“A carefully planned humane dying within the limits of the law is possible thanks to this book which is based on reports from witnesses. Guide to a This can bring peace of mind to anyone in a desperate g end-of-life situation wishing to have control over u i a death of one’s own.” d Richard MacDonald, M.D. e t Humane Self-Chosen Death . o This Guide to a Humane Self-Chosen Death offers scientifically based a information on how to achieve a humane, self-chosen death. h u Through authoritative information on toxicology and pharma - m cology, this book improves upon other guides to self-deliverance. a n Moreover, this book offers a scientific approach by providing a e critical appraisal of witnessed reports on both successful and failed s e attempts at a humane self-chosen death. l f This book is not for those who are acting on an impulsive wish to - c die. Given the difficult legal position of many doctors to assist in a h humane self-chosen death, it is to be expected that a number of o s gravely ill patients will want to find out for themselves what to do in e n order to achieve a good and humane death. d A humane and self-chosen death should take place with e a emotional support and comfort from others. Suggestions are given t for relatives and friends who may wish to be present with a dying h loved one, without legal harm to themselves. The methods in this book require careful planning in order to achieve a peaceful death. An individual can carry out the steps described in this guide without substantial involvement from other people. The authors of this guide do not in any way wish to encourage suicide. Someone with a wish to die should receive spiritual w comfort, adequate palliative care or professional therapy to make o z life bearable. But for some people who know they will die soon z f anyway, the methods discussed in this book provide just that piece o u of information that brings a humane self-chosen death within n d reach. For those individuals this book is written. a t i o n wozz Foundation 2nd expanded edition 2006 Guide to a Humane Self-Chosen Death wozz Foundation This guide was made possible through the many reports from witnesses at a humane self-chosen death. The authors thank those who have re- ported cases by completing the anonymous report form in Appendix 2. Thereby,the methods discussed in this book have been improved. We hope to further improve our knowledge with the help of others who will send us their eyewitness report. If a carefully prepared self-chosen deaths by one of the methods discussed in this guide is unsuccessful, that report would be important as well for a next edition of this guide. This may help people in the future who might consider to use a particu- lar method and want to avoid mistakes. © Stichting wozz, 2006 first edition in Dutch, wozz, Delft, 2003 (out of print) second expanded edition in English, wozz, Delft, september 2006. isbn 00 0000 000 00 Book design and layout by Gerrit Vroon Printed and bound in the Netherlands by MacDonald/SSN bv All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, scanning, or by any information storage and retrieval system, without the written permission of the Publisher, except where permitted by law. Cover image: Kardinaalsmuts (Lat. Euonymus Europaeus) * . ** D D oundation hiatrist F psyc Admiraal M.D. criminologist anesthesiologist Guide to a clinical pharmacist medical toxicologist Russel D.Russel Ogden wozz Jan Glerum Ph. Aad Rietveld Ph. Pieter Boudewijn Chabot M.D.Boudewijn Humane Self-Chosen Death * a pen-name ** for technical advice Contents Warnings to the reader 6 1. Introduction 7 1.1 What this guide is about 7 1.2 About the authors 9 1.3 For whom this guide is intended 11 1.4 Why this guide fills a gap 13 1.5 Summary of contents 14 2. Basic information concerning the lethal drugs discussed in Chapters 3-7 18 2.1 Few drugs are both effective and humane 18 2.2 The preparation phase: What to know and what to do 20 2.3 The final phase: What to know and what to do 31 2.4 Notes about collecting lethal drugs 35 2.5 The report form: a strategy to increase knowledge 39 2.6 Overview of Chapters 3-7 40 3. Barbiturates and glutethimide 41 4. Opiates 48 5. Chloroquine 55 6. Tricyclic antidepressants 60 7. Orphenadrine 63 8. Helium gas: a non-drug method 65 Drug Table: n o i t a Generic names and brand names of drugs in eleven countries d n u (fold out between Chapters 8 and 9) 73-74 o F z z o w 9. How doctors do it: physician-assisted suicide in Switzerland, the Netherlands and Oregon 74 9.1 Physician-assisted suicide by a lethal dose of barbiturates taken orally 75 9.2 Euthanasia by two consecutive injections 79 10. Well-known methods that are ineffective or dangerous to others 82 10.1 Plastic bag with sedatives method 82 10.2 Carbon monoxide 85 10.3 Debreather 87 11. Judicial risks for relatives and trained lay persons in five countries 88 11.1 Introduction 88 11.2 Canada 90 11.3 USA 92 11.4 Switzerland 94 11.5 Germany 95 11.6 The Netherlands 96 11.7 Conclusion 100 Literature References Appendix 1: Addresses of organizations concerned with humane self-chosen death 102 Appendix 2: Report form for an eyewitness of a humane self-chosen death 104 Appendix 3: How to order this book 106 Warnings to the reader 6 The Board of the wozz and the authors of this guide do not in any way wish to encourage suicide. Someone with a wish to die should receive spiritual comfort, adequate palliative care, professional therapy or oth- er help to make life bearable. It is of the utmost importance that no person with an impulsive wish to die should have access to the information in this book.For this reason the wozz has decided not to publish this guide through a publishing house,bookstores,or on the Internet.It will sell this book exclusively to right to die societies in various countries. Right to die societies can de- velop their own policies for distribution of this guide, in a manner that is consistent with the practices and laws of their own countries. It will become clear from this book that a humane self-chosen death requires many time-consuming preparatory steps, which are not com- patible with acting on an impulse. This book offers scientifically based information on how to achieve a humane self-chosen death. A Dutch edition was written in 2003 and has been sold only to physicians, pharmacists and professionals who have been trained to care for dying people. Severely ill people whose death may be a matter of weeks or months and who want to consider the option of a humane self-chosen death should be allowed access to the information in this book. It remains the reader’s responsibility to comply with all the laws regarding topics covered in this book. When someone is present at a humane self-chosen death to offer moral support, this person must not give instructions that may lead to death nor act to cause the ill person’s death. This edition has corrected and expanded on the Dutch edition. It is particularly important that one not deviate from the steps outlined in this book if one hopes to achieve a humane death.Even so,neither its au- thors nor the wozz Foundation can guarantee that death will be n o i t a achieved. d n u o F z z o w chapter 1 Introduction 1.1. What this guide is about 7 This guide presents the practical steps involved in a self-chosen death, realised without conscious suffering and caused by oneself. The stan- dard phrase for this, ‘dying with dignity’, has acquired so many ideo- logical overtones that we prefer the term ‘humane self-chosen death’. The authors of this book consider adeath humane when someone dies in the presence of others (relatives, friends or health care workers) with- out conscious experience of pain or serious discomfort. In most cul- tures dying in a circle of loved ones is regarded as a ‘good death’, while dying alone and dying in pain is considered to be a ‘bad death’. We consider a good death as self-chosen if a competent person prefers to die rather than to live on in irreparable physical and mental pain. This decision should be based on adequate information about possible viable alternatives for death (e.g. spiritual comfort, adequate palliative care or professional therapy). To avoid the mistakes of a shortsighted and preoccupied mind, that decision needs to be discussed with a loved one and with a compassionate professional. We consider a humane death as self-executed if the series of acts that together cause death are all performed by the person himself. Unfortu- nately, at present no reliable,precise and comprehensive information is available on how to do just that. No one should be forced to an aggressive suicide by violent means because of a lack of adequate information on humane methods to end one’s life. This is one of the reasons we provide detailed information, which is impossible to find in medical or pharmacological textbooks.