Magazine and Scottish News
EXIT

Our beliefs, our record so far, and our aims
A history of our movement
Famous cases
Living wills (advance medical directives/statements)
Self-deliverance
Bibliography - some recommended reading
Books available from The Scottish Voluntary Euthanasia Society
Excerpts from our Journal
Older excerpts from our Journal (courtesy of DeathNET)
Related links
Contact us

Our beliefs

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."

Our record so far

In 1980 the Voluntary Euthanasia Society of Scotland 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 in this country, breaking down the barriers to the use of living wills, and published Beyond Final Exit with essays on the latest research into self-deliverance.

Our aims

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.

A Short History of Important Events

1935 Formation of a voluntary euthanasia society in England (later known as "Exit" or "The Voluntary Euthanasia Society") by Lord Moynihan & Dr Killick Millard.

1936 King George V receives euthanasia from Lord Dawson unofficially.

Voluntary Euthanasia Bill presented to the House of Lords: rejected.

1969 Voluntary Euthanasia Bill debated again in the Lords and again rejected.

The term "living will" is coined by Luis Kutner to describe an advance refusal of medical treatment.

1973 Voluntary Euthanasia societies formed in the Netherlands.

1974 Dr George Mair publishes "Confessions of a Surgeon" giving details of voluntary euthanasia practised in a hospital.

1976 Voluntary Euthanasia societies formed in Japan and Germany. 1st international conference of voluntary euthanasia societies, in Tokyo.

1977 Dutch Medical Council officially accepts V.E.

1978 Derek Humphry's "Jean's Way" published in London, telling how his wife had made a pact with him to end her own life.

1979 British V.E. Society votes to publish a guide to self-deliverance. Membership quadruples. Publication delayed until 1981 by legal and other obstacles, and the book subsequently withdrawn after further legal problems.

1980 Scottish Exit (later known as VESS and, later still, EXIT) assumes independence under the auspices of George Mair and Sheila Little, and publishes "How to Die With Dignity" - the first suicide guide to be published in the world.

Official formation of the World Federation of Right-to-Die Societies.

1981 Nicholas Reed, of the English V.E. Society, is sentenced to prison for assisting suicides.

A Rotterdam court states conditions under which aiding suicide and administering Voluntary Euthanasia will not lead to prosecution in the Netherlands.

1983 Legal worries over publication of the English Society's guide to self-deliverance continue. The Attorney General unsuccessfully seeks an injunction to prevent distribution.

1984 The Supreme Court of the Netherlands declares that V.E. is acceptable subject to ten clearly defined conditions.

1985 Lord Jenkins presents a Bill to the Lords to repeal a relevant clause of the English Suicide Act: defeated.

1990 Roland Boyes MP presents a Bill to Parliament for euthanasia: defeated.

1991 US Congress passes the "Patient Self-Determination Act", compelling hospitals to respect Living Wills.

Derek Humphry's book on self-deliverance, "Final Exit," tops an American best-seller list for several weeks.

Washington State Initiative Bill legalising voluntary euthanasia narrowly defeated.

1992 Dr Cox is tried for administering euthanasia to Mrs Boyes and receives a suspended sentence.

The British Medical Association declares its support for living wills.

1993 The Law Lords allow the feeding tube of Tony Bland, who is in persistent vegetative state, to be removed.

Sue Rodriguez, a young woman with Lou Gehrig's disease, seeks permission from the Supreme Court of Canada for assistance to die, and is refused by a narrow majority.

Formation of the International Drugs Consensus Working Party and publication by VESS of "Departing Drugs," the first scientifically researched international self-deliverance guide.

Formation of the House of Lords Select Committee to investigate euthanasia and living wills.

1994 First international collection of living wills published (by VESS).

The Council of the British Medical Association declares support (in principle) for legislation regulating living wills.

Oregon USA passes a law to allow doctors to prescribe lethal drugs, but an injunction prevents it from taking effect.

