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.

August 7, 2022

Pros & Cons of Couples Going Together

The Pros & Cons of Couples Going Together is a topic that needs comment, especially in light of the recent alleged botched double suicide of Exit Members Marijke and Tony Smyth in Queensland in Australia.

By Fiona Stewart

I want to compare this awful ordeal (at least as it was for Tony) with the orderly, successful death in 2021 of American couple Audrey and Greg.

I knew both couples.

I resent the fact that Australian laws have failed the elderly so greatly that respectful, caring, compassionate men such as Tony are at risk of being hung out to dry.

With more consideration and an open mind, there was nothing to stop the state of Queensland from adopting a Swiss-style law.

Indeed, that was the subject of Exit’s submission to the 2020 Queensland Law Reform Commission Inquiry.

Now the Queensland Government – rather than Tony – has blood on its hands.

Australia (and all other countries who prioritise the medical model of the assisted death) need to wake up to themselves.

We can and must do better!

If a wish to die (together) is long-held, considered and made by rational elderly adults, what right do the rest of have to interfere?

We might not like their decision, but it is surely theirs to make and ours to respect?

Audrey and Greg go to Switzerland

It is a year ago this month since I witnessed the joint deaths (yes a suicide pact) of American couple Audrey & Greg (not their real names) at a clinic in Basel in Switzerland.

Their deaths were long considered, well planned and incredibly peaceful. They died arm in arm to the melodic tune of ‘Moon River’ by Frank Sinatra.

‘Breakfast at Tiffany’s’ was, after all, their favourite movie.

During the time I knew Audrey and Greg, I found them an intense mix of sadness and joy.

Sad because Greg had been diagnosed with a rare form of cancer which even the most sophisticated of new technologies could not conquer.

Audrey on the other hand was not sick. Yes, she had any number of niggling things which came with being in her 70s, but she was quite well, all things considered.

The couple had long ago decided that they wanted to go together.

Audrey & Greg, 1986

Never having had children, their decision might have been easier than for others. Their extended family were not told until the eve of their departure to Switzerland.

Upon leaving for Switzerland, they had organised everything.

The house was on the market, their assets had been placed into a trust (to be later dispersed to various charities).

Their favourite niece was said to have full control of the details of two lives well lived.

On their death I had strict instructions to return this and that back home to the States.

Before their death, I was one of many who was the recipient of Audrey’s largesse.

A successful, self-made businesswoman, Audrey was a great aficionado of Chanel and Cartier. It seemed only sensible to wait until the day before she died to impart the remainder of her possessions.

On the said day before, I therefore received 2 pairs of shoes, one overcoat (Audrey had come to Switzerland with romantic dreams of the snow capped alps despite the fact that it was late summer) one ipad cover and a beautiful set of sunglasses.

It is crazily bitter-sweet to accept such gifts from a woman who will die the next day.

(I would later re-distribute these gifts – with the exception of a single pair of shoes – to friends and acquaintances for whom such luxuries would always be out of reach, but whom would cherish and appreciate them).

When I told Audrey I would wear her shoes in her memory, she quickly replied ‘you don’t need to do that. Just wear them and enjoy them’. That was the spirit of Audrey.

On the days leading up to their deaths, Audrey and Greg stayed at the grand old Hotel des Rois on the Rhine in Basel. They took a suite where they could have their meals delivered.

They said they had no inclination to live it up.

Instead they stayed in their rooms, spending time with each other and watching the parade of swimmers with their ‘wickelfische’ float past them down the river. Audrey said she always loved the water.

On their final day, Philip and I drove Audrey & Greg to the Liestal clinic.

There they filled in their final paperwork and took their places on the bed.

You Can’t Take it With You

In between these two actions, a few things of note happened.

Firstly, Audrey had come to Basel with her usual jewellery assortment; things she wore daily.

For Audrey, this meant an impressive array of diamond rings, necklaces, earrings and watches.

I mention this not to brag (that only rich people who go to Switzerland to die) but to make note that it was not until the moment immediately before her death that Audrey felt she could part with these precious possessions (things that would later be sent back to the States for inclusion in her estate).

We are what we wear? Maybe.

At a practical level, at what point does the old adage that ‘you can’t take it with you’ sink in?

I guess none of us will know until we get there.

In the hour before their death, Audrey and Greg also imparted their ipads and phones with the promise that the data would be destroyed and the devices repurposed and given to a local charity.

