May 4, 2023

Exit Does Not Support ‘Sanctioned Suicide’ Site

This Blog Entry is a FACT CHECK to ensure discussion is based on the truth and not what some would like to believe is the truth.

There are no alternative facts in this regard.

To make it clear, Exit International has NO relationship to the Sanctioned Suicide online forums (despite what some may allege).

Exit does not and never has supported these forums.

Indeed, Exit has reported these forums over the years – when possible to hosting companies – for breach of copyright.

Sanctioned Suicide are well versed in playing cat and mouse in ensuring their site remains live.

Exit has also, in the past, written to the media (eg.BBC) to encourage them to focus on Sanctioned Suicide and use the power of the media to have them taken down, permanently. We have issued more take-down notices that we can count.

Exit continues to work hard to ensure that anyone who is in the Sanctioned Suicide forums does not also have access to the Peaceful Pill eHandbook, even if they are over 50 years.

This is why our high-security, photo ID video authentication and the mandate that one must be over the age of 50 years was instigated prior to the sale of every Peaceful Pill eHandbook.

In terms of copyright, Exit is always aggrieved when the copyright of the authors of the Peaceful Pill eHandbook is breached on any site or any public forum. This is theft.

Exit is especially annoyed when past editions of the book have found their way to the Sanctioned Suicide forums given that its members include young people.

Exit watches the Sanctioned Suicide forums daily.

Exit removes rights of access to the Peaceful Pill eHandbook as soon as we become aware that a person may be posting information from the book. Indeed, posting or sharing the contents of the eHandbook with a third party – online or offline – is a breach of our terms of sale and justification for a life ban on re-subscribing.

In regard to Canadian Kenneth Law, Exit has no association or acquaintance with him. Law is not and never has been a subscriber to the Peaceful Pill eHandbook.

It is a travesty that young people are being needlessly caught up in older people’s legitimate and rightful access to end of life information.

Exit stands by our belief that older people (over 50 years) and those who are seriously ill have a basic right to the best end of life information.

A peaceful death is every (elderly and seriously ill) person’s right!

See the Exit International website for more on Exit’s Philosophy

April 30, 2023

Overcoming Impediments to MAiD Another approach?

Overcoming impediments to medically assisted dying: A signal for another approach?

This Blog was originally published in the British Medical Journal of Medical Ethics on 6 April 2023.

By Juergen Dankwort (Chapter Coordinator – Canada, Exit International)

The proposal to provide assistance with voluntary assisted dying (VAD) has grown significantly over the past two decades at an accelerating rate.

Right-to-die movement societies and organizations now number over 80 from around the world, 58 of which are members of the World Federation of Right to Die Societies.

However, most are also increasingly beset with formidable challenges opposing their advances that raise profound ethical, moral and legal considerations.

The prevalent approach towards VAD

A review of these assisted dying regimes show how they were set up through legislative acts often resulting from initial court challenges to an existing assisted dying prohibition within that country’s criminal code.

They reveal a common paradigmatic model whereby the criminal act remained intact with amendments added establishing a legislated framework to allow a service under specifically designated conditions and exempting the providers from punishment.

Generally, the legal criterion for accessing such a medically-centred service requires a person to be suffering intolerably from an existing, irremediable condition defined within legislated parameters, establishing who may access them, best practices, where and when they can be done, and who may perform them.

While not alone, Canada’s often-vaunted medically assisted dying regime (also known as MAID), implemented in 2016, is exemplary of this development with attendant massive challenges facing it.

Its formulation illustrates an attempt to balance a previously court-declared constitutional right to life, liberty and security of the person with a perceived societal harm resulting from a state-sanctioned service to assisted dying.

Such legislated regimes have since been challenged legally numerous times by persons refused access, while featuring alarming stories in the media when access was sought and granted.

A backlash to VAD has gained recent traction.

Traditional assisted dying opponents, including the orthodox religious, some disability groups, and conservative politicians who often troll to their populist base, are joined by additional academics and some physicians, providing more legitimacy with compelling arguments at stopping any wider access to a state-initiated and financially-covered national health service.

Germany breaks tradition

In a remarkable judgment by the German Federal Constitutional Court in February 2020, regarding assisted suicide, a ground-breaking option for any country or jurisdiction contemplating the creation of an assisted dying regime was identified that may well avoid much of the controversy and many of the challenges faced by existing ones.

It does so by revealing a pathway to set up the service based on an entirely different orientation and approach from the existing one that began decades earlier in Europe, and later largely copied by others.