1995 The British Medical Association produce a Code of Practice on Living Wills.

The Law Commission propose legislation covering living wills and health care proxies.

VESS distributes a radical new living will form after much research, anticipating the BMA guidelines, and also introduces the values history document to the UK.

The Irish Supreme Court decides that the feeding tube may be removed from a woman who has lain in a vegetative state for over 20 years, so that she may die.

The case of Mrs Johnston, who has been in a coma for three years, is brought to the Scottish Courts to see if her feeding tube may be removed, allowing her to die.

1996 Northern Territory, Australia, passes the first law in the world to allow active voluntary euthanasia, allowing doctors to administer a lethal injection. The law was linked to improvement of palliative care. A few people were able to use the law before it was overturned, some six months later, by the Australian Federal Government.

Paul Brady is admonished and set free by the Scottish Courts for assisting in the suicide of his brother.

Glasgow University produces a VESS-sponsored Research Report on the feasibility of doctor assisted suicide, plus a draft bill.

1997 The Supreme Court of America rules on the constitutionality of assisted suicide.

1998 Oregon USA puts its Physician Assisted Suicide law into operation, allowing doctors legally to prescribe lethal doses for certain termially ill patients who persistently request the same.

Cases from history

(An appeal by the Scottish Voluntary Euthanasia Society)

In March 1993 Anthony Bland had lain in persistent vegetative state for three years before a Court Order allowed his degradation and indignity to come to a merciful close. The judges said that if he had made a living will expressing his future wishes he could have been allowed to die in peace earlier. The Scottish Voluntary Euthanasia Society is at the forefront of living will research in the UK. Your subscription will help to make a peaceful death through a living will a reality for anyone who desires it.

In 1992 Dr Cox openly defied the law and assented to 70 year old Mrs Boyes' persistent request for voluntary active euthanasia. Mrs Boyes' was so ill that she "screamed like a dog" if anyone touched her. Conventional medicine did not relieve her agony. In her last days, when she repeatedly requested to die, Dr Cox finally gave her an injection of potassium chloride, bestowing on her the boon of a peaceful death so many of us feel we are entitled to. Dr Cox, although given a suspended sentence, was hauled through the courts like a common criminal. We believe good doctors acting in all conscience like Dr Cox, should be lauded, not vilified, and should have the benefit of legally approved codes of conduct that embody consistent safeguards against abuse. Together we should ensure that medicine and the law serve the patient and the citizen once more. Together, we can stand and be counted. And, from pooled resources, each small contribution will contribute to the powerful tidal wave that the Scottish Voluntary Euthanasia Society can use to bring this about.

Sue Rodriguez, a mother in her early thirties, died slowly of Lou Gehrig's disease. She lived for several years with the knowledge that her muscles would, one by one, waste away until the day came when, fully conscious, she would choke to death. She begged the Courts to reassure her that a doctor would be allowed to assist her in choosing the moment of death. They refused. She lived on in terror, helped eventually by a doctor who, in February 1994, covertly broke the law to help her die in peace. A law on assisted suicide with rigorous safeguards could have saved her the nightmare during those months before her death, given her the confidence to carry on - with the reassurance that when it got too bad she could rely on a compassionate doctor to follow her wishes at the end. The Scottish Voluntary Euthanasia Society is pledged to support research for drafting the most thorough, yet feasible, assisted suicide Bill yet presented to Parliament. Your support will make it happen.