While Audrey was itemising her jewellery to me, Greg sat restless at the table, toying with his wallet which still held a single credit card (all others had been destroyed).

Perhaps he had saved it ‘just in case’. Just in case of what one might add? He didn’t die as planned?

He wanted out and needed to book the next flight back to America.

Greg didn’t want out and he never booked a flight.

But right up until the moment he went into the room with the bed, he kept that wallet in his hand or back pocket.

When, finally, he did stand up to follow Audrey into the room, he tossed the wallet on the table.

As if he finally realised ‘this is it’.

This was such a simple gesture but also one that was overladen with meaning. It remains stuck in my mind.

This was Greg’s last vestige of control over the things that make up a life.

Within the hour he would be dead. He finally realised he didn’t need a wallet where he was going …

In the room during their deaths was clinic doctor. The couple had requested privacy.

The others of us sat in the outer room, listening to their sweet good byes and, of course, to Moon River.

Despite the crass interior of the clinic and the ugliness of its industrial surrounds, Audrey and Greg’s death was as good as it gets.

Not because they had a doctor administer Nembutal into their veins, but because they had been able to plan ahead and did not have to creep around like criminals: just to have the death they wanted.

Their death could not be further from recent events concerning Tony and Marijke Smyth in Queensland Australia.

While no one yet knows what really happened with Tony and Marijke, this is what the Police via the media are telling the Australian public:

AN elderly man has been charged with aiding in a suicide at a rural Far North home on Sunday and is set to appear in court this afternoon.

On July 24, a 74-year-old woman was found unresponsive at an Upper Barron home by police and emergency services where her death was labelled suspicious.

A 76-year-old man, who was alleged to have assisted in the death, was also found at the address suffering from injuries.

He was taken to Atherton Hospital and then Cairns Hospital where he was treated and later discharged.

The incident was being investigated by the Tablelands Criminal Investigation Branch.

The 76-year-old man, who is in custody, was expected to appear in Cairns Magistrates Court on Tuesday.

More to come.

What we do know is that Marijke had MS and that before he retired, Tony had worked as a team leader in aged care.

Marijke and Tony joined Exit in the 1990s, not long after the organisation was established.

I met them at a workshop in Cairns in May 2009 at a workshop that was well over-booked.

Cairns Exit Workshop, 26 May 2009

If they had been planning to go together this was certainly not a last minute decision.

In 2016 the couple wrote that they were ‘long term past members of the Cairns Exit chapter, and staunch supporters of Dr Nitschke’s efforts to change our archaic laws’.

Our heart breaks that Tony has now been charged with assisting the suicide of Marijke.

It is bad enough to lose a partner: someone you loved so much that you wanted to die with her.

Things should never have come to this. While things normally do not go wrong at home (these are the deaths we do not hear about), sometimes this can happen.

When one is forced to sneak around in the dark, sometimes one’s death can be an accident waiting to happen.

In a better world, the couple should have been able to a) safely, reliably and lawfully import Nembutal for their own private use at some possible time in the future or b) if a) were a step too far in the primitive confines of the far north of Australia, they should have been able to ask a doctor to prescribe Nembutal to them both: so they could go peacefully together, at home and in their own time.

If they had been prepared to leave home, Tony and Marijke could have died together in Switzerland. Lawfully.

But why should Australians have to pay more than €10,000 each (no 2 for 1 discount applies), and travel to the other side of the world to get a peaceful death?

It makes no sense.

If Australia has, as their Voluntary Assisted Dying Act shows, been prepared to change their law, it is nothing short of reprehensible that people like Tony and Marijke have become the collateral damage.

For Christ’s sake, even Marijke would not get help to die in Queensland: MS is not a terminally illness.

No doctor would sign papers to say she would be dead within 6 months (the qualifying criteria).

This is an indication of how limited (and some might say useless) the new Queensland law is.

Where to now for Tony?

The only ‘where to now’ is that Exit supports Tony in every way imaginable to help see him through this legal mess.

While he is voluntarily confined to a local mental health institution, Tony is needlessly occupying precious health resources (just like Chris Lovelock was forced to do in Melbourne recently).

Tony doesn’t need mental health treatment, he needs time to grieve the loss of his beloved Marijke, and to then, in the cold light of day, reconsider his own options.

