I had joined Exit in the early ‘80s as part of some research for a small publishers that particularly concerned itself with human rights. The editor-in-chief asked me to investigate a group in Scotland that looked at the rights of terminally ill people. Exit, I discovered, had broken away from its parent organisation in London (which is now called Dignity in Dying) over a disagreement on whether to publish a book on methods of rational suicide. There was vast public support for such a book: yet it would be the first book of its kind in the world and there were many legal worries in the English society.
Working to help people in the future (by campaigning for a change in the law on assisted suicide) and working to help people now are two different, but very necessary tasks. After an amicable split, the two organisations have pursued their respective goals independently to this day.
Scotland got the ball rolling with its book How to Die With Dignity. Several others followed, including Derek Humphry’s Final Exit and even a short-lived book from the English society called A Guide to Self-Deliverance.
When I joined Exit, the Society was distributing How to Die With Dignity as well as Humphry’s Final Exit, yet there seemed to be little or no agreement within the scientific community about what drugs and what dosages could be relied on to cause death. As a young delegate with little authority it was extremely difficult to challenge the status quo, yet I found there were indeed several quiet voices who were concerned about the lack of any really scientific research. As an initial project, I invited Cheryl Smith, then staff attorney for Hemlock, if she would like to investigate a particular drug with me that was mentioned in the German society’s booklets but not in any other manuals.
At the World Federation of Right-to-Die Societies meeting at Kyoto in 1992, I determined to find out if anyone had scientifically collated evidence on self-deliverance drugs.
There were many strong opinions being bandied around about but no-one seemed to have produced any reliable evidence. In the months following the conference, we collected folder upon folder of published research from medical journals. By using good medical libraries, universities and computerised search facilities we were able to uncover a wealth of information – why had nobody looked before now? Debates continued, but could now be pursued with intellectual rigour thanks to the vast amount of published information. Our work was supplemented with interviews, especially examining failed suicides and discovering the reasons for failure (and how they could be avoided!)
In 1993, as our research on various methods neared completion, I founded the International Drugs Consensus Working Party and set up protocols to ensure our work could be properly peer-reviewed. Smith had left Hemlock by this time and we were in a position to co-author a new volume. Results were published in Departing Drugs (a small ‘how-to’ manual) and Beyond Final Exit (that included more technical details).
Weaknesses in earlier manuals had been identified with some certainty, and medical hypotheses put under scrutiny. Many errors in self-deliverance information result from following off-the-cuff doctors’ advice. This is a very flawed approach. Doctors are trained and qualified in how to keep people alive, not in what quantity of a drug will reliably cause death. They generally offer little more than educated guesses, and our responsibility was to provide meticulously documented evidence. Similarly, pharmacists and pharmaceutical manuals give an idea of what quantity of a drug may be dangerous or lethal, but not how much is reliably so. This is largely due to two factors: the drugs testing by pharmaceutical companies (aimed, in this respect, mostly to establish the limits of safe doses) and the data provided on this basis. ‘A lethal dose’, in pharmaceutical terms, simply means someone has died or might die from such a dose, which is very different from saying that no-one taking such a dose will survive.
This is why failures have always played such a big part in our research, as they allow us to go back to the drawing board and question original assumptions. Similar reservations apply to knowledge obtained by first-hand observation – either by assisting someone to die or being present. Just because a method has worked well for several people is no proof in itself that it will work in all or even most cases. Our knowledge of failures came from several sources, including letters and phone calls from our own members, but also from the Dutch society, a hands-on counsellor in California, and professors at Glasgow University where I was completing a Masters Degree and giving occasional lectures.
With all this data, we were able to refine advice to minimise chances of failure and make instructions sufficiently foolproof to be relied on with confidence. Final drafts are always checked by medically qualified experts to ensure we have not overlooked anything. The process is largely one of negation, to rule out inaccuracies, unsuitable methods or flaws by a process of subtracting them or re-submitting them until no flaws can be found by any of the scrutinizing processes. Where possible, physical experiments are made, and ideas and ease of dress rehearsals fortified in our workshops across the country.
In 2007, the method resulted in a more substantial book, Five Last Acts (the title refers to five principle methods), and a greatly expanded second edition in 2010, Five Last Acts II (about twice the size, and the largest ‘how-to’ book available worldwide at the time).
By this time, the movement had gained considerable impetus. While Exit works largely under the radar, a similarly named group from Australia had sprung up (‘Exit International,’ founded 1996) and was giving high profile talks in many countries. It’s leader, Philip Nitschke published The Peaceful Pill in 2007 detailing difficult methods such as sourcing barbiturates abroad or making your own pills in a laboratory. In 2001, Geo Stone had also published a broad ranging examination of methods under Suicide & Attempted Suicide.
Similarly persons concerned about such issues required a comprehensive reference book. (While rather large for your coffee-table or handbag, this has now been published – see sidebar and the publications tab above for The Exit Path).
Polls consistently and reliably show around 80% of persons in nearly all modern countries want control over their own dying. This includes the most reputable studies such as those in British Social Attitudes. It is very noble to campaign for changes in the law to this end. But meanwhile there are people dying badly, suffering terribly, for whom the best attempts in modern medicine and palliative care are not enough. Maybe in the future they will be – but for people suffering now, they are not. Neither can everyone afford the large cost of going to Dignitas in Switzerland for help. For these people, a future bill is to late. For these people, fancy ideas about the value of suffering bring no relief. For these people, certainty in how to “pull the plug” is often their only comfort. For many of the rest of us, that uncertainty about the future is with us. Maybe we have seen a relative die badly. Maybe we just say, My Life, My Death, My Choice. For such people, being forced to endure an undignified and painful end to a good life, erodes the very sanctity of life itself. We may never use the “key to the door marked EXIT” but it is good to have the option.
Note – we have appended some reputable self-deliverance manuals. Of these the Five Last Acts series (including The Exit Path) are the only ones that address the issue of self-deliverance in hospital, as well as a multitude of methods and unseen difficulties, guiding you with clear diagrams, easy-to-follow text, and footnotes describing the scientific proof for each piece of advice.
How to Die with Dignity 1980, 31 pages
Departing Drugs 1993, 68 pages
Final Exit 1991, updated 2011, 220 pages
Beyond Final Exit 1995, 115 pages
Suicide & Attempted Suicide 2001, 496 pages
Five Last Acts* 2007, revised 2010, 414 pages
The Peaceful Pill 2007, updated 2010, 311 pages
The Exit Path* 2013, 752 pages
*Details of these can be found in the sidebar (top right of this page) or on our publications page.