"Re C" A 68 year old prisoner of Jamaican origin had been diagnosed as suffering from chronic paranoid schizophrenia and was treated with drugs and electro-convulsive therapy. In September 1993 the prison doctors found he had gangrene in his right leg. They felt his chance of survival with conventional treatment was no better than 15%, and so recommended that his leg be amputated below the knee. The prisoner refused amputation and received conventional treatment only. There was a likelihood, however, that gangrene would recur. The prisoner stated he would rather die on two legs than live on one, and his solicitor asked the hospital to promise not to amputate in any circumstances without the prisoner's consent. They refused, and he sought a court injunction to uphold his wishes. The court considered expert testimony in the case (known as Re C) and found that, although the prisoner was suffering from schizophrenia, there was nothing to suggest that he did not understand the nature, purpose and effects of treatment; he had understood, and, with a full knowledge that death might result from refusing amputation, had clearly made his choice. The court upheld the prisoner's right to make an advance refusal of treatment and granted an injunction. The case paved the way for acceptance of advance refusals of medical treatments and so for living wills. Completion of a Scottish Voluntary Euthanasia Society living will document could save distressing and drawn-out court proceedings if ever you were incapacitated.

Karen Ann Quinlan collapsed on April 15th, 1975. She was twenty-one years old. Within hours, she entered a coma from which she could never recover. Her parents, staunch Roman Catholics, knew their daughter would not want to be kept alive by extraordinary means. A year later, as Karen lay in a "persistent vegetative state," the courts finally allowed her treatment to be stopped; but artificial feeding was continued and she was maintained as a living corpse until June 1985, when she eventually died of pneumonia. Her case spurred thousands of letters of sympathy and fuelled the "right to die" movement. How many people need to die degrading deaths before society learns a little humanity? The Scottish Voluntary Euthanasia Society is committed to research and teaching in these difficult areas. Help us to help you, and all those who would seek die with dignity and give you their heartfelt thanks.

Ramon Sanpedro is currently seeking, through the courts, the assistance of a doctor to help him die with dignity. He was paralysed in Spain as a result of a swimming accident during his youth. He describes himself as "a head attached to a corpse." He writes:
"Why die? Because every journey has its departure time and only the traveller has the privilege and the right to choose the last day to get out. Why to die? Because at times the journey of no return is the best path that reason can show us out of love and respect for life, so that life may havea dignified death."
Ramon Sanpedro makes no suggestion as to what the wishes of others in a similar physical condition might be. In fact, some people who are so paralysed take enjoyment in life and want to go on living. Their choice should be respected and they should be given every support. But Ramon Sanpedro has made his choice and his choice should also be respected. We should seek to ensure that the rights of the individual are always respected without allowing others to feel endangered or pressurised. The Scottish Voluntary Euthanasia Society provides international technical and informational support. With your help, we can make the world a better place.

Nancy Cruzan lost control of her car one day in January 1983 in Missouri. When the paramedics arrived, they were able to restore her breathing and heartbeat and she was transported, unconscious, to hospital. She continued to be fed through a surgically- implanted gastrostomy tube. After several years, a court found that, although her respiration and circulation continued unaided, she was oblivious to her surroundings except for reflexive responses to sound and perhaps painful stimuli; her brain had degenerated, irreversibly; she was a spastic quadriplegic; she suffered contraction of her four extremities, with irreversible muscle and tendon damage; and had no cognitive or reflex ability to swallow food or water or to maintain her essential daily needs nor would she ever recover such an ability. She lay in persistent vegetative state even though she had told her housemate that, if sick or injured, she would not wish to continue her life unless she could live "at least halfway normal." This was the first time the U.S. Supreme Court had been faced with what we call the "right to die." They said that Missouri had "arrogated to itself" the power to define life, and Nancy Cruzan's life and liberty consequently put into disquieting conflict. She had not made a living will, and the court case paved the way for a uniform, national Patient Self- Determination Act that regulated living wills and made them more widely available. The Scottish Voluntary Euthanasia Society is campaigning for uniform UK reform to make living wills more widely available. Your help can make it a reality.