He is not mentally ill. Not everyone who suicides is (the understatement of the decade).

Exit will continue to keep our members updated of the plight of Tony Smyth.

The organisation is now looking to schedule an additional workshop in Cairns in early 2023, in order to help prevent this type of thing happening to others.

July 29, 2022

Be careful who you tell

Be careful who you tell is the message from Exit’s long-time Melbourne Chapter Coordinator, Chris Lovelock.

After long and careful consideration and forethought Chris had made an Exit Plan. Chris told a ‘close friend’ about this plan. Unfortunately, the so-called ‘close friend’ then told the Police.

Here is what happened next to Chris in July 2022.

Chris Lovelock (front left) with fellow Exit Chapter Coordinators, Australia 2019

Chris’ Story

July 11 Monday 2022

At [a regular] current affairs Zoom class, [my friend] Jeff Hall announced that he would not be available for the next four weeks and suggested that Helen and myself might be prepared to stand in for him.

Not wishing to disclose my reasons for declining the invitation in front of the whole class, I merely said that I could not do it the next week.

July 12 Tuesday

Jeff emailed the class telling them that I would do the next but one week and also a fortnight later. I had not agreed to that. I emailed Jeff saying that I would be unavailable at any time in the future and believing that he was entitled to an explanation, I told him that I was intending to end my life on the evening of July 14.

July 13 Wednesday

At 0850 I received a phone call from Jeff saying “What’s going on”, and I explained fully but briefly. Jeff said that he would “have to” report my proposed action to “The Authorities”.

I believe that he mentioned the police. I told him that I did not want him to do that and the conversation was terminated.

At about 1030 two police officers from the Boronia station arrived. I was expecting a visit from my daughter Alana around that time and met all three at my front door.

There was a brief discussion between the four of us and then SC Ray Rinderhagen asked if he could speak with Alana privately.

As I am unable to stand for any length of time I suggested that I go inside the house and talk to PC Danielle Day.

I then went inside with PC Day where we had a brief amicable discussion and were shortly joined by SC Rinderhagen and Alana.

The discussion continued amicably except that I told them that I was not prepared to go anywhere with them unless they could produce an arrest warrant.

It was then explained to me that they did not intend to arrest me but they had some sort of a document relating to the Mental Health Act which gave them the authority to detain me, using force if necessary, and transport me to a hospital of their choice where my mental health would be assessed by a suitably qualified person.

I think it was at that stage that I was told that an ambulance was on its way.

I pointed out that there was a chronic shortage of ambulances and I did not want to make that situation worse and would prefer to be transported in their divvy wagon, but when it was explained that the divvy wagon was frequently used by some less than salubrious detainees, I opted for the ambulance.

I don’t believe that I really had a choice and I realise that they were acting in my best interests, at least as far as transport was concerned, and when the ambulance arrived shortly thereafter, I entered it without further objection.

I arrived at Maroondah Hospital somewhere around 1130 where I was briefly transferred from the ambulance stretcher to a hospital wheel-chair and left in the ED corridor with both ambulance officers and both police officers standing guard, and told I would be assessed by a psychiatrist when one became available, with at least one person (a drug user who was “smoking” a vape) ahead of me in the queue.

After a couple of hours the ambulance officers left and I was transferred to a cubicle, still within the ED corridor but without the wheelchair.

At about 1600, the person that I was told was ahead of me in the queue walked past, her visit to the psychiatrist obviously complete.

About this time I was transferred to another cubicle outside the corridor. An hour later I was interviewed by a “mental health professional” but not a psychiatrist, and told that I was to be transferred to Box Hill.

This happened about 2330 in another ambulance.

July 14 Thursday

On arrival at Box Hill I spent half an hour in the ED then taken to the psychiatric ward 1 East room 12 where I was relieved of my belt (but not my shoe laces) and given a “pair” of pyjamas consisting of a top too small to wear and bottoms at least 12 inches too long. I slept until 0700.

At about 1100 I was interviewed/assessed by psychiatrist Chamath Rangoda and Jessica ? who introduced herself as “almost qualified as a gerontologist”.

I had a reasonable discussion (mainly with Cham) lasting over an hour, during which time he verbally acknowledged that in his opinion I was not suffering from depression or anxiety but told me that I would be held for up to 28 days for treatment for my mental illness because it would be impractical for me to receive such treatment outside the hospital.

