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Peaceful Pill Blog

March 28, 2021

Assisted Dying and Organ Donation

At Exit, we are often asked about assisted dying and organ donation. For example, is it possible to donate one’s organs after a suicide or, in the context of an assisted dying law, after the assisted death/ assisted suicide.

In general, the answer has always been no, except in countries such as the Netherlands, Belgium and, more recently, Canada. This is despite widespread organ shortages in almost all western countries.

Indeed, I was especially heartened to receive by mail in Amsterdam last month, notification from the Dutch health authorities informing me that my adopted country now had an opt-out system of organ donation.

This means that should I be hit by the proverbial bus, my organs and tissue will automatically go into the organ collection pool. I can opt out of this new scheme if I want, but I won’t.

There have always been strong public policy reasons as to why a person who is electing to die early/ voluntarily (through a VAD – voluntary assisted death) cannot donate their tissue or organs.

The most obvious of these is the perception that the person may be encouraged to ‘do the right thing’ in order to give their body parts to others. It could be seen that the person is being encouraged to suicide for the greater good.

This standpoint seeminly had enough political traction to be published in the British Medical Journal March 2020. The article by a little known researcher from Belgrade, Dr Zeljka Buturovic, argued that there were no sufficient safeguards that would ‘disentangle MaiD from organ donation decisions’.

Pro-life fanatics such as Wesley J. Smith have long scare-mongered that assisted suicide laws would create untold fortunes for the ‘organ donation industry’. As always with such extremists, the situation is black and white with no room for a nuanced, humanist approach in between. They argue the slippery slope is real; we will soon all be being put down so as organs can be sold on.

Others highly critical of allowing mutual assistance in dying and organ donation such as the outspoken American Catholic doctor, E. Wesley Ely, have suggested that this is a short route towards euthanasia via organ harvesting. That is, people are put down because their organs are removed. Rather than those organs being removed after the person’s ‘good death’ (euthanasia).

The highly politicised field of assisted dying and these sensationalised ‘ethical dilemmas’ (the church is a powerful lobby group) have been enough to scare legislators into excluding the topic of organ donation from many of the new right to die laws that are now sweeping the western world. No where in Australia or the US for example, can a person who is getting lawful help to die, elect to donate their organs.

However, as with so many areas of life, it has been the pragmatic Dutch (and Belgians) who have led the way with devising a path forward where euthanasia recipients can give life to others.

Organ donation has been possible in the Netherlands since 2011, with the first clinical guidelines devised in 2017. More recently, Canada has followed suit. In all countries that allow both practices, the ‘dead donor rule’ applies: meaning that organs are only taken after the euthanasia or assisted death has been completed. So much for the hysterics of the anti-choice lobbyists.

Practical Problems

Of course, organ donation of euthanasia/ assisted dying recipients is no straight forward affair. There are numerous practical issues which make the practice difficult.

For example, most people will need to die in a hospital if their organs are going to be successfully harvested and donated to others. Yet most people want to die at home. Fortunately, modern medicine is coming to the rescue. On 7 March 2021, Canadian Huntington’s disease sufferer, Mike Neill, made the headlines when he was able to donate his lungs. What was so special about Mike’s ‘gift of life’ is that he died at home. The media reported this donation as a ‘world first’.

The donation of a major organ such kidneys, lungs, hearts and livers after euthanasia/ assisted dying stands in stark contrast to tissue donation which can be recovered following home deaths. In this regard, the donation of eyes, heart valves, bone tendons and skin is much more straight forward.

The Benefit of Planning Ahead

Many people who elect for an early death/ assisted suicide have a deeply thought-out sense of the world and their place in it. If we were to characterise Exit Members it would be as older people who know their minds. They tend to be people who have led highly independent, autonomous lives and who are used to making their own decisions and being in control.

One benefit of planning for an assisted death followed by organ donation must be the fact that it can be planned ahead of time, and every detail discussed and thought through.  The relative time of death is always known so the services needed to make the organ donation successful can all be put in place before hand.

