one is afraid of the moment when “the lights go out . . .”

What does it have to do with self-euthanasia you might ask? Are there displays of helium hood kits and demonstrations of the compression method? Well, no (and at least not planned, as far as we know at the time of writing). But the answer of course is fairly simple: quite apart from the fact that not everyone can afford £10,000 to have assisted suicide in Switzerland – all the knowledge of self-deliverance in the world won’t help if one is still afraid of dying itself, of the moment, “when the lights go out.”




Exhibition details:
24 October 2015 – 13 March 2016
Monday – Friday, 10am–5pm
Weekends 10am–6pm
Entry: Pay What You Think
Last entry 30 minutes before closing
Bristol Museum & Art Gallery: Queens Rd, Bristol BS8 1RL

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“I’m Not Afraid”

"I'm Not Afraid"For two and a half years, documentary filmmaker Fadi Hindash followed a psychiatrist as he assists one of his patients with her suicide. It is her story, as well as that of her doctor, facing the reality that helping his patient die is the only way to save her. Fadi Hindash is an award-winning filmmaker of both fiction and documentary work.

The film-makers have now released a very moving extended trailer that our readers may enjoy (please click on the photo or the link at the end of this post).

One of the complications in the movie is that this is a film about the before-during-and-after an assisted suicide, but it involves the controversial area of mental suffering.

Mrs. L suffered severe anxiety disorder all her life. She spent her days alone, heavily medicated and forty years of mental illness isolated her to the extent of having no family or friends. That lonely existence is in complete contrast to Dr. Polak’s life. His is packed with friends, grandchildren, birthday dinners and colleagues.

Despite his active social life, Dr. Polak has built an emotional wall around himself. He is a man who cherishes his freedom above all else. But as he witnesses Mrs. L embrace death without fear, he begins to re-evaluating what freedom means to him personally.

As we know only too well, independent films like this take money to finish, so Fadi Hindash has asked Exit to share with our readers some of the ways you can support the final editing stage (details also in the link).“But isn’t Exit seeking funding to complete Exit’s own movie,” I here you ask? Indeed we are: but can we in all honesty ask you to support our project and ignore another which may be equally worthy? Have a look . . .

For more about “I’m Not Afraid” and a remarkable four-minute mini-trailer, go to:


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What is “appropriate” dying?

And Who Should Forbid ThemInstead of a set of rules where “one size fits all”, or wordily-phrased “rights”, psychologists have looked at a different model: one of, “Is this an appropriate death?”

The most common scenario, where laws are proposed based on certain check-boxes being fulfilled, is deeply flawed. “Two physicians must agree” – yet if the doctors in the area all happen to be opposed on principle, then they are not likely to agree. “Where the patient has six months to live” – and quite apart from the difficulty of determining this, we know that most major headline cases were not terminal: Debbie Purdy, Tony Bland, Terri Schiavo, Ramon Sampedro. Like these cases, when you have a set of fixed rules, the future will often surprise with one that feels morally right but doesn’t fall within the strict ‘rulebook.’

Exit’s response was to commission a University study on feasibility. The researchers found that the best type of law reform, instead of ‘legalising’ certain types of assisted suicide outright, would simply be to enact powers to the Courts that would allow them to make exceptions to the rule against assisted suicide.

The confusion over law-making stems not from how and when assisted suicide should be allowed, but something more basic: the question of, what is an appropriate death? The indicators would provide clues for all possible deaths, not just assisted suicides.

Psychologist David Lester, from the Center for the Study of Suicide in New Jersey, built on the work of Avery Weisman and Thomas Hackett in considering the sort of criteria that lead us to conclude that a death is ‘appropriate.’

  1. The role of the individual. There is a temptation to just call this ‘autonomy’ whereas it may not be quite that simple. A person struck by lightning has no autonomous role in the death, whereas a suicide, whether through very understandable causes or through a lack of social support and a place to live, might or might not be judged ‘autonomous’ – depending how in control we think that person is. But if a person does play a large role in their own death, that would indeed be a factor to consider.
  2. Consistency in lifestyle. One person might always have been of the outlook, “Just leave it up to the doctors.” If they suddenly changed their mind and sought assisted suicide, it would seem less consistent than someone who had firmly believed in their ‘right to die’ for a long time.
  3. Timing. We use phrases like, “It was his time.” Someone who is very ill, without the prospect of decent recovery, or someone who is very old, may seem more convincing to us than a young healthy person.
  4. What about the kind of death? Someone who dies alone and isolated, unable to leave their house, suggests to us something inappropriate. Violent deaths such as road accidents also seem inappropriate (although Ernest Hemingway’s suicide by firearm seemed at least consistent with his lifestyle). Natural death, when a person’s body just gives up, usually seems appropriate. Psychological death, when the brain has completely ceased to function but the body goes on, can in many ways be sensed as death but does not have the finality of physical death. Assisted suicide in cases where the above conditions are recognised tend to be seen as more appropriate than when such conditions are absent.