The German Court’s ruling stated for the first time that matters of quality of life and degrees of suffering are wholly subjective and that governments should therefore not prescribe nor proscribe assisted dying access based on categories of populations defined by such individually-experienced life-determinants because such restrictions would violate entrenched principles regarding personal autonomy and the liberal foundation separating state and personhood in pluralist societies.

A VAD regime built on this premise could then also avoid all expressed objection to assisted suicide, no longer based on those normative criteria.

A recent study out of Europe contrasting two ways of how assisted dying services function, detail the actual process deciding for whom and when the service may be administered and who can perform it. The legislated regime of Belgium – a model used for Canada’s – was compared with the process in Switzerland.

Importantly, no legislated system was erected in Switzerland that specifies through amendments or exceptions how, when, by, and for whom it may be done.

It has remained unlawful for decades with the simple caveat if it is done to exploit another vulnerable person. Several salient differences were observed by the researchers that also reveal the challenges presently facing existing VAD regimes.

The Swiss model featured:

• less hierarchical structure in decision-making
• less institutionalized through legislation
• less subject to resulting cultural and political opposition
• unencumbered by delays to service based on lengthy court decisions regarding eligibility, best practice, who was authorized to perform the service
• more pliant as the normative decisions for service provision and administration could be determined by those immediately implicated on a case-by-case basis in line with changing health determinants.

While claims that Canada has become the wild west for assisted dying with catastrophic consequences is arguably exaggerated given its stringent access requirements, it is nevertheless exemplary of a heightened political drama resulting from the path it took historically that set it on its stormy course.

That begs the question if the many countries and jurisdictions now considering a VAD gateway might not consider taking a different route illustrated by the current Swiss way, recently given a legal foundation by its European neighbour.

Though convincing evidence is still lacking on how expanding assisted dying allegedly leads to a slippery slope of harming the most vulnerable, as reported by some right-to-die societies and as shown in studies, opposition and barriers to it will likely invite more impulsive, desperate suicides that may traumatize and endanger friends, family, and first responders.

Author:  Juergen Dankwort

Affiliations: Associate, University of West Virginia Research Center on Violence

Competing interests: Member, Right to Die Society of Canada; Supporter, World Federation of Right to Die Societies; Coordinator, Canada chapter, Exit International.

Declaration

The author was not paid by any organization, group, government or individual in conducting research for and writing this article.

Drs Juergen Dankwort & Philip Nitschke, Vancouver BC Canada, 2017

October 9, 2022

What if there were a Shop for Nembutal?

Over summer, Exit’s Philip Nitschke made the trek to the Dutch city of Utrecht to have a look at the new XTC (ecstasy) pop-up shop, asking what if there were a Shop for Nembutal?

An initiative of the Poppi Drug Museum in Amsterdam and in partnership with the University of Utrecht, the purpose of the pop-up was to show the public different possible modes by which XTC could be distributed, if it were made legal.

There is a current push in the Netherlands to tackle black-market drug crime through the legalisation and regulation of so-called party drugs such as XTC/ MDMA.

Another sunny Sunday in Utrecht

1. The candy store

The first model by which party-goers could access XTC was in a store akin to a candy store.

In the mock-up, pop-up, visitors filled in a survey on one of the bolted-down ipads and were then rewarded with their mock-up ecstasy pill from the candy vending machine.

The Dutch love their sweets/ candy (Snoeptjes)  – so a candy store was an obvious choice to get the crowds in.

The Mock-Up Candy Store

The Candy Machine

2. The Government Pharmacy

A second model of distribution was the clinical, regulated government pharmacy.

In such a pharmacy, the drugs would be provided in packets similar to any over-the-counter drugs such as paracetamol for headaches or loratadine for allergies.

Distribution would be tightly controlled with this model.

The Government Pharmacy

3. Nightclub

The third model was via a vending machine in a night club.

In this model the drugs would be provided in a convenient match box packet. Perfect for all-night clubbing.

The Nightclub Vending Machine

The questions that visitors to the pop-up needed to answer before they could receive their mock-up drugs included:

• What age limits, if any, should apply
• Should photo ID be required
• Should a doctor’s script be required
• In what forms the drugs should be made available (drinkable shots or pills or lollipops/ brownies etc)
• For what purpose should XTC be available (eg. only for therapeutic purposes eg. past trauma)

Different drug packaging. From top: pharmacy, nightclub & candy vending machine

Each model of distribution asked a different set of questions.