Planning ahead for donating one’s organs also removes the person’s family and loved ones from having to make often difficult decisions at a time of extremis. And consent can be withdrawn right up to the last moment, allowing for flexibility in individual decision-making.

Organ Donation in Switzerland

It has long been bemoaned that in the one country in the world where one does not need to be seriously ill in order to get lawful help to die, that organ donation in prohibited. Like most other countries, Switzerland is presumably concerned about the message it would send if recipients of assisted suicide were also allowed to donate their organs.

Would people be pressured into dying, just so their organs could be donated? This seems an ironic question for a country which allows the use of organs of those who die by ‘violent, unassisted suicides’. It seems the principal stumbling blocks for the Swiss lie in practical concerns.

Given that most people who are helped to die in Switzerland die at home or at an assisted suicide clinic, how might the organs get to hospital where they are needed. What about the quality of the organs? And would allowing organ donation act as a disincentive to those travelling to Switzerland for an assisted death if they knew what ‘could’ happen after they are gone.

As a country with a scarcity of organs available for transplant and a historically week culture of organ donation, it seems a hugely wasted opportunity.

Imagine what can be

At Pegasos Swiss Association, one makes the VAD application online. In the course of this application, all sorts of boxes are ticked. What music would you like us to organise for you? Do you wish to have champagne for a final toast? Where should we send your ashes? Who will be accompanying you? And so on it goes.

How sensible, common sense and convenient would it be to add the box, do you wish to donate your tissue and organs once you are gone? Tick for yes.

This would allow Pegasos’ Organ Donation Facilitator (an imaginary futurist position) to make the appropriate arrangements, thereby ensuring that your death gives life.

Alas.

Canada’s Way Forward

Organ donation seems to be a last bastion for change within the assisted dying movement. Canada is to be congratulated for going it alone in following the Benelux lead. This country is proving innovative and progressive when it comes to tweaking its end of life law to accommodate the needs of its citizenry.

As of March 2021, to qualify for help a person no longer needs to have a death that is ‘reasonably forseeable’ (a criteria which in other jurisdictions is translated as < 6 months to live and which is hugely problematic).

This expansion of qualifying criteria opens the way for people with disabilities and other conditions that have no clear prognosis but which make one’s life so miserable that a dignified death has become a preferable option.

Finally, the recent Bill C-7, via a new sunset clause, leaves the way open for people suffering from mental illness to be able to ask for help to die.

In Canada, unlike in the Netherlands and Belgium, a request to die can still not be included in an Advance Health Directive and nor can people who have ‘completed life’ or are ‘tired of life’ ask for help to die.

Finally, there is nothing in these legislative changes that take the decision-making away from the medical profession.

There is no Dutch-style Completed Life Bill which advocates that all people over 70 years of age should be able to be issued with Nembutal so that they can make their own end of life decisions should the need ever arise.

In this regard, there is no place like Holland!

assisted dying and organ donation

 

 

 

 

 

 

March 7, 2021

The First Place in the World

 Very Brief History

On 1 July 1995, the Northern Territory of the Australia became the first place in the world to pass an assisted dying law.

The Rights of the Terminally Ill Act  (ROTI) was that law.

On 1 July 1996, the full implementation of the law occurred.

On 22 September 1996, the law was used for the first time when Darwin local, Bob Dent, who was suffering from prostate cancer, became the first person in the world to receive a legal lethal voluntary injection.

Bob Dent used Exit Founder Philip Nitschke’s ‘Deliverance Machine‘ to set the Nembutal flowing via intravenous infusion (the same process used at Pegasos Swiss Association today).

Deliverance Euthanasia Machine

Philip Nitschke with the Deliverance Euthanasia Machine, Darwin 1996

Timelines

The Northern Territory was the first place in the world because Oregon’s Death with Dignity Act was waylaid by legal action and was not used until October 1997.

