Interview with Dr. Philip Nitschke – Director, Exit International

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By Scott Douglas Jacobsen

Dr. Philip Nitschke is the Director of Exit International. Here we talk about his background, work, and views.

Scott Douglas Jacobsen: If you reflect on early life, how were discussions around death and dying amongst the adults for you?

Dr. Philip Nitschke: Like many growing up in the 50’s and 60’s I was surrounded by a death denying culture. We didn’t want to think about death, and it was rarely discussed. Faith (much of it misplaced) was placed in the medical profession which we hoped would eliminate all known causes of suffering and disease.

I saw my first dead body when in my teens and I note now that our society is so good at removing this spectacle that the age the average person sees their first body rises every year. We might see a 1000 bodies a night on television, but the real thing is quickly and cleanly removed from sight, especially from the children.

It wasn’t till I started working in other cultures that I realised that the western strategy of denial and removal was questionable and quite possibly pathological. In the Aboriginal societies where I worked in my 20’s, the dying were part of the community, involved as best they could, dying, while the children played around them. I was impressed. This restored some balance.

At medical school in my 30’s I was once again plunged into Western death denial. The word euthanasia wasn’t mentioned, all death was considered a failure.

So, it was a very great relief to be in the Northern Territory when, in my 50’s I found the opportunity to work on establishing and enacting the world’s first euthanasia legislation.

Jacobsen: What is the proper definition of medically assisted dying or euthanasia? Also, what are the most up to date terminology?

Nitschke: Voluntary euthanasia as I use it means broadly, a self-elected peaceful death at a time of one’s choosing. I use it as a catch-all phrase although it has also been defined as the occasion when another person acts to ends the life of a person at their request.

Sensitivity over the use of the term euthanasia, and more recently suicide has seen the growing use of other terms to describe assisted dying.

Semantics rule supreme, with terms such as medical assisted dying, assisted suicide, physician assisted suicide, and so on.

I should add that medically assisted dying MAD or MAiD is the new term of physician assisted suicide or PAS as it’s also known.

This is when a doctor helps a patient to die by prescribing them a lethal drug.

The shift to MAD from PAS has come about as an awkward attempt to remove the word suicide and to differentiate rational suicide for the sick and elderly from irrational suicide for the depressed teenager.

At Exit we’re quite keen to call this sophistry for what it is: Suicide is when a person takes their own life. Own it.

If the act needs clarification try rational suicide to show that it is an informed and considered, long-held decision.

Rational suicide also takes the medical professional out of the picture.

Dying is not a medical event. It is forever frustrating that the professional has colonised the good death, just like they did child birth.

As Professor Susan Stefan said in her 2016 book Rational Suicide Irrational Laws, the trouble with doctors is that once you let them into the dying experience you’ll never get them out again. How right she is.

Jacobsen: What is the purpose and scope of Exit International? Why is it important for those who think about the end of life for loved ones and themselves in a more secular context, typically?

Nitschke: Exit is an organisation that aims to ensure that every rational person over 50 years, can have access to accurate and reliable information and the means so they can achieve a peaceful death at a time of their choosing, should the need ever arise.

The 50 year age restriction is something of a compromise. We try to restrict access to ‘troubled teens’ with little life experience, but do not exclude those younger than 50 with valid reasons for accessing such information.

Exit is a bit like an insurance company. We offer insurance for the future. You hope you will never need it, but are comforted from knowing that you have a choice, should the need ever arise.

The average age of Exit members is 75 years. This has not changed in the past 20 years.

While Exit has folk from all walks of life in our community, it may be accurate to say that we have an overwhelming number of non-believers.

This is not surprising since if you are a member of Exit you are likely to want to choice over when and how you might die.

You have little interest in leaving your death to God, or any other religious or spiritual figure.

You are a person who wants autonomy and wants control. Of the ‘my life, my death’ persuasion.

Lots of women from second wave feminism are members of Exit, having fought for the right to control their reproduction, many have turned their attention to this next hurdle, control over the time and means of one’s death.

As populations’ age and growing numbers move into their eighties and nineties many have first-hand experience of what dying badly and with zero choice looks like.