Further reading
Robert Grimminck, 10 Heartbreaking Right-To-Die Cases
Exit website, Cases in History
Grace Murano, 8 Most Controversial Cases of EuthanasiaBBC News Assisted dying: What does the law in different countries say?
Exit website, A draft bill
Wikipedia Suicide Legislation
American Psychological Association, Psychological research can inform state policies on the controversial measure.

Further References
Weisman A, Hackett T, Predilection to Death: Death and Dying as a Psychiatric Problem
Lester D, Psychological issues in euthanasia, suicide, and assisted suicide


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Afraid of dying?

Sunset from the bridge, Ayr, Scotland, front cover from the first edition of Five Last Acts

Sunset from the bridge, Ayr

Earlier this year on this Blog, we added the strapline, Taking away the fear of death. Fear of dying badly is one aspect, hence Exit’s original mission; fear of everything coming to an end is also an aspect. Knowing how to take matters into your own hands, should the need ever arise, tackles the first part. But what of the taboo of even thinking about death? Is it ‘bad’ for you? Is it easier to think of someone else’s death?

A recent headline in the Living section of a popular newspaper proclaimed, “Thinking about my death is the best cure for anxiety. Trust me, it works!” It has a worryingly similarity to that dubious adage, “Trust me, I’m a doctor!” (and these days we know we cannot usually “trust the doctor” if it is a case of rational suicide assistance). Thinking deeply about death can help us to face our fears; but what about the taboo of even doing that? Just saying to one’s family that you are making an advance directive (living will) can trigger responses such as, “You shouldn’t be thinking about death!”

The next most common response is to think about it vicariously. To think about someone else’s death, to hope it will be peaceful and so on. For those in favour of assisted suicide, it sometimes fuels donations to those organisations hoping to change the law. Making a donation feels like “doing something” – after which we feel free to, “think about something else.” Most rational people realise such a change is unlikely to occur in their own lifetimes (in the U.K., people have been trying, and believing it will happen “soon” since 1935). But what about helping people now? That’s where we come in.

Scots reading this forum will remember that wonderful, crusading, independent Member of Parliament, Margo MacDonald. Margo repeatedly campaigned for an assisted suicide law (and many other issues close to the heart of the people). When I spoke to Margo, she enthused about the reasons we need a change in the law to help people die; yet when I moved the subject to self-euthanasia, to people who want answers now, she suddenly became anxious and terminated the interview.

Helping a future generation is thinking vicariously. It avoids thinking too deeply about one’s own death, about how to manage it well, peacefully, and with minimum upset to one’s nearest and dearest. Oxytocin, the ‘feel-good’ hormone, increases generosity toward philanthropic social institutions, as opposed to immediate benefits directed at individuals or groups. (Exit has run on a shoe string since its inception, even though it is our research and literature that people turn to after supporting the wealthier ‘campaign’ institutions.) Somehow the thought of helping altruistically in a generalised way is more satisfying than actually doing something that can have a more direct effect now. It takes that taboo subject (whether starving children or difficulty in dying) one step further away from direct confrontation. Until the individual thinks about his or her own last moments on earth.

Anxiety and fear can be in response both to real concerns or imaginary ones. Excessive anxiety is related to an increased risk of cardiovascular morbidity and mortality, so facing and dealing with some of the fears can actually help you live a loger life! (This mirrors letters received from some Exit members, saying how knowledge of self-euthanasia methods has given them ‘the courage to live longer.’)

In dealing with fears, a common distinction is suppression (where we avoid thinking about it) versus reappraisal (where we deliberately revisit and reformulate the meaning of a situation). In studies, reappraisal is more effective than suppression. We do this in workshops but you can also try it by following the guidance in our Blog. If the question of death anxiety is left until we are almost dying, there is little chance to for reappraisal. The suppressed anxiety may even have taken years off our life as well as the quality of your life.