The initiative was confronting, thought-provoking and a progressive look into a future where drugs are de-criminlised and the black market eliminated.

Exit Proposal

This type of de-criminalisation initiative could also be applied to sodium pentobarbital, Nembutal.

Then elderly people would not need to risk having to deal with online scammers.

Nor would one need to book travel to far off destinations such as Peru or Mexico.

And no one would need to sneak around like a criminal just to get the drug that is an insurance policy for the future.

So how would it work?

The most sensible model would surely be the ‘Government Pharmacy’.

2 Safeguards would apply.

1. Photo ID (proving one is over 70 years) would be shown at the door.

2. The client would complete a supervised AI survey to assess and confirm their mental capacity.

Once these two criteria were addressed, the drugs would be dispensed.

Regulations would apply to their safe storage in the home.

This is food for thoughtful consideration for the future, isn’t it?

A Vision for the Future?

Read more in an article from The Guardian (18 August 2022)

October 1, 2022

Backlog of Euthanasia Requests by Mental Health Sufferers

In a report to the Dutch Parliament this week, the Dutch Minister for Health, Ernst Kuipers, has reported on the problems associated with the backlog of euthanasia requests by mental health sufferers (inc those with dementia) in the Netherlands.

Reports such as this are a key element in the Netherland’s commitment to transparency in the system.

Ernst Kuipers writes:

Since 2010, there has been an increase in the number of euthanasia in cases based on mental suffering. In 2021, there were 115 euthanasia deaths, representing 1.5% of the total number of euthanasia deaths in the Netherlands.

In the vast majority of those cases (83 out of 115), the euthanasia was performed by a doctor affiliated with the Euthanasia Expertise Centre, (EE), rather than by the treating psychiatrist.

The Euthanasia Expertise Centre’s own study of this target group has shown that 70% of those who applied in the period 2012 – 2018 were rejected: mostly due to the requirements of the Termination of Life on Request and Assisted Suicide Act (Wtl) were not met.

A further 20% of patients voluntarily withdrew themselves from the process. However, the majority of those who made a request to the EE for euthanasia were rejected.

The number of requests received by the EE from people with mental suffering has increased to such an extent that the demand for help and the supply of care are out of balance. There is now a waiting list of around two years.

This has not only led to too high a workload at the EE, and the Centre believes that it would be better if the patient were helped by their own practitioner.

In this regard, the EE is working actively to ensure that more people are helped in regular mental health (mental health) care. This will help reduce the waiting list.

In 2021 there has been some progress in this regard with more euthanasia deaths occurring place outside the EE. Also in 2021, mental health practitioners sought the help of an EE counsellor (28% more often in 2021 than in 2020).

Cooperation and exchange in knowledge and experience between the EE and the mental health field has been strengthened by the deployment of an EE relationship manager who actively seeks contact with regional mental health organisations and highlights the EE as a source of advice, support and training.

However, in practice, patients are still being referred to the Euthanasia Expertise Centre too often and too quickly. Reluctance and hesitancy to act on the part of mental health practitioners and other doctors who have received a euthanasia request from a patient.

A request for euthanasia may be a symptom of the psychiatric illness. This may affect the person’s capacity to consent to a euthanasia request. The death wish may vary in intensity but be persistent.

When a persistent death wish develops into a euthanasia request based on psychological suffering, Kuipers notes that it is ‘important to carefully explore and assess this request’.

While most Dutch psychiatrists support the idea of euthanasia for psychological suffering, there remains a reluctance among psychiatrists to explore and assess a euthanasia request or to perform euthanasia themselves.

Kuipers reports that this is related to the fact that psychiatrists very rarely have to deal with a euthanasia request from their patients (ie. a few times in their careers and thus remain relatively inexperienced in the process).

Indeed, research from the Euthanasia Expertise Centre has shown that a significant proportion of referrals to the EE were made because the psychiatrist did not consider him/herself competent to make the assessment or perform the euthanasia.

In addition, there is a reluctance because psychiatrists consider the assessment of a euthanasia request on psychological grounds to be exceedingly complex.

Backlog of Euthanasia Requests by Mental Health Sufferers

Kuiper’s concludes that it is against this background that the policy vision of providing timely and appropriate care to people who, because of their psychological suffering request euthanasia, must be fulfilled.

‘People with a persistent euthanasia request on psychological grounds should be able to count on help at the right time, in the right place and preferably without a (long) wait’ he says.

Read the full report (in Dutch) on the Riksoverheid website.