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Peaceful Pill Blog

January 23, 2017

Only in America

The US is nothing if not a country full of real surprises. One has to look no further than at this week’s inauguration to have that confirmed.

But of relevance to those wanting access the choice of a peaceful death, and in particular those in the US States that have now passed legislation granting permission for the dying to access lethal drugs, is this.

The Canadian manufacturer of the barbiturate drug, Seconal, has decided to hike the price. And, not just a little, but by a massive 200%!

As far back as April 2016, the Seattle Times reported that Valeant Pharmaceuticals International of Quebec had raised the price of a 10gm dose of the drug from its original price of ~$150 to a staggering $3000!

Why not shop elsewhere I hear you say?

The equivalent (or even preferred) barbiturate, Nembutal, the drug universally used in Europe for an assisted suicide, is not (legally) available in North America. This is because of its role in US executions.

There can be no justification for this sudden price rise other than corporate greed. The only explanation is that the company realized its marketing edge – with the passage of assisted suicide laws in California, Colorado and Canada – and decided to go in for a killing – so to speak!

And while Valeant has been getting rich,  it was quickly becoming clear that some in the US will miss the cut. Not because they aren’t sick enough to qualify (even if they could convince a panel of doctors that they are of sound mind), but simply because they are just too poor: too poor to die.

So the call has gone out for a cheap, peaceful, lethal alternative.

The result is the proposed mixture of three common (and cheap) drugs

  • The 1900’s sedative Chloral Hydrate
  • Morphine
  • The slow-acting Barbiturate, Phenobarb (which is still used as an anti-convulsant)

There is little doubt that this combination will work and work well.

It will be a little slower than the hitherto unaffordable Seconal (or unavailable Nembutal). But it will be reliable.

Those who have taken the combination have certainly died.

Although reports suggest that it does leave a literal bad taste in the mouth. Not just from the thought of having been forced to use a drug(s) that is second best, but because of the very real burning taste that comes with drinking the significant amount of chloral hydrate.

This is why in mid-2016 a new non-burning cheap drug mixture was developed.

This new mixture comprised four drugs:

  • Morphine (again)
  • Valium &
  • The cardio-toxic combination of Digoxin and the B Blocker Propanolol.

Total cost of the new combo ~$500: a bit more afordable than the $3000 a pop Seconal. And very much on a price par with illegal Nembutal, as it is purchased over the Net.

The new combo, known as DDMP, is now used widely in the US.

Valeant may have, metaphorically, cut their own throat.

To regain market share they will have to slash their price.

A script price of closer to the $100 it actually costs to manufacture the drug would be a good step (after all Valeant, did not invent the barbiturates: that was down to Alfred Baeyer back in 1864).

But for those who want absolute control, with none of the restrictive legislative entanglement of the new US and Canadian laws, the appeal of having $500 / 25gm of pure Nembutal powder in the cupboard, just in case, remains strong, although illegal (we have to add that bit).

However, with a shelf life better than 30 years, some say the choice is a no-brainer.

The issue will be explored in greater detail in the next Update to The Peaceful Pill eHandbook.

For more information see:

Seattle Times

Kaiser Health News

Philip Nitschke

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January 9, 2017

Harm Minimization & Drug Testing

The January 2017 Update to The Peaceful Pill eHandbook identifies a commercial laboratory that will test your Nembutal.

Free preview at: The Peaceful Pill eHandbook

The decision to die is the most serious and profound decision any of us will ever make.

At Exit we believe that the decision to die at a time and place of our choosing is a fundamental human and civil right.

A good death – euthanasia  – is not a privilege to be bestowed only on the very sick by the medical profession.

Rather, it is something that should be within the reach – if desired – of every rational adult.

Putting an end of life plan in place allows an individual to organize their death.

While there is a range of ways that a peaceful, reliable death can be achieved, for many the role of the barbiturates is top among the possibilities.

Pentobarbital powder from China or liquid from South America each provide a peaceful, reliable death. But only if they are not adulterated.

The testing of barbiturate powder will give its owner peace of mind when and if the time arises for its use.

More than this, verification that the powder purchased as Nembutal is indeed Nembutal is the responsible thing to do. This will benefit those who might be with the person when they ‘exit’, and others who might find the person in the morning.

The right to a peaceful and reliable death brings with it responsibility.

Drug-testing to ensures that one’s Nembutal is the real thing, is a strategy of harm minimization.

Harm minimization has emerged in modern medicine as a guiding principle.

This is because testing addresses the risk of failure and the possibility of a nasty surprise which a failed attempt ultimately brings.

Positive test results should bring peace of mind to all concerned.

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November 17, 2016

Global Law Reform: 2 Steps Forward, 1 Step Back

There is little doubt that voluntary euthanasia/ ‘medical aid in dying’ law reform is on the move!

The recent success of Colorado’s Proposition 106 is the good news story in this regard.

You can read more about this new End of Life Choices law here.

Following on Colorado’s heels is Washington DC’s Council passing their ‘Death with Dignity’ bill this week.