If this is all a bit ‘deep’ to think about now, have a break with some of the fun links below, inspiring quotes from famous people on the subject. You can bookmark this page and come back to it at any time. If you want to help our work (see the end of this article for more about what we do and our track record) you can use the donate button in the right hand column or follow this link.

What did they say about death, dying and living? Click and see…
you can also use the left-right arrows (next page) to scroll


Trust me it works!” Pop star, Rita Ora, and Daisy Buchanan in The Telegraph
One cannot escape death (an ExitEuthanasia Blog on facing the fear)
Margo MacDonald and her assisted suicide bill (Evening News)
6 Positive Ways To Overcome Your Fear Of Death (Huffington Post)
Anxiety and the Fear of Dying (CalmClinic Website)
How to Overcome Fear of Death (WikiHow)
Death anxiety (psychology) (Wikipedia)
Oxytocin infusion increases charitable donations (Barraza et al, Hormones and Behaviour)
Neurocircuitry of Fear, Stress, and Anxiety Disorders (Shin & Liberzon, Neuropsychopharmacology)
Reappraisal and Suppression (Goldin et al, Biological Psychiatry)
The Choice to Face Your Choices (ExitEuthanasia Blog)
Exit: the Director’s Story (ExitEuthanasia Blog)


EXIT’S ACHIEVEMENTS (A history of our work)

  • 1980 First “how-to” booklet in the world on self-euthanasia, with detailed methods and materials (How to Die With Dignity).
  • 1993 First booklet in the world to be published with full peer review of its scientific data (Departing Drugs).
  • 1994 Small book on different methods that included more academic analysis, for the first time in the world. A companion to Departing Drugs. (Beyond Final Exit).
  • 2010 A more comprehensive book proposing five different methods for different circumstances and the first book of its kind in the world to detail the ‘compression method’ (Five Last Acts).
  • 2015 The ‘big brother’ edition of Five Last Acts is updated and expanded to over 800 pages, and the first book in the world to give detailed instruction on the ‘nitrogen method’ (The Exit Path).
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Can breathing inert gas rupture the lungs?


A correspondent recently contacted us with an unusual concern. He had read that breathing helium could rupture the lungs: hardly a peaceful death!

Helium is an inert gas and perfectly pleasant to breathe (though dangerous as it can produce unconsciousness without warning). Death occurs through lack of oxygen to the brain rather than a rupturing of the lungs. The process, properly managed, is completely painless, as confirmed by many witnessed accounts, including those by Professor Ogden in Canada and others (a few such links are provided below). Consequently we were slightly puzzled as to the source of such information.

A quick search of the Internet soon provided the answer. The media had picked up on some foolish examples such as persons at a party, or having fun making the voice change pitch, and breathing helium directly from the canister. This is exceedingly dangerous and can cause (completely unintentioned) death. The ‘rupture’ of aveoli (the small balloon-like sacs within the lungs) was caused not by helium, but by the pressure of the gas (any gas). Helium in party balloon canisters is compressed to about 260 pounds per square inch, so suddenly opening the gas jet in an irresponsible way can cause a fairly formidable pressure of helium. The other possibility is in diving, where a diver comes to the surface and gas in his or her lungs expands suddenly.

The concern over helium and self-euthanasia is not about gas pressure, which is easily regulated by sensible adults studying the method, but over manufacturers’ announcements that many of their cylinders are now supplied with a helium-air mix, which is unsuitable for self-euthanasia.

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Suicide and impulsivity

suicide debateWhat can be done to help people to make rational choices? Abolitionists will say, “What about people who die who shouldn’t?” One should never advise or encourage anyone to commit suicide. In fact dissuading is part of the ‘right-to-die’ remit, for although the will to live is very strong, there is a presumption in favour if it, and it is the individual’s autonomous determination over and above the will-to-live, over and above the best efforts of palliative care, over and above the best available social support and counselling, that makes a request for assisted suicide (or the decision for rational self-suicide) compelling.

Possibly unique among ‘right-to-die’ societies, Exit is trained in suicide prevention. Both the person dying an unrelievably painful, undignified death (who actually needs information) and the high-schooler who has failed an exam and so feels suicidal (and who actually needs support) have one thing in common: they both need empowerment to make their deepest, truest objectives real (the one to die peacefully: the other one to live).