The Netherlands’ Termination of Life on Request and Assisted Suicide (Review Procedures) Act was not passed in law until 2001 and was not used until 2002.

This left the little-known, Northern Territory of Australia alone as the first place in the world where a doctor could lawfully assist a dying patient to die.

However, the NT ROTI Law only lasted 9 months before it was overturned by the Euthanasia Laws Act (known colloquially as the ‘Kevin Andrews Act’).

This law came about as a result of a private member’s bill. The sponsor of that bill was the conservative, catholic Liberal Party MP from the Melbourne seat of Menzies, Kevin Andrews.

Leunig euthanasia cartoon

This is to say that Andrews used an historical quirk in the Australian Constitution (section 122), which allows the Federal Parliament to make laws for the Territories of Australia (the Northern Territory, the ACT and Norfolk Island).

Put simply, the Euthanasia Laws Act disallowed Australia’s Territories to make laws on voluntary euthanasia. Despite being the first place in the world, the NT can make laws on anything, but not euthanasia.

Above all, this was a cynical, political and strategic way to deny Australians choice at the end of life and it worked.

The Euthanasia Laws Act was put to a conscience vote and was voted through by both the then conservative Prime Minister John Howard and the Leader of the Opposition, Kim Beazley.

Tony Burke (now Manager of Opposition Business, ALP) joined with Kevin Andrews in voting down choice.

National Day of Shame March, Canberra 26 March 2007

In 2021, some 26 years later, there is finally a push underway for the Euthanasia Laws Act to be amended.  Most importantly, this time, the Murdoch press is behind the push.

In the Northern Territory News this week, a full 4 days of lead articles urging the Federal Parliament of Australia to act.

Yes, it is indeed time …

First place in the world

NT News Front Page, 1 March 2021

Why was the Northern Territory the First?

In Killing Me Softly: Voluntary Euthanasia and the Road to the Peaceful Pill (Penguin, 2005), authors Philip Nitschke and Fiona Stewart set out to try to explain why the Northern Territory did it first.

They wrote:

In watching the enactment of VE bills elsewhere in the world since 1997, I have come to realise that certain ingredients are required for the successful passage of a law on VE.

In the mid-1990s in Darwin, we had all that was needed.

For example, we had a charismatic politician who was prepared to stand by his beliefs.

More than this, though, Marshall Perron was something of a legend in the Territory.

His long involvement with Darwin gave him unique insight into the Territory psyche; something he was able to put to good use as he carved out his successful political career.

Perron is also a straight talker.

He doesn’t mince words and can be a powerful force in any debate. He has that admirable talent of taking the people with him.

A politician from the conservative side of politics, his leadership on VE reinforces the fact that the issue is beyond party politics. One’s right to die transcends political divisions and ideological differences.

A second factor in the initial success of the ROTI Bill in the Northern Territory parliament is that they have no upper house.

This makes the passage of legislation more efficient.

The government of the day is all the more powerful when the checks and balances of the house of review of the traditional Westminster system are absent.

This was the case in 1995 in the Territory and it worked in voluntary euthanasia’s favour.

A third factor that helped get the ROTI Bill through is that the Northern Territory is the least religious place in Australia.

According to Social Trends 1994, 18 per cent of the Territory’s population consider themselves to have no religion.

This compared to 10 per cent in New South Wales and a national average of 12 per cent. Territorians are also the most likely people to leave the religion question in the census unanswered.

Finally, the Territory has a mindset that is different from everywhere else in Australia.

In this part of the world, car registration plates contain words like ‘Frontier’, ‘Barra Country’ and ‘Outback’ – words that conjure up Territory fact and myth. And this is the point.

Territorians can be rough, rugged and cynical as hell about the gentrified south.

In some ways, the Territory welcomed a VE law precisely because no one else had one. No other state or territory was tough enough to find a legislative way to deal with this political hot potato.