That bill is now at the Mayor’s desk awaiting signature into law.

Both the Colorado Act and Washington Bill are incredibly restrictive.

Both allow assistance only for the terminally ill, with less than six months to live.

The entire process is doctor controlled and mediated. This the ‘medical model’ of assisted dying writ large.

The third place to move on Voluntary Euthanasia/ Assisted Dying is the small Australian state of South Australia.

However the news is less good from here. Disastrous in fact.

The bill was introduced by Liberal MP Duncan McFetridge. With a tied vote of 23 votes for and against the Speaker of the House of Assembly, Michael Atkinson, voted against the bill. The fat lady has sung.

This is the 15th time a Voluntary Euthanasia bill has been defeated in this tiny state’s Parliament.

Exit Member, Max Bromson, was instrumental in bringing the issue back to public debate in South Australia.

Max died in July 2014 after illegally importing Nembutal from China.

Max was 66 years old and suffering from bone cancer.

Max Bromson & Philip Nitschke

Max Bromson & Philip Nitschke at Adelaide Central Markets, July 2014

The next Australian state to address the issue will be Victoria in early December 2016.

Watch this space for updates.

Fiona Stewart

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November 6, 2016

Why America’s Medical Aid in Dying Acts are Failing Seniors

In recent weeks, the Dutch Ambassador to New Zealand, Robert Zaagman, has described NZ political debate about whether to introduce a voluntary euthanasia/ assisted suicide law as being akin to Dutch debate 20 years ago.

While an increasing number of US States are moving beyond the ‘should we’ – ‘shouldn’t we’ legislate on end of life choices, the model that States such as Colorado and Washington DC are envisaging is far from ideal. Indeed it could even be discriminatory and cruel.

In Exit’s opinion, the chosen model of law is so firmly predicated on the medical model of doctor-assistance that it disenfranchises the majority of older people who would seek control over their end of life.

Let’s explain:

On 8 November, Colorado – with its Proposition 106 – is expected to become the third State to pass a ballot to legalize ‘medical aid in dying’. (Colorado will follow Oregon and Washington).

Colorado will join Oregon, Washington, Vermont and California in legislating for end of life rights. (While Montana case law has confirmed the legality of assisted suicide, that State is yet to legislate).

Like all other States, the Colorado legislation is not only ridiculously restrictive but it places the control disproportionately in the hands of the doctors.

Take a look at the qualifying criteria.

1. The person must be an adult

The law refuses to acknowledge that teenagers (aged 18 years and under) can be unlucky enough to get terminal diseases.

Neuroblastoma, for example, is a common childhood cancer. Survival rates are 1 in 2. However, there is very little treatment if relapses are experienced.

Why should young people with this cancer not have the same rights to end their suffering as their adult counterparts. Especially given the advanced maturity of young people with terminal illness and the fact that they are already expected to make decisions about their various treatment options.

2. The person must be terminally ill, with six months or less to live

This type of so-called ‘safeguard’ is inherently problematic.

Firstly, many terminal illnesses do not have a defined timeline prognosis.

This means that some folk with a terminal illness will fail to qualify to qualify.

You can’t just have cancer if you want to be prescribed your lethal drugs. You must have really-advanced or really fast-moving Stage IV cancer.

Determination of a person’s prognosis sets physicians up as futurists, and as Gods.

This is neither logical nor fair. There is no crystal ball when it comes to being ill.

Secondly, and equally importantly, the criteria of six months or less to live excludes people with, for example, Multiple Schlerosis or other painful conditions such as Rheumatoid Arthritis.

And what about people with disabilities such as Tetraplegia who may live forever but who have had enough, but can’t help themselves to suicide?

Or what about eye conditions such as Macular Degeneration?

Over the past 20 years, Exit has been approached by many many older people with conditions such as these.

While they may not be our reasons for wanting choice in dying, they are some people’s. And they deserve respect.

Colorado’s law will exclude everyone but those who are ‘almost dead’ anyway.

3. The person must be mentally capable of making their own healthcare decisions

At law, capacity is a presumed fact. That is a person is considered to be capable of making decisions about any number of issues, until they are proven otherwise.

In medicine, however, it is a lack of capacity that is presumed.

This means that capacity to make decisions must be proven. And it must be proven without doubt before that person will be able to qualify to use a law such as that being proposed by Colorado.

In a real life scenario, this presumed lack of capacity means that the person wishing to be prescribed end of life drugs (so they have an option in place) must prove to two different doctors (one a psychiatrist/ psychologist) that they are of sound mind.

This means the very very sick person must subject themselves to even more medical testing. And what for? They are going to die. This is simply so they can die ‘well’.

If they are not able to prove they have capacity (for example if they are depressed), they will still be terminally ill. They will still be on the trajectory towards a premature death.

The only difference is that they will be deprived of their Nembutal.

Is this good enough? We don’t think so.

