Exit in the British Medical Journal

How To Die With Dignity was the world’s first “How To” manual.

How to Die With Dignity was the world’s first rational suicide manual for persons suffering from unbearable and unrelievable illness. This month, the BMJ, one of the world’s leading medical journals, publishes details of Exit’s work and history.

It was a London doctor, Colin Brewer, who probably first mooted the idea. “I drafted most of the proposed booklet (the first of its kind) but some members objected or feared prosecution, which caused delays. Scotland never criminalised suicide and has no specific law against assisting it, as exists south of the border, so impatient Scottish members declared independence and published a booklet in 1980.”

He notes that updates advice (more than 400 pages) is still available from that Scottish society, which as you know is called Exit. The BMJ ran articles by Colin and by Exit, explaining the position then and now.

(Both articles are available in the print edition and online, but for copyright reasons we can only reproduce the one from Exit.)

As the author of the updated do it yourself advice and director of the Scottish society, Exit—both mentioned by Brewer(1)—I would like to clarify a few points.

Many people are worried about the ready availability of information about suicide. Exit takes both patient empowerment (of the kind mentioned by Brewer) and suicide intervention seriously. Those with a persistent rational wish to die (as exemplified by Tony Nicklinson(2)), and those who need to be protected from their own temporary suicidal urges, deserve honest recognition and support.

We make information on self deliverance available to UK members of Exit in strict accordance with the law, after a basic age check and three months’ wait. These precautions prevent young people or those in the first stages of acute depression from obtaining the information. Newer evidence on impulsivity challenges the accepted view that people can be suddenly “pushed over the edge” to suicide,(3) but we still enforce the three months’ wait.

Suicide information is available online—from newsgroups recommending bleach and toilet bowl cleaner (hydrogen sulphide suicides) or less painful methods and from organisations similar to ours. We are a very small player.

The print version of our updated advice is also available to anyone.(4) Until legislation allows a full range of assisted dying options, and better safeguards exist for the current “back street or Switzerland” approach, this seems the “least worst” course of action.

Cite this as: BMJ 2012;345:e7073
Competing interests: CD is the author of Five Last Acts and director of Exit.
1. Brewer C. Assisted dying: “all good doctors do it anyway.” BMJ2012;345:e6536. (28 September.)
2. Kmietowicz Z. Man with locked-in syndrome who fought for doctors to end his life has died. BMJ2012;345:e5729.
3. Smith A, Witte T, Teale NE, King SL, Bender TW, Joiner TE. Revisiting impulsivity in suicide. Behav Sci Law 2008;26:779-97.
4. Docker C. Five last acts (2nd edition): expanded and revised. Exit, 2010.
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