A common fallacy is that people suddenly decide to kill themselves and go out and do it. It may even appear in some cases that that is what has happened. A large proportion of us will have, or have had at some time in our life, suicidal thoughts: yet we don’t commit suicide. Somewhere, at the back of our minds, we realise the truth of the common knowledge that most pain, and even the most terrible psychological suffering, will one day go away or can be treated (even if it doesn’t feel like that). This is very different from someone who has pursued all the options, psychological, medical and palliative (and we go to great lengths in our books urging people to do just this). Very large, independent and exceptionally competent studies suggest that people do not commit suicide on sudden impulse. They will have thought about it for a long time. (In cases of irrational suicide, this is the ‘window,’ often a very difficult window, where helpful intervention tries to offer support.)

For anyone contemplating suicide, for rational or irrational reasons, there are two distinct frames of mind, often identified by two different questions: “Are you feeling suicidal?” and, “Have you made a plan?” Roughly speaking, the first is emotional, the second, intellectual. Do not be afraid to ask these questions, or to listen carefully and non-judgmentally to the answers.

There are controversial arguments on whether removing the means to suicide is effective. In some studies, it seems to work by extending the window of contemplation, whereas other studies suggest it merely diverts people to less savoury means. Information on rational suicide (books) as opposed to the means (rope, high buildings, barbiturates etc.) are two very different categories.

The methods of rational suicide investigated by Exit do not easily lend themselves to sudden, unpremeditated death. As Dr Bruce Dunn wrote in 1994 (a time when significant strides in understanding rational suicide were being made), “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.”

A law allowing doctor-assisted suicide or euthanasia could encourage persons to voice their feelings to a doctor without fear of bias or being judged. Openness with supportive loved ones can create bonds. On the one hand, legislation would open the window of support with options to examine all available routes to make life bearable where that can be achieved or, on the other hand, provide compassionate options for euthanasia where all other routes are exhausted. Similarly, being open to the innermost feelings of loved ones, and talking to them, can extend the window – and sometimes allow a person thinking irrationally of suicide the breathing space to reconsider.

If you are maybe reading this as a ‘right-to-die’ supporter, you may be thinking, “But surely your job is to make it easy!” That is not quite the case: firstly, rational and dignified suicide is not simple in that sense (as opposed to throwing yourself of a bridge – which incidentally is not always simple either). It is one of the biggest decisions of life. Any fool can jump under a car. Rational suicide on the other hand requires very careful contemplation and planning. There are no lethal gas ovens left. Doctors don’t readily prescribe lethal pills. What we do is research and more research. Botched suicides don’t always “save lives,” they simply make death more ghastly. We look at things that can go wrong, clear the debris from the road, find the science of the most rational, painless and dignified methods. For those that wish to become empowered, we offer truth, the key that takes away fear.

If you are reading this and feeling suicidal, our first advice is to talk to someone. It might be a trusted friend or an understanding family member. Unfortunately not all irrational suicides can be prevented; and not all rational suicides will go smoothly. We can only do what we do: to help things, responsibly, legally, ethically, compassionately. We cannot solve all the world’s problems or produce perfect solutions on life and death, nor can we prevent death or bad decisions. Everyone dies: we hope that for those that have reached a point where they are committed to drawing life to a close at a time and manner of their own choosing can do so with as little pain and indignity as possible.

A few selected references and further reading:
Lester D, Psychological issues in euthanasia, suicide and assisted suicide, J Soc Issues 1996;52(2):51-62.
Anestis M, Soberay K, Gutierrez P et al, Reconsidering the link between impulsivity and suicidal behavior, Pers Soc Psychol Rev 2014;18(4):366-86.
Witte T, Merrill K, Stellrecht N et al, “Impulsive” youth suicide attempters are not necessarily all that impulsive, J Affect Disord. 2008;107(1-3):107-16.
Sisask M, Värnik A, Media Roles in Suicide Prevention: A Systematic Review, Int J Environ Res Public Health 2012; 9(1): 123–138.
Exit also includes very extensive references from all ‘sides’ in its books.
Exit, while pro-legislative reform, is primarily a research group. We are not a suicide hotline and not involved in the field of one-to-one counselling, whether for rational suicide or suicide prevention. Below are some (we believe) responsible organisations (a very short list!) that can also be consulted:
The Samaritans (Europe)
Philosophical Practice for Life Questions (Europe)
Dignitas (Europe)
Final Exit Network (USA)
Rubin Battino (therapist, USA)


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