Demonstration in Canberra, March 2007 on the 10th Anniversary of the overturning of ROTI Act

 

January 31, 2021

Vale – Kevin Andrews Loses Preselection

International readers may well ask who is Kevin Andrews?

In a nutshell, he’s the guy whose private member’s bill in the Australian Parliament (The Euthanasia Laws Act) led to the overturning of the world’s first voluntary euthanasia law – the Rights of the Terminally Ill Act (NT) (ROTI) in 1996.

A Catholic extremist, (and well known for his traditional marriage counselling prowess) Andrews once boasted that he had set the euthanasia movement back 20 years. And he was right.

Why do we highlight this now?

This week, Kevin lost the vote (pre-selection) in the Australian Liberal Party (Australia’s right wing political party) to continue as their candidate for the Melbourne seat of Menzies.

Kevin will never again represent the electorate of Menzies in the Australian national Parliament.

Twice I campaigned as an Independent candidate in Menzies against Kevin Andrews (See archive photos below!).

In 1997, I forced him to preferences. This meant I came the closest of any candidate during his tenure to beating him. Sadly, Menzies is a safe Liberal seat and so Kevin prevailed.

Until now …

Campaigning against Kevin Andrews in Menzies, 2007

Campaigning against Kevin Andrews in Menzies, 2007

Below is an extract from my book – Killing Me Softly: Voluntary Euthanasia & the Road to the Peaceful Pill – that puts that man and that time in perspective.

How could this happen?

In my mind, strategic and persistent lobbying of politicians could have prevented the passage of the Kevin Andrews Private member’s bill.

I was furious that the state voluntary euthanasia societies were not prepared to do more to save the ROTI Act.

Canberra (Federal Parliament) was able to override the NT legislation through use of Section 122 of our Constitution which grants the Commonwealth the power to make laws for the government of any territory of Australia.

While state laws are preserved, the Northern Territory, Norfolk Island and the ACT are subject to this special power – a power which rides rough-shod over proper, regional democratic processes.

But this is only half the story.

The other half concerns a wide-reaching network of people, many from within the Lyons Forum (the secretive organisation of the far-Right of the Liberal Party) and Catholic Church-based propagandists.

With ringleaders headed by Kevin Andrews but including former Young Labor president Tony Burke – and now member of the shadow cabinet –and Sydney businessman Jim Dominguez, the ‘Euthanasia No’ campaign was well-funded and effective.

In the words of award-winning journalist Michael Gordon, the No campaign was a ‘story of a network [where] all the principals are Catholics – its influential connections, its single-mindedness and the tactics it employed’.

Philip Nitschke, Democrats & Kevin Andrews - Townhall meeting Doncaster, November 2007

Philip Nitschke, Democrats’ Candidate Damian Wise & Kevin Andrews – Townhall meeting Doncaster, November 2007

White ants in the media

A second group that set out to undermine the legislation was the national media, most particularly The Australian newspaper in Sydney. As a prominent member of the ‘Euthanasia No’ campaign, the then Murdoch-hack & editor-in-chief, Paul Kelly, openly abused his position at the paper to promote ‘Euthanasia No’, ensuring his personal opposition to voluntary euthanasia was effective in the process.

Kelly’s complicity in the campaign was exposed to me by The Australian’s then Darwin correspondent, Maria Ceresa.

While her Fairfax counterpart, journalist Gay Alcorn, filed stories without bias, Ceresa was increasingly thwarted by the paper’s hierarchy in her coverage of the issues surrounding the ROTI law.

Ceresa would later tell me that unless the story was highly critical of the legislation, the paper would not run it. She felt herself professionally compromised as a result.

Menzies Candidates ballot paper

Menzies Candidates ballot paper

White ants in the right-to-die movement

To my dismay, during 1996 I discovered that the right-to-die movement itself was unwittingly helping to undermine the legislation. I knew something was not right as I travelled from state to state during 1996, trying to involve the VE societies, and trying to get them to mount a coordinated campaign to save the ROTI Act.

