Section 1

Why Switzerland?

“Many countries around the world allow assisted suicide but Switzerland is the only one where it is available to non-residents”

In October 2021 the UK right-to-die organization Dignity in Dying published “Last resort: The hidden truth about how dying people take their own lives in the UK”.   This estimated that between 300 and 650 terminally ill people take their own lives every year under the current ban on assisted dying.   Even more alarming, they said there were “ten times as many attempts”.

Suicide attempts usually make things worse

Suicide is not a crime in the UK, nor is attempting suicide.   However, assisting a suicide clearly is a crime.   The Government has put all sorts of obstacles in the way of successful suicide attempts, as a result of which most fail.   Many (a number uncounted) not only fail but leave the person with long-term consequences of the attempt, thus worsening their condition.   The use of helium is one example.   The human body cannot detect an absence of oxygen.   Therefore oxygen can be replaced by an inert gas such as nitrogen, helium or argon in order to produce a quick and peaceful end of life.   However, the human body can detect the presence of too much carbon dioxide and will cause a choking fit as a result.   Therefore any replacement of oxygen must be 100% pure.   An oxygen level as low as 5% in a bottle of helium is enough to prolong breathing long enough for the body to detect that carbon dioxide is building up.   So, guess what, the sort of helium you can buy to fill balloons at a party is often now deliberately contaminated with some natural air (which is 21% oxygen) specifically to prevent it being used as an instrument for a self-administered death.

There is a similar dilemma with regards to Paracetamol.   It is the drug of choice for most people attempting suicide.   However, it takes a long time to be fatal and it is easily cured by treatment with NAC (N-acetylcystaine) if that can be administered within eight hours.   Most people attempting suicide take about twenty 500mg tablets.   The record is 120 !   For those who try and fail, which most do, there is an initial problem that the stomach will reject the huge dose and will cause vomiting.   If that has been avoided then the dose might simply not have been strong enough.   For those who do not receive NAC within a relatively short period of time there is a huge risk of survival with very serious liver damage.

The simple message from examples such as these is that most attempts at a do-it-yourself suicide at home carry a strong likelihood of failure and, worse, long term side-effects that go on to make life worse.

The awfulness of DIY suicide attempts

Then there’s hanging.   I must confess I cannot imagine why anyone would want to do that.   The pain is terrible – almost certainly worse than the pain from which relief is being sought.   The aesthetics are appalling.   There are even rumours, probably untrue, that suicide by hanging is often accompanied by involuntary defecation.   Even if those rumours are untrue, I would not want to run the risk.

There are, of course, also the more exotic solutions.   People jump off high motorway bridges, throw themselves under tube trains (known in London Underground parlance as “one under”) or drive their cars off Beachy Head.

These strike me as unbelievably messy and disruptive to the lives of others.   Above everything else, I do think that “reputational damage” is something to be avoided, even when you’re dead.   Some people, and I am one of them, are very conscious of the arrangements that should be made for their own funerals.   This is natural and seems to be widespread.   Apparently, Lord Mountbatten left 140 pages of instructions for his State Procession through London.   So I am conscious then when people are standing in a pew to remember me they should not at the same time be conjuring up a picture of a mangled car smash.

In the 1980s and 1990s many people gassed themselves in their cars.   They took exhaust gases, fed them through a car window and just sat in the car until they died.   That is rarely done now.   The impact of catalytic converters, unleaded petrol and oval exhaust pipes make it a difficult and very unreliable method.   It doesn’t work with a diesel.   And don’t try it with a Tesla.

Getting it done abroad

So, for many people, there is just one conclusion.   Do it abroad.

By “abroad”, I do not necessarily mean Switzerland.   Nembutal (pentobarbital of sodium), the most effective drug for ending life, is available over the counter in Mexico and is also widely sold in Thailand.   Amitriptyline is not as effective as Nembutal but is certainly better than paracetamol.   In the UK it is available only on prescription and, even then, only in limited quantities.   Other European countries are more relaxed about it.   The trouble with both of these, particularly if you are buying abroad or on the internet, is that you never know what you’re getting.   There is a serious risk that the pills or powder you buy are not what they say they are.   At best, they will not work, and you will just have lost several hundred pounds.   At worst they will cause lasting damage.