This experience motivates many. And provides the impetus for putting a plan in place.

Jacobsen: What is The Peaceful Pill Handbook? Where does this phrase “Peaceful Pill” originate?

Nitschke: The Peaceful Pill Handbook is our practical guide, now published in 5 languages, to explain how an older person or someone who is seriously ill might put plans in place and obtain the drugs or equipment needed to have a reliable and peaceful death at a time of their choosing.

If a person has access to the best, accurate and reliable information, based upon science, then you control the process. With no need to seek permission or involve doctors or other experts.

And, you don’t need the white coat beside the bedside, there is nothing inherently medical about dying.

Dying is a biological, social and cultural event we are all going to experience. It is not necessarily medical or religious in nature.

The book came into being as after Australia’s Rights of the Terminally Ill Act was overturned by the Federal Australian Parliament in 1997 (after I helped 4 patients to die in 1996 during the 9 months the law existed).

Just because the law had gone, did not mean that people ceased to want to know about their end of life options. Indeed the opposite was true, and demand grew for workshops where people could be given information and taught the best way they could end their own life should the need arise.

The subject material and the audience questions of these workshops were largely the same, no matter the city or country.

A book seemed a reasonable and logical way to provide the information to a much wider audience of interested folk.

The term Peaceful Pill is a metaphor for a means of death that is peaceful and reliable, be this a small drink or an actual pill: something that is accessible, easy and reliable.

The inspiration for the Peaceful Pill came from the Dutch Judge, Huib Drion who coined the term the ‘Drion Pill’, something he argued should be provided freely to any elderly person who requested it.

Judge Drion rationalised that every person over the age of 70 should have access to such a pill, just in case, and he thought it inappropriate that this option should be restricted to doctors or pharmacists, just by virtue of their training.

Indeed the idea that all over 70s should be issued with a peaceful pill – thereby having control over their life (and death), regardless of whether they are sick or not, is a topic of widespread current debate in the Netherlands.

This is what I like about living in this country, its openness and frankness about something as fundamental as dying. The ever-pragmatic Dutch. I do admire them.

Jacobsen: Why is respect for individual choice or personal autonomy about what to do with one’s life of utmost importance in free societies?

Nitschke: In modern society, the decisions we make throughout our lives go a long way to defining who we are, both in our own eyes and that of our communities.

We define ourselves by what we do for work, our marital status, whether we have kids, and so on. Look at anyone’s Twitter profile and you’ll see this writ large.

Obama says he’s a dad, husband and former President. This is how he sees himself, and how the rest of us see him.

Ten years ago, Exit made a TV commercial called ‘Exit Choices’ which took the ability to make decisions about vis a vis ‘this is who I am’ as a theme.

It had a guy sitting on the bed in his pyjamas saying ‘I chose to go to university, I choose to drive a Ford’. ‘I didn’t choose to get cancer and I certainly don’t want to choose my family watching me suffer’.

He closed saying ‘I’ve made my choices all my life about how I am and how I live. Why can’t I choose how to die?’

It seems a good question.

I strongly disagree with the counter argument that says a person choosing a time and place to die might injure the community that is left behind.

In the 2004 film Mademoiselle and the Doctor by Janine Hosking I explained this.

I have often noticed that there can be a deep resentment on the part of those left behind when someone chooses to leave early, to suicide. It’s as though many of us feel deeply and personally insulted when someone leaves essentially telling those left they have no time for the game the rest of us our playing.

Jacobsen: How does voluntary euthanasia differ from rational suicide?

Nitschke: As in the definition, voluntary euthanasia has come to mean an act carried out on another person, ending their life at their request. Suicide needs no other person, and rational suicideis when a considered and informed decision is taken by that individual.

I strongly believe in the words of Thomas Szasz who said that suicide is a fundamental human right, one that society has no moral right to interfere with.

Jacobsen: What are some of the techniques available in for either option in the current moment?

Nitschke: Voluntary euthanasia is taken to mean a doctor-administered lethal injection, this can be legally carried out in the Netherlands, Belgium and Luxemburg providing the legal prerequisites are met.

In Switzerland a lethal injection can be administered, but the person must activate the drug line as voluntary euthanasia is illegal.