57 year old Georgette Malette, in the early afternoon of June 30th, 1979, was rushed, unconscious, by ambulance, to hospital. The car in which she was a passenger, driven by her husband, had collided with a truck. Her husband had been killed; she had suffered serious injuries. She was a Jehovah's Witness and carried a card stating her firm conviction that no blood or blood products should be administered to her under any circumstances. The doctor treating her ignored the card and gave her a blood transfusion which he decided was medically indicated. In June 1980 Mrs Malette brought charges against Dr Shulman. The judge found that Mrs Malette had suffered emotionally and mentally and ordered substantial costs to be paid. It made no difference that the medical team didn't agree with her beliefs. Her advance refusal of treatment was unambiguous. Unfortunately, living wills tend to be far less clear cut, dealing with a wide range of circumstances in which interpretation is sometimes necessary. The Scottish Voluntary Euthanasia Society is at the forefront of research into living wills and other ways of having your wishes respected at the end of life. Public support will help us to help make dying more dignified for all those who want to retain some control and self-respect in their dying phase.

When her case came to trial, Claire Conroy was unable to move from a semi-fetal position. She was severely demented, had heart disease, hypertension and diabetes and her left leg was gangrenous to the knee; she had sores, couldn't speak, had only a limited ability to swallow, and had eye problems; she had a urinary catheter in place and was unable to control her bowels. She was able to moan and scratch, and occasionally smile when someone combed her hair. Claire Conroy eventually died before the courts were able to decide what to do. She was not a candidate for voluntary euthanasia. She had not made a living will. But her case posed very worrying dilemmas about end of life decisions. Pushing difficult deaths to one side will not make them go away or make them any easier. The Scottish Voluntary Euthanasia Society encourages open discussion of the problems increasingly facing us in society. We care, and we listen with an open mind. We ask you to work with us so that every person can die with dignity in the way that he or she would choose.

LIVING WILLS

The law favours patients being able to make their own decisions about health care, but the practicality of ensuring this is far from clear. Living wills are an attempt to implement this with respect to refusal of certain medical treatments (such as resuscitation) should certain states of incompetence arise (such as coma, persistent vegetative state, heavy sedation or advanced dementia).

Difficult medical decisions may need to be taken when the patient is unable to speak for him or herself. With little or no possibility of recovery, would you want measures that might only prolong the dying process - possibly to a more distressing conclusion than might be achieved without active treatment? The advance instructions of the patient for such eventualities are invaluable, and may be formalised into a written document or "living will."

Living wills are perfectly lawful, and encouraged by parliament, the British Medical Association and the Law Commission; they have little or nothing to do with active voluntary euthanasia, which is at present illegal; but the voluntary euthanasia societies, from a humanitarian interest in the dying process, are involved with the promulgation of living wills, in addition to campaigning for reform on active voluntary euthanasia.

Living wills accord with the present law and good medical practice

Living wills do not authorise active voluntary euthanasia

Living wills do not ask a doctor to perform anything that is illegal or against good medical practice

Living wills are supported by all major professional medical and nursing bodies

Many organisations produce living will documents - some are better than others - some are misleading and are better avoided

see: living will packs For further reading on living wills, see under the A-Z Index section on living wills.

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. Hopefully you would never want someone to do that anyway - most terminal suffering can be relieved these days - but if you were one of the unlucky ones whose suffering couldn't be relieved, what consolation is it to know that the law might be changed long after you're dead? Probably not a lot. But a doctor or friend helping you (or even being in the same room with you) when you decide to end your life could result in a criminal prosecution for the survivor.

In a country where voluntary euthanasia and assisted suicide are unregulated and illegal, 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 such as Russel Ogden and Lonny Shavelson.

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 number of years a best-selling book on methods of self- deliverance called "Final Exit." The book is easily purchased from almost any bookstore. Although the success of the book has drawn valuable public attention to the desperate need for such information, the Scottish 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 an option in this country, 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.