Switzerland is not the only country that permits medically assisted dying.   It is the only one, however, that permits visitors from outside to travel there for the purpose of not returning alive.   Other countries, such as Canada and Belgium, have very advanced assisted dying laws but they are not available to non-residents.   It could possibly be available for foreigners in Colombia but that remains a path untrodden.  

Within the UK it seems likely that the law in Scotland will change before the end of 2024 and that some form of assisted death will then be allowed.   It, too, is likely to be available only to people who have been Scottish residents for more than twelve months beforehand.   The forthcoming change in Jersey is similarly likely also to be of benefit only to residents.

Books about assisted suicide

For those readers who remain unconvinced that a journey to one of the Swiss facilities is either a sensible choice or affordable, there is a good history of publications upon the issue of assisted suicide.  

In the early 1980s, “How to Die With Dignity” was published by “The Voluntary Euthanasia Society of Scotland”. In 2010 this was replaced by “Five Last Acts”, a 400 page book by Exit Director, Chris Docker. In its 2015 updated version it is still available on Amazon.

In 1991 an American author named Derek Humphry published “Final Exit – The practicalities of self-deliverance and assisted suicide for the dying.”   It became a bestseller, reaching number one (or #1 in America-speak) in the New York Times non-fiction list.   Apparently it sold 750,000 copies.   Certainly it was the most influential of the books in the 1990s debate upon medically assisted dying and was the main authority behind the subsequent change in the law in the State of Oregon.   It, too still available on Amazon and can be found on Ebay.

“The Peaceful Pill Handbook” was published in 2006 by Dr Philip Nitschke and Dr Fiona Stewart.   The publisher was Exit International USA.   It has become an authoritative textbook upon all the chemistry, pills, drugs and methods available.   Published in America, its terminology is inevitably rather transatlantic and the original first edition has become dated.   In its printed edition, it is now kept up-to-date with revised versions frequently made available.   The current edition costs £60.00.   The most sensible version, however, is no longer available in print at all.   An online subscription is available at $95 for 24 months.   This is not downloadable and not printable but successfully keeps pace with all the many changes being made to the law and the medications.

In addition to these two authoritative works, there is a very large number of self-published personal stories.   Many people choose, when cancer is first diagnosed, to make a record of their own thoughts and activities.   Frequently these are published, either in their own lifetimes or as memorials shortly afterwards.   Inevitably, not all are good but some are excellent – and they can be very funny, too.

In passing, it is worth mentioning that Exit International launched something called an “Assisted Suicide Pod” at the Amsterdam Funeral Fair in 2018. It is called a Sarco. This exotic piece of machinery, looking rather like a jet-ski designed for rainy weather, involves shutting you in an airtight container whilst all air is removed and replaced with pure nitrogen. For legal reasons, Exit International can’t actually sell these things but they can sell the blueprints for them to be “printed”. I think my little HP OfficeJet Pro would struggle a bit with that. So far as I can see, a Sarco has only been used once – and it worked.

Interesting plants

As a final comment before leaving this little section, it is worth noting that Derek Humphry’s book, above, was first published by an historic organisation which had the cheerful title of “The Hemlock Society”.   This got me thinking about hemlock itself.   And maybe deadly nightshade.

Hemlock is the most dangerous of all the poisonous plants that can be found in the UK.   It is a tall plant with small white flowers which appear in a bunch.   The stems have purple spots.   There is no known cure for hemlock poisoning.   When sentenced to death but given a choice as to how he wanted to die, Socrates in 399 BC chose a jug of hemlock tea.   If that was the best death available, the others must have been pretty grim.   It can take between 48 and 72 hours to be fatal and even then, death only occurs through a collapse of the respiratory system – meaning that you die struggling for breath.

Deadly nightshade, also known as Belladonna, is similarly common.   It has small, shiny black berries that can be mistaken for blueberries or even cherries.   A big dose can certainly kill you but, once again, through damage to the respiratory system.   Its most famous victim was the Emperor Augustus.   He was given it by his wife Livia after a somewhat noisy domestic.   It has been used for cosmetic purposes, can be bought in the USA with the trade name Donnatal and is also used as a hallucinatory recreational drug.   Avoid.

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Section 2

What services could be expected in the UK?