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Peaceful Pill Blog

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

November 8, 2020

Dying in Switzerland during COVID-19

This week’s news has concerned an anonymous 45 year old British woman (Ms Anon) who went public with her plight to die.

According to the media reports, her story went like this.

She had gone from working in a senior position in the NHS (National Health Service). But then got the diagnosis so many women dread: breast cancer.

With a terminal diagnosis, Ms Anon, was opting for Switzerland. A trip to Zurich, to Dignitas to be specific.

The media reports made 3-4 main points.

We applied the Exit Fact Checker to each of them to see where the truth lies!

  1. Right to die laws in the UK are archaic!  TRUE
  2. If she was going to go to Switzerland she had to go before lockdown POSSIBLY TRUE THEN BUT NOT TRUE NOW
  3. She got a personal exemption for travel from the Swiss Government FALSE
  4. She had to leave family behind FALSE

Let’s take each in turn.

UK Right to Die Laws are Archaic

The most recent attempts to change the law in the UK, concern the Assisted Dying Bills of Labor Lord Charlie Falconer (2014) and then MP for Wolverhampton South West, Rob Marris (2015).

The laws proposed were strict medical models.

Terminally ill, no dementia (or other mental illness), approved by 2 doctors. No Ifs & no buts.

Neither Bills produced a change in the law in the UK.

Leaving the UK in Lockdown for a VAD in Switzerland

Until the UK Health Secretary Matt Hancock clarified the status of travel for a VAD during the British lockdown, this point was perhaps not clear.

It is now obvious that a one-way trip to Switzerland for an assisted suicide constitutes a ‘reasonable excuse’ for leaving home.

Personal Exemptions to Enter Switzerland

During the pandemic, groups such as Pegasos Swiss Association have been operating quietly and consistently, working with the Swiss Authorities to allow clients into the country for the purpose of a Voluntary Assisted Death.

Pegasos has achieved this streamlined operation via their quiet professionalism, and in the context of their excellent relations with the Swiss Government.

Pegasos has never needed to enter into their own fanfare. They have no need for sensational headlines, believing instead that quietly-but-surely is the best way to conduct their VAD service at this time of great need.

So-called ‘Personal Exemptions’ have never been required if the person coming to Switzerland is a member of a well-administered, professional organisation such as Pegasos Swiss Association.

Leaving Family Behind

Throughout the COVID-19 pandemic, Pegasos Swiss Association has continued to welcome the family and loved ones of the person receiving the VAD at their clinic outside of Basel.

No one has needed to leave their family behind, just because of COVID-19

The Swiss Government recognises that a person coming to their country for a VAD should be supported by those they love. This is the only compassionate thing to do.

It is nothing short of misleading to suggest that a person must have a VAD alone in Switzerland. The experience of Pegasos shows that this is simply not the case.

In Conclusion

This blog post has been written to provide correct, factual reporting on the current state of play of dying in Switzerland.

While it is to be expected that the media can get important points wrong, the type of scare-mongering put out by Dying with Dignity UK, a lobby group who should know better, is both disappointing and destructive.

Anyone desperate enough so as to be interested in going to Switzerland to die, should not be used as a political pawn in a group’s advocacy campaigning.

There is more to the promotion of the right to die issue than the tabloid headline. There is the ethical and moral obligation to push and report the facts as they stand. Not as some shameful, worse case scenario, peddled only to an organisation’s personal brand profile.

People’s lives (and deaths) are at stake.


November 1, 2020

NZ Votes Yes to Voluntary Euthanasia

On Saturday 17 October 2020, New Zealand held its most recent federal election.

Coupled with the election were 2 referenda.

One on euthanasia, the other on cannabis.

In counting to date, around 65% of voters voted in favour of legalising assisted suicide/ assisted dying for the terminally ill. The final result will not be known until 6 November.

This is perhaps, in part, the legacy of NZ lawyer, Lucretia Seales, who died of a brain tumour in 2015.

The new law will not take effect until 12 months after the result is know (so that is 6 November 20201 – if they world does not end first).

This is a bit of a major step for a country whose Chief Censor (yes such a post exists in New Zealand), 12 years ago, banned and then approved (with heavy redactions) an early edition of The Peaceful Pill Handbook. Censorship is alive and well in this country.

Philip Nitschke & Former VE Society of NZ President Jack Jones (dec) with a redacted Peaceful Pill Handbook in Auckland, 2008.

Voting ‘yes’ is also a major step for a country that continues to harbor such conservative anti-choice groups such as the Society for the Protection of Community Standards.

It is a major leap forward for a country who, in the 1950s, eagerly classified one of its most famous writers, Janet Frame, as an antipodean madwoman with schizophrenia, while her diagnostic conclusion in the UK was that she was ‘just different’; a shy woman who preferred to be alone.

And in case readers were at risk of forgetting, this is the country where in 2016 Police set up an unlawful roadblock, known as Operation Painter, not far from Suzy Austen’s potluck Sunday lunch to trick the Exit Members who attended into handing over their name and addresses; so as they could be put under police surveillance and later visited and compelled to hand over any end of life drugs they may have illegally acquired.

Suzy Austen defeats Operation Painter

Suzy Austen outside the Wellington High Court, 23 February 2018

What is it that New Zealanders have voted for?

As with the Australian state of Victoria, when voluntary euthanasia/ assisted suicide/ assisted dying becomes the law in NZ, it will be situated within the medical model.

Those assisting must be medical professionals.

Those receiving the assistance must be terminally ill with < 6 months to live.