Cham told me that I was entitled to ask for a second opinion which I then did.

At about 1400 I was given a copy of form MHA110 Temporary Treatment Order which included Cham’s observation “You are at risk of suicide with a clear plan and intent. You are wanting to leave hospital despite the risks.”

This document also included a statement to the effect that “….. the person has a mental illness…… “ but did not specify what that mental illness might be.

I was also given a nine page document “Temporary Treatment Order – Statement of Rights” and another form with which to lodge an appeal to the Mental Health Tribunal. I immediately lodged an appeal.

The Statement of Rights advised that “A psychiatrist will also look at your advance statement if you have one” but at no time was an advance statement EVER mentioned.

Later that day, or possibly the following day, I asked Jessica what was my mental illness, to which she replied that it was “Adjustment Disorder”.

Upon my enquiring as to when I might expect to see my “second opinion” I was told that it would be “as soon as possible”.

July 15 Friday

No sign of my second opinion.

July 16 Saturday

Still no sign of my second opinion.

About 1600 I reported that I was cold and shaking and was given a blanket and another covid test. I had previously (don’t remember when) been given a couple of tests which were negative. I was shaking when I went to bed to sleep. I requested some form of medication to help me sleep but the request was ignored.

July 17 Sunday

When I woke about 0700 I was told that my latest covid test was positive. So much for the hospital’s “duty of care”.

At 1330 Alana arrived to deliver some “goodies” and sundry other items including nail clippers and electric shaver which were both promptly declared contraband.

At 2115 I was transferred to the covid ward and an hour later a guard arrived, taking up residence in my bedside chair.

His name was Kurkura and despite the fact that I experienced language difficulties, he insisted on bashing my ear about how lucky I was that someone had intervened to save my life

July 18 Monday

First thing this morning Kurkura was replaced by nursing aide Peter, a vastly different kettle of fish.

At 1100 I was examined (chest/lungs) by two doctors, and questioned. Where am I? What year is it? What month?

At 1200 I saw my “second opinion”, psychologist Jo (Jonathon) Storke plus two others. Jo agreed that I have no mental illness and said that he would confer further with Cham.

The infamous One Flew Over the Cuckoo’s Nest

An hour or so after seeing Jo, Ben Taylor (he had been taking notes during Jo’s interview) brought me form MHA112 Revocation of Temporary Treatment Order or Treatment Order with Jo’s comments “You do not have features of a significant mental illness at the current time.

While you still consider ending your life as an option, you do not have an immediate plan and you are willing to discuss community support.”

I was free to go but was required to wait for “patient transport” (not an ambulance). Expected about 1700, then 1800, 1830, 1900, then not before midnight.

Eventually I was told that I could arrange my own transport, as I had suggested that I do some five hours earlier, and Alana arrived 2115 and I was taken home.

Summary

1. This little exercise resulted in two non-essential ambulance trips (2 x 2 paramedics plus equipment) at a time when other people were waiting on urgent medical attention.
2. The services of two police officers who were tied up (idle) for about six hours, then another two following a change of shift. They could have been out chasing criminals.
3. I occupied a bed in the psychiatric ward for five days.
4. I occupied a bed in the covid ward for one day plus.
5. I “utilised” the services of two psychiatrists, sundry students/interns, and innumerable trained nursing and other ancillary staff.
6. I received no treatment for my “mental illness” other than an unopened box of Mirtanza [anti-depressent] tablets given to me (with an invoice) on my release.
7. I acquired COVID-19, despite my maximum and recommended four inoculations.
8. During the course of my six day incarceration, I freely discussed my thoughts on matters such as

a. Why was I brought here as I had not committed any crime?

b. Why was I being held?

To both of these questions I was given the vague answer to the effect that “they” had a duty of care to me.

At no time, with the exception of the “guard” that I had to suffer on Sunday night, did I encounter anyone who disagreed with my basic philosophy that a rational adult person had the right to determine their own future.

There is no doubt that this is a shocking story and an awful experience for any 80 year old man of sound mind to have to go through.

Exit will now explore the avenues open for redress and seek a legal opinion that can serve as a warning to others should they find themselves in Chris’ shoes.

To comment on Chris’ story, join the discussion at the Peaceful Pill Forums

Bedlam, founded in 1237 as England’s first mental asylum – Now Bethlam Museum of the Mind, London