But the response I received was patchy, and although I managed to get representatives from Queensland, South Australia and the ACT together for a strategy meeting in Canberra, there was little willingness to pool resources and mount a national campaign.

As for the Victorian society, they did not even attend the meeting and argued that it was unwilling to put money into a project that would not directly benefit that State. Later I met with the president, Dr Rodney Syme, and the then executive officer, Kay Koetsier, whereupon they expanded on this view.

Syme explained that while the society was prepared to pay for survey work that could benefit Victoria, there would be no involvement in a national campaign to lobby federal politicians. Koetsier went so far as to claim that the passage of the Andrews Bill could even bode well for Victoria.

When I asked Koetsier to elaborate on this extraordinary claim she said that if the Senate voted in favour of the Andrews Bill, there would be a national outcry.

Then, the Premier of Victoria, Jeff Kennett, would take it upon himself to ‘do the right thing’ for the people of that State, and pass right-to-die legislation. History tells us otherwise. I found Kay’s comments to show a profound lack of judgement.

I told her I didn’t agree and the conversation moved on.

In retrospect, it was little wonder the ‘Euthanasia Yes’ campaign was defeated. Not only was the Commonwealth–Territory power not on our side but the media, the Church and a whole network of powerful and wealthy people pulled out all the stops to defeat the landmark legislation.

Campaigning in Bulleen

Campaigning in Bulleen

The parliamentary word

In an unprecedented occurrence, when the Kevin Andrews Bill was finally debated in the Senate it went on for the best part of four days. The speeches heard in both houses of parliament were some of the most emotional ever made by Australian politicians. While some MPs spoke about the rights of the individual, others views were fueled by the dogma of the Catholic Church. Some talked critically of State/Territory versus Commonwealth powers.

The speech of Labor frontbencher (now Labor leader) Anthony Albanese is of note for its eloquence and passion: ‘This debate is hard – real hard,’ Albanese said. ‘It is hard because it is about death.’ He went on:

Most people are uncomfortable talking about dying … [Yet] this debate, as hard as it may be, is important. The outcome of this debate will reflect on our maturity both as a parliament and as a nation for it will determine the manner in which we seek to control each other’s lives.

I oppose this [Andrews] bill because I support human dignity. I oppose this bill because I support freedom of choice. I oppose this bill because I support civil liberties. I oppose this bill because my Christian upbringing taught me that compassion is important. I oppose this bill because modern medical practice should be open and accountable, not covert and dishonest…

I oppose this bill because I oppose the moral posturing of the Lyons Forum. I oppose the hypocrisy of those who say, ‘This debate is so important’ and then vote to debate it upstairs in sideshow alley.

Most importantly, I oppose this bill for one critical reason, and that is this. We have all accepted that this parliamentary debate should be a matter for our conscience.

How arrogant to then suggest that the ability to exercise conscience should be taken from a seriously ill patient who wants to die. There is nothing moral about our exercising a free conscience vote as members of parliament and then voting to deny to others the right to exercise their conscience.

What possible right do Kevin Andrews, Leo McLeay, Lindsay Tanner or Anthony Albanese have to have exercised Bob Dent’s conscience for him? It was his decision and he had a right to do that.

Of those who focused on territory rights, it was the Territory’s own Senator Bob Collins who led the way. Although a hostile opponent of the ROTI law, Collins was angry at the vilification of both the Territory and its politicians by Federal Parliamentarians. He was especially critical of Kevin Andrews and Senator Eric Abetz from Tasmania.

He was angry at Andrews for his audacity to think that ‘Territorians have no rights, only obligations’. Collins was also scathing of Abetz when the latter had tried to argue that ‘the Northern Territory parliament exists only by the grace and favour of the Commonwealth parliament. What the Commonwealth parliament gives, it can also take away’.