People of advanced old age are excluded from eligibility as are those with a disability (eg. quadriplegia) or a mental illness, such as dementia.

The End of Life Choice Act

  • be aged 18 years or over
  • be a citizen or permanent resident of New Zealand
  • suffer from a terminal illness that is likely to end their life within 6 months
  • have significant and ongoing decline in physical capability
  • experience unbearable suffering that cannot be eased
  • be able to make an informed decision about assisted dying.

A treating doctor may also NOT suggest voluntary euthanasia as an option.

A request for voluntary euthanasia may NOT be included in an advance directive.

Interestingly, the Act DOES provide for the administration of a lethal injection, instigated by either the person or the medical professional.

Medical Profession Oversight

As with all medical model end of life laws, doctors will play a central role in the End of Life Choice Act.

In this regard, if a  doctor decides that the person requesting assisted dying is eligible, they must seek a second opinion from an independent doctor.

The independent doctor must also agree that the person meets all the criteria, which includes being competent to make an informed decision about assisted dying.

If either doctor is unsure of the person’s ability to make an informed decision, a third opinion from a psychiatrist is required.

Available Methods

1. Ingestion, triggered by the person.

2. Intravenous delivery, triggered by the person.

3. Ingestion through a tube, triggered by the doctor or a nurse practitioner.

4. Injection, administered by the doctor or a nurse practitioner.

Oversight will be via the ‘Support and Consultation for End of Life in New Zealand (SCENZ) Group’ and an End of Life Review Committee.

This SCENZ Group will ‘make and maintain a list of doctors who are willing to act as replacement and/or independent doctors’.

A Summary of the End of Life Choice Act

As with all medical model legislation, there are considerable hurdles that must be completed before one is able to use the law.

This type of regime of so-called safeguards makes the society that has voted in the law feel much more comfortable with their decision.

However, it harks back to the question raised by Bob Dent in Darwin in 1996 when he became the first person in the world to receive a legal, lethal voluntary injection under the Rights of the Terminally Ill Act (NT).

Bob questioned the fact that as a dying man he was forced to undergo so much final testing, just to be able to die in peace. He always maintained that had he had the drugs at home in the cupboard he would have simply gone quietly to the cupboard and taken them. He did think it fair or reasonable to have been seemingly persecuted by the burden of proof.

And then there are the Issues of Old Age & Awful Diseases that Kill Slowly

A law that expressly excludes people of advanced age, people like 104-year old Australian ecologist Professor David Goodall, who was not sick but was old (enough), are not laws for everyone.

And a law that mandates certain death within 6 months is simply cruel. Such a law would never have served Melbourne firefighter Troy Thornton who had multiple system atrophy (and was becoming slowly but surely completely paralysed, and who chose to die in Switzerland) or New Zealanders like Rachel Rypma who has Huntington’s Disease, one of the most cruel and degrading genetic conditions ever invented.

Indeed, with this exclusion they make themselves laws for the very few.

For Exit this remains a needless restriction. Perhaps the most meaningless restriction; especially given the fact that we are likely to live longer in poorer health than any generation preceding us.

What about the Colonisation of Dying and Death by the Medical Profession?

The one aspect of New Zealand’s End of Life Choice Act must be the central role of the medical profession in the operation of the Act.

Unlike in Switzerland where a person does NOT need to be terminally ill (or even sick), but only needs to have the capacity to understand and initiate the act themselves and the person providing assistance only does so for altruistic reasons, like so many other countries New Zealand has created a framework that inserts a medical professional into an area of human existence which is not intrinsically medical in nature.

As British public health specialist, Dr Lucy Thomas, wrote recently (30 September) in the British Medical Journal:

… giving people access to the means to end their life is not, in itself, a medical procedure, and there is no practical need to involve a medical professional. More fundamentally, it becomes difficult to reduce something as profoundly complex as the desire to end life to a medical problem.

All of us experience suffering in our lives, and at times we all ponder the meaning of our existence in the context of our personal histories, social relationships, and wider circumstances. Many of us have occasions when we question whether our lives are worth living, and some go as far as to consider ending life, either in a moment of desperation or after lengthy, considered deliberation. The underlying existential struggle is not fundamentally different in the presence or absence of illness or disability; nor is it determined by how long or short a remaining life is predicted to be.

Philip Nitschke in Zurich

In doing so, medical professionals become the gate-keepers of this most private and intimate of all life’s decisions.

And, in being the gate-keepers, they are the wielders and arbiters of power over the lives (and deaths) of others.

Exit congratulates New Zealand on their great leap forward but with these reservations in mind, we wonder how great a leap it truly is, and the perspective of forward and backward can surely only be understood from one’s unique standpoint?

October 18, 2020

Letter from Ireland Doxit Podcast

Exit first met Tom Curran in 2008 when he attended our initial Irish workshop at the Seomra Spraoi anarchist collective in Dublin (because no other booked venue would host the public meeting and workshop): such was the controversy surrounding assisted suicide/ assisted dying in Ireland.

Fast forward a decade, and Tom has become the legitimate face of the Irish right to die movement.

A director of Exit International, Tom’s commitment stems from the experience of his late partner, Marie Flemming who died in 2013 after suffering for many years from MS. In recent weeks, the Irish Parliament has voted to progress a Dying with Dignity Bill to the committee stage.

Listen to Tom’s journey over the past decade and his instrumental role in pushing for a law for people with a ‘life-limiting’ condition.

Listen Here on Anchor

Listen Here on the Peaceful Pill Handbook site

Tom Curran Podcast