Rational suicide is legal and possible anywhere if a person has access to the best information. This is the reason for publishing the Peaceful Pill Handbook. This is not only about drugs but can be about gases, poisons and other methods. The two most important criteria are that the method must be peaceful and it must be reliable.

Jacobsen: What tends to the most preferred methods – by demographics if you have them? Who are the majority demographics of voluntary euthanasia and rational suicide cases?

Nitschke: Most people – the overwhelming majority of Exit members and the readers of our book – want a pill that they can take and which allows them to die peacefully in their sleep.

The best Peaceful Pill is Nembutal which is a barbiturate sleeping drug from the 50s. The chemical compound is pentobarbital which when taken in overdose either by mouth or injection, causes death by respiratory depression while one is in a deep sleep. This was the drug used by Marilyn Monroe, Judy Garland and Jimi Hendrix to end their lives.

The popular book Valley of the Dolls, described these times when the use of Nembutal was at its peak in the 1950s.

The drug is no longer prescribed as a sleeping agent, and was replaced in the 1960s by the much safer benzo-diazepam family of drugs.

Exit members are people from all walks of life, some have seen family members die badly, others see having a plan in place for their own death as common sense. Many talk about an insurance policy for the future. Others dread the idea of having to leave their home in old age and move into an institution. Some others simply say that when they can no longer look after themselves, it is time to go.

Jacobsen: Where do you see the future of Exit International into the 2020s in terms of expansion and renewed interest via secularization of the advanced industrial economies?

Nitschke: The future of Exit? In 2019 we are having a serious look at how to use technology to speak to increasing numbers of interested people around the world. This includes live-streaming workshops, using hologram and virtual presentations and so on.

We are looking at how to future-proofing the organisation to withstand the relentless attacks on the organisations by those who strongly disagree with our philosophy and who argue that we should be forcibly closed. Our goal is to continue to disseminating accurate and easy-to-understand information about how to have a peaceful and reliable death at a time of your choosing, and to research and develop even better options.

My generation, the baby boomers, have rewritten history all our lives. Why should we not rewrite the rules on dying? This has been my life’s work. The trip has been and remains an exciting and highly rewarding one to be working on.

I should add my current project is the Sarco euthanasia capsule.

I am working with a Dutch industrial designer on this. The idea is to create a capsule in which a person can die. The capsule is aesthetically beautiful. It is 3D printed which means that in time, and with the plans being made available, it will be widely accessible as the person will be able to take the plans to their local 3D print shop and get one made for them.

And, as the Sarco is powered by liquid nitrogen (causing death by hypoxia, low oxygen), this may also offer a euphoric death.

The Sarco is aimed at totally overturning how we view death; from gloomy and macabre to an event of celebration and even joy.

Sound far-fetched? We are testing the boundaries for sure. I was pleased last year to see Sarco referred in Newsweek to as the Tesla of the assisted dying movement.

I do believe there is a parallel there.

Jacobsen: Any final feelings or thoughts in conclusion? How can people become involved with Exit International and other organizations?

Nitschke: Exit runs workshops in many countries which members can attend either in person, or on-line. We also operate forums which provide a Q&A service. We also actively support a R&D program that encourages the use of new technologies to provide better and more accessible end of life strategies.

You can find more information about our non-profit Exit and the activities we are involved in at www.exitinternational.net

Or about our publishing activities (based in Amsterdam) at www.peacefulpillhandbook.com

Thanks for considering me for this interview.

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Scott Douglas Jacobsen is the Founder of In-Sight: Independent Interview-Based Journal and In-Sight Publishing. He authored/co-authored some e-books, free or low-cost. If you want to contact Scott: Scott.D.Jacobsen@Gmail.com.

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Do not forget to look into our associates: Godless Mom, Nice Mangoes, Sandwalk, Brainstorm Podcast, Left at the Valley, Life, the Universe & Everything Else, The Reality Check, Bad Science Watch, British Columbia Humanist Association, Dying With Dignity Canada, Canadian Secular Alliance, and Centre for Inquiry Canada.

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Photo by Alvy Martinez on Unsplash