‘This’, said Collins, ‘from a senator from a state with about twice the population of the Northern Territory’s, and five times its representation in the House of Representatives and six times its representation here in the Senate’.

Mark Latham also supported both points made by Collins, but is best remembered for the following:

The euthanasia debate … should not be about forcing terminally ill people to judge life itself through the prism of someone else’s moral code. The only way religious questions have ever been successfully dealt with in public policy is by fostering choice.

Terminally ill citizens deserve nothing less than liberty in determining the manner by which their lives might end.

Other politicians focused more on their own moment in history.

Citing the eighteenth-century libertarian Edmund Burke in some detail, Barry Jones followed Burke’s lead, stating that he as ‘your representative’, ‘owes you, not his industry only, but his judgment; and he betrays instead of serving you if he sacrifices it to your opinion’. Jones’s mistake – and that of other politicians who drew on Burke – was to believe that it was appropriate for politicians to dismiss the ‘opinion’ of their electorates in favour of their own prejudices.

Sure, the political paternalism of Burke might have suited the uneducated, illiterate electorate of Bristol more than 200 years ago. But it is nothing short of arrogant to suggest that politicians like Barry Jones should do our thinking for us.

If Burke must be treated as the patron saint of politicians, then those who quote him should reacquaint themselves with the letterhead of the Whistle Blowers’ Society: ‘All that is necessary for the triumph of evil is that good men do nothing’.

Letters to the editor in the Sydney Morning Herald echoed my own feelings at what had just happened at the hands of the politicians:

I don’t understand why these evangelists of their own belief systems have the right to take away another individual’s right to end his or her own suffering.
This is the worst kind of politicking, far worse than acting out at Question Time, making errors with expenses or jetting around on fact-finding missions. I don’t care what ‘God’ a politician chooses to follow, but when his belief affects others I consider he has overstepped his already poor standing in the community.

My heart goes out to those who are suffering and those wanting to help them within the law.

Kevin fails to show for final Townhall debate

Kevin Andrews fails to show for final Townhall debate

The phoenix that rose to become Exit International

As the fog lifted in the weeks following the success of the Andrews Bill, it became clear that while the ROTI Act was no more, the need for people to have access, if not to voluntary euthanasia, then to information about end-of-life options remained. Sick people still wanted to die. And so my focus changed. Political lobbying was over.

The previous twelve months had been as intense as they had been public and they had taken their toll on me. Yet I found that my work was just beginning.

I established the Voluntary Euthanasia Research Foundation (VERF) for people wanting to find out more and began a workshop and clinic program for people wanting to find out more that has since spread to all Australian capital cities and more recently to New Zealand.

One of the other challenges I took on in 1998 was to stand against Kevin Andrews in the federal election. Putting my money where my mouth was, I moved to Melbourne to stand in Andrews’ own electorate of Menzies, in Melbourne’s eastern suburbs.

During the campaign I worked closely with the Victoria Voluntary Euthanasia Society. Distinct from the poor effort they had made defending the NT legislation in Federal Parliament, they put their total support behind my challenge, and it gave me some insight as to what might have been possible when we were trying to defend the ROTI Act. If only.

Menzies Campaign party

Menzies Campaign party, election day, November 2007

Over $120 000 in donations came in, an amount that stood then as one of the highest records for campaign funds ever raised by an independent candidate. On election day we secured nearly 10 per cent of the primary vote.

While I’m not sure how worried Kevin Andrews was on that day, we were pleased that the Liberal seat of Menzies was forced to count preferences for the first time. This seemed suitable payback for the misery that his bill had caused, and this sentiment reminded me of another letter I had seen in the newspaper back in March 1997:

May I wish Mr Kevin Andrews a long and excruciatingly painful life.

With the 1998 election out of the way, my attention turned to the world stage and I flew to Zurich to attend the Conference of the World Federation of Right-to-Die Organisations.

There I spoke at length on the concept first put forward by Huib Drion of the Drion Pill.