THE SCOTTISH VOLUNTARY EUTHANASIA SOCIETY - PIONEERS IN SELF-DELIVERANCE In July 1979, Exit - then the Voluntary Euthanasia Society (Great Britain) decided that a book on how to end one's own life would be a good idea. After announcing their intention, membership rose at a rate of 1,000 a month from an initial 2,000. The following year however, concerned over conflicting legal opinions, they decided not to publish. The Scottish Branch voted to become independent in order to publish and so, in 1980, the Scottish Voluntary Euthanasia Society (Scottish Exit) became the first right to die society in the world to publish such a booklet for its members. It was called "How to Die With Dignity." The booklet was based on the opinions of a single doctor and contained many errors, as have subsequent books, and so eventually in 1993 an International Drugs Consensus Working Party met at the Society's headquarters to finalise a scientifically researched volume called "Departing Drugs." The academic foundations were published in a later work called "Beyond Final Exit", and the legality of publication examined by the Scottish Regius Professor of Law, Joseph Thomson.

The booklet was compiled and distributed as a non-profit venture and, unlike Final Exit, available not from bookshops but only by formal application to the Society. Before the book was issued, one of the rules was that any purchaser must have been a member of a right to die society for at least three months, so discouraging irresponsible or ill-considered use of its contents. The Society also reserves the right to refuse to sell it - something an assistant in a bookshop is unable to do with the "popular" guides. We take our responsibilities very seriously. Most members who purchase the booklet are in excellent health and are simply wanting a sort of insurance for their dying years, months or days. But if an individual seems suicidal we always offer counselling or referral to a support group.

DO PEOPLE USE SELF-DELIVERANCE IN THE NETHERLANDS? When a person has made a successful request for voluntary euthanasia, doctors often favour allowing the patient to take the final, lethal medicine him or herself, as a final act of will. Departing Drugs is currently being translated into Dutch (as it has been translated into Spanish, German and French). However, only a few patients are physically able to do so by the time they want their final release. For those that are, there is the added assurance that the doctor will take over if anything goes wrong. Equally important, there is always the presence of a reassuring hand, whether of the doctor, friends or relatives - all of whom may be present.

It is a sad reflection on the society in which we live that people sometimes need to die 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.

Selected Bibliography - some recommended reading:

Books available from EXIT

Departing Drugs

Beyond Final Exit

Living Will Info Pack

Departing Drugs

Beyond Final Exit (out of print)

Five Last Acts

The 2010 comprehensive 400+ page volume that replaces all earlier books and booklets. Order through Amazon.

Living Will Info Pack

The latest living will document and a guide to customising it to your individual needs

A "values history" to guide you when articulating personal values, and to guide the health care team and family when trying to assess the patient's wishes in areas that cannot be anticipated by a living will

Some features of the main living will document in this pack:

escape clauses to prevent non-treatment that would accord with the letter but not the spirit of the document

explanation of all medical terms in non-medical language

option directing a proxy to use either substituted judgement or own judgement

formal encouragement of dialogue with the doctor

eye-catching use of colour and different font sizes/styles

avoidance of any mention of the "voluntary euthanasia" (such as in the name VESS or EXIT)

inclusion of a short values-history

Please note contents may vary from time to time

Price including postage:
·30 GBP (included free with membership subscription to Exit Newsletter journal.)
British currency only. Overseas (outside UK): £50.

Exit

(formerly known as the Voluntary Euthanasia Society of Scotland or VESS)

Journal subscriptions/Memberships Constitution

Director: Chris Docker, M.Phil (Law & Ethics in Medicine)
17 Hart Street, Edinburgh EH1 3RN, Scotland, United Kingdom
Tel (International) +44-131-556-4404. Inland: 0131-556-4404

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Click on this email link to send us message: exit@euthanasia.cc

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Also contactable at the EXIT email:
The Dying in Dignity Mensa Special Interest Group
Open to all Mensans anywhere in the world. Distributes the Dying In Dignity Mensa Sig News Journal. Furthers "pro-life" and "pro-choice" views. Mensa as such has no opinions.

exploring the options for dying with dignity...