4. The person must be fully informed of all their options for care, including pain management, palliative care, hospice and comfort care

This requirement has been a standard feature of all laws in this area, and dates back to the Northern Territory’s Rights of the Terminally Ill Act of 1995.

In reality, this requirement means that the person must be spoken to – perhaps in a childlike fashion – to ensure that their decision to decline further (often miraculous but high intrusive) medical treatment is one made in full knowledge of such options.

5. Two physicians must determine the person has no mental condition impairing their ability to make decisions and is free from undue influence or coercion

There is always the rumor that granny is being encouraged to die so the greedy relatives can inherit her house, savings etc.

At Exit over the past 20 years we have seen extremely little evidence of this. We are not saying that ‘elder abuse’ does not exist, but that it is not common.

The requirement for two doctors to sign off on one’s sanity serves to ram home Medicine’s message that you are not thought to have capacity to make decisions about your life and death until you have proven to two doctors that you do.

6. The person must be able to take the medication themselves

The requirement that the person must take the medication themself is something that even Switzerland demands.

The purpose of this requirement is to ensure that the act is voluntary and that a third party is not forcing death upon a would-be victim.

It is a reasonable requirement but it does rule out those who are not able to move.

For example, where does it leave a person with a disease such as Lou Gehrig’s (ALS/ Motor Neurone Diseases) and another neurological illness: conditions that rob a person of movement?

Does this requirement mean that such people must take the medicine while they are still physically able?

Yes it does.

A right to die law that brings death forward in time is hardly a good thing.

This is a significant drawback of the law being proposed in Colorado and in play elsewhere.

7. The person must be a Colorado resident

Ahh death tourism.

Colorado is just fine with tourism based on their famous great outdoors, they are not fine with out-of-staters flying in to die.

What are they so afraid of?

Only Switzerland allows non-residents to use their enlightened assisted suicide law.

8. The physician must offer the person multiple opportunities to take back the request for aid in dying medication

First step to use the CO law is that the person must be terminally ill with less than six months to live.

As problematic as this is, the law also demands that the person’s request end of life drugs (so they have control over their life and death) is further tested.

For God’s sake. The person is about to die anyway!

What sort of Indian Giver offer is this?

This requirement assumes that the only reason the person is still alive is because they haven’t yet got the means to end it.

If we are talking about a totally rational adult in the most advanced stages of a terminal illness are we not talking about a person who wants to hang in there.

A person whose decision about their short future has been a long time coming and is extremely well considered?

This is a ridiculous ‘safeguard’ and is testimony to all that is wrong with the medical model of assisted dying.

9. Two witnesses must sign the request form confirming that the person is mentally capable and the request is voluntary

More red tape. Remember we are talking here about a person who is about to die. It is not as if the person who is terminally ill with less than six months to live is about to miraculously get better.

Surely bureaucracy should be kept to a minimum?

Two witnesses? ‘Whatever’ the dying person will say.  If they can muster the energy and enthusiasm.

10. Wills, contracts, insurance and annuity policies are not affected by a person choosing aid in dying

Guarding against discrimination is an important goal. Ensuring one’s life insurance policies will not be affected, simply because one is electing to go a few months, weeks or days early is a good thing.


The model of law reform being voted upon by Colorado pure medical model on issues of power and control.

The patient must perform to the satisfaction of the physicians present. The doctors will decide who gets help (and dies ‘with dignity’) and who dies with no help and even less dignity (or even violently as that is all they can do).

The Colorado law provides no scope for those wanting the peace of mind that comes from knowing that one has lethal drugs locked away in the cupboard, just in case.

This is not a law that serves the vast majority of older folk who wish to have control over when and how they die.

The Colorado law is a law of last resort for those who will die in the very near future.

If these people are considered those most in need, then the law is a good thing.

It is directing resources to those who need them most.

But if end of life rights are considered more broadly, Colorado and California and Oregon and Washington and Vermont are all failures.

Under all these legal models, medical aid in dying is – as its name suggests  – a medical treatment

None of these laws serve the vast majority of the over 70s.

None of the laws bring any benefit to those who are not ill (now) but who wish to be prepared for the contingencies of the future.

Dying well – euthanasia – is not yet a civil right.

Is this reason not to support such ballots? Likely not. But beware.

As Law Professor Susan Stefan – author of Rational Suicide Irrational Laws (Oxford University Press 2016) has argued, ‘once you let doctors into our lives (and deaths) you will never be able to get them out!’

Colorado poll

Colorado Poll showing 70% support

The Dutch Direction

In the past month, the Dutch Government has announced that by 2018 it will legislate  for older people who feel they have ‘completed life‘ to get help to die.

While the medical profession will still be the gate-keepers, the Dutch plans are a first step towards treating the good death as a civil right for all citizens.

All older citizens of sound mind regardless of their physical health will be able to request medical help to die.

Perhaps we should be asking the Dutch Ambassador to the US, Henne Schuwer, if the debate that Colorado and Washington DC are now having about end of life rights is what the Dutch had 10 years ago.

Would be interesting to see his reply.

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