Building on the conceptual work of Drion, I presented my own early thoughts on what the development of a ‘Peaceful Pill’ project might involve.

Given the unlikelihood of another VE law, I was already aware that new strategies were needed.

VERF, the foundation I established, was renamed Exit … the rest as they say is history.

Philip Nitschke, Amsterdam 31 January 2021

 

Aftermath of Menzies, 2007

Aftermath of Menzies, 2007

December 8, 2020

Mental Illness & the Good Death

This blog entry has been prompted by the recent wave of law reform occurring in Australia and its neighbour, New Zealand.

From a rocky start some 25 years ago when the Northern Territory (one of Australia’s 3 territories vis a vis states) passed the Rights of the Terminally Ill Act (the law lasted only 9 months before it was overturned by the Federal Australian government).

Fast forward to 2021 when Victoria and West Australia have passed assisted suicide/ dying laws, and the cogs of the legislative wheel are now turning in Tasmania and Queensland.

Every place in Australia (and New Zealand for that matter) that has passed or is contemplating the introduction of end of life choices laws, is excluding people with a mental health diagnosis.

In the area of mental illness and assistance to die, Australia and New Zealand are following the lead of countries like the US and Canada in excluding mental illness as a qualifying criteria.

Australia is not following the lead of countries such as the Netherlands, Belgium and Luxembourg where euthanasia is not only available to children, but to the mentally ill.

While Swiss law mandates ‘mental capacity’ before a person can be helped to die, that country has also, wisely, decided against a conflation of mental illness with a loss of capacity.

For this they are to be commended.

As a position statement, Exit International fully supports the right of a mentally ill adult to  a) take their own life and b) request assistance to take their own life, as long as they have the mental capacity to make an informed choice and to understand the consequences of their actions.

While mental capacity is usually determined by a psychiatric assessment (as is the process at Pegasos in Switzerland), Exit is currently exploring AI (artificial intelligence) possibilities in this regard.

This exploration of AI is intended to contribute to the demedicalisation of death: to finally, and once and for all, remove control over the decision to die from the medical profession.

It is indefensible, and ignorant, for a law on end of life rights to automatically exclude a person with depression, dementia or other mental illness from being able to request assistance to die. Or to be able to take their own life themselves.

This is the medical model of ‘mental capacity’ determination run wild.

It raises the question that never goes away. What right should the medical profession have over a person’s right to die?

The more progressive scholarly literature shows that mental capacity cannot, and should not, be determined (or predicted) solely on the basis of a mental illness diagnosis.

Nor should a civilised society wash its hands of those who are mentally ill: people who may present with a long-held, considered wish to die.

Exit welcomes people who have mental illness to subscribe to the Peaceful Pill eHandbook.

We do what we can to be egalitarian in access.

What we request is that subscribers show they have the mental capacity to make informed decisions. One’s diagnosis is much less important.

Exit’s approach mirrors that of western legal systems where mental capacity is assumed, unless there is evidence to the contrary.

Adam Maier-Clayton (27 years) made contact with Exit and had several conversations with Philip Nitschke about the end of life options available to him.

Adam then used the Peaceful Pill eHandbook to obtain end of life drugs.

He did this with the support of his parents who did not want him to live a life of suffering.

Adam had multiple mental health diagnoses including severe anxiety, obsessive-compulsive disorder, and dissociative disorder. Did he have mental capacity? Without doubt!

What upset Adam’s parents (and Philip Nitschke) was that Adam died alone in a strange motel room.

Adam wanted to shield his parents, Margaret and Graham, from any accusation that they assisted him.

Adam Clayton was a young, intellectual man with a deeply considered (and considerate) outlook on the world.

Vice told Adam’s story in their 2019 feature documentary, Time to Die.

Adam Maier-Clayton remains an inspiration to Exit in our work towards ensuring that ‘a good death is everybody’s right’: not only those who are terminally ill with < 6 months to live as Australia’s new laws demand!

Adam Maier Clayton