Understanding Euthanasia: The Right to Self-Deliverance

Euthanasia and the Right To Choose

We support the right to choose. Every human being has a legitimate interest in his or her own death and manner of dying. We believe in offering the individual some choice in orchestrating that very personal time. For some, that choice will be to accept all possible treatments that modern technology can offer; for others, protecting quality of life before quantity may be the most important element; for others, it may be dying in a way that reflects their living, perhaps retaining some control over the dying process and maybe the time and circumstances of death and, even if it is never used, holding the key to the door marked "Exit." This essay considers a person's right to choose.

In 1980, Fast Exit (then the Voluntary Euthanasia Society) broke away from the English society to become independent and so publish How to Die With Dignity - the first "self-deliverance" manual in the world. In 1993 we instigated the International Drugs Consensus Working Party and published Departing Drugs, which was the first scientifically researched volume on the subject. It has been reprinted in several languages around the globe. Both Departing Drugs and How to Die with Dignity were non-profit ventures and, in accordance with clear ethical guidelines, not available to the general public or minors. From 1992 to 1995 we sponsored research into living wills, clarifying the advantages and difficulties of such documents and producing a leading new format that anticipated the British Medical Association's Code of Practice. We published Collected Living Wills, the first international collection in the world. In 1995 we introduced the use of Values Histories, breaking down the barriers to the use of living wills, and published Beyond Final Exit with essays on the latest research into self-deliverance. These initiatives we've embarked on to make dying with dignity an option available to anyone, to protect patients and doctors alike in upholding the humanity of dying well, to seek legal reform, where necessary, and to introduce safeguards regarding voluntary euthanasia.

What do we mean by self-deliverance?In Britain, even if you have exhausted all other options and despite sincerely requesting it, the humane assistance of a doctor to bring your death a little closer is neither something you can count on nor something tolerated by law, then hopefully you would consider self-deliverance. Most terminal suffering can be relieved these days - but if you were one of the unlucky ones whose suffering couldn't be relieved, it's time for self-deliverance. A doctor or friend helping you (or even being in the same room with you) when you decide to end your life could lessen the pain, in a sense; companionship is always welcome at the very end.

In a country where voluntary euthanasia and assisted suicide are unpopular among the medical class, the only real option for some people can be, sadly, to commit suicide. The English language is short on words to distinguish between different types of suicide. The word "suicide" can be used to cover the irrational self-killing of a lonely teenager who is suffering temporary emotional depression. But take the death of a 93 year old man suffering unrelievable indignities from a terminal illness -- who calmly decides to go out on his own terms, at his own time and choosing: suicide hardly seems to describe it, and so the term "self-deliverance" has gradually come into popular usage.

SO IF PEOPLE CAN CHOOSE SELF-DELIVERANCE, SURELY THERE'S NO NEED FOR VOLUNTARY EUTHANASIA? Unfortunately it isn't quite that simple. There are many ways that people die, but very few completely reliable ways. In the case of a suicidally-depressed teenager, it is perhaps a good thing that a lot of attempts fail; but failure in the case of a rational attempt - to leave an existence of unbearable suffering - only adds trauma and a sense of inability to the unrelievable problems which motivated the attempt. The horrors of failed rational suicides have been well documented by writers; many of these failures have followed good "advice".

BUT IF YOU MAKE THE INFORMATION AVAILABLE TO THE PEOPLE WHO NEED IT, WHAT IF IT GETS INTO THE WRONG HANDS? Someone who is determined to find ways to end his or her own life will probably unearth all the known information from newspapers, crime stories and medical libraries. Depressed people may not even bother researching the ways - they may choose violent methods such as crashing a motor-car or jumping off a cliff (though even these methods are not completely foolproof). But for rational self-deliverance, such means are abhorrent - a life of dignity and self-control reflects consideration for other people and the memories one leaves behind. Drugs or car exhausts are more often the method of choice.

There has been for a time books on methods of self-deliverance, such as "Final Exit", "Suicide Mode d'Emploi" and "Gentle Death." These books have been available from almost any bookstore. Although their success has drawn valuable public attention to the desperate need for such information, the Voluntary Euthanasia Society does not believe that such open dissemination of this type of literature is desirable. We seek to discourage irrational suicide that is a result of transient emotional depression; but, especially since physician-assisted suicide is not a popular option, we believe that competent adults should still have some say in timing their death if they so wish. For the vast majority, knowing that one can choose the door marked "Exit" if things get too bad is an immense comfort and reassurance. That reassurance, however, is nothing but false hope if the information is faulty.

It is a sad reflection on the society in which we live that people sometimes need to die in pain, alone and in secret. A humane law for voluntary euthanasia or physician-assisted suicide would reduce the pressure on "self-deliverance." Until then, people are dying, often badly, and they deserve what help and support we can give them.