Académique Documents
Professionnel Documents
Culture Documents
Preface
C h a p te r 1 - E n d o f L ite C o nsideratio ns
C h a p te r 2 - S uicid e an d the L aw
C h a p te r 3 - T h e P eaceful Pill
C h a p te r 4 - T h e E xit R P Test
C h a p te r 5 - H y p o x ic Death & th e Exit Bag
C h a p te r 6 - C arb o n M o n o x id e
C h a p te r 7 - C y an id e
C h a p te r 8 - D etergent Death
C h a p te r 9 - Introduction to Drugs
C h a p te r 10 - D ru g O p tio n s - M o rp h in e
C h a p te r 11 - D ru g O ptio ns - P ro p ox yp hen e
C h a p te r 12 - O th e r D ru g s & C o m m o n M yth s
C h a p te r 13 - D ru g O p tio n s - N em butal
C h a p te r 14 - O b tain in g N em b u tal
C h a p te r 15 - U s in g N em b u tal for a P eaceful Death
C h a p te r 16 - S y n th esis o f a Peaceful Pill
C h a p te r 17 - T h e S w iss O ption
C h a p te r 18 - A fter i t s O v er
Exit R P Table
R eferences
S u p p o rt E xit International
A bo ut Exit International
http://www.exitinternational.net
http://www.peacefulpill.com
C o n ten t R evised :
1 A u g u st 2 0 12
For
D e re k H u m p h r
fo r h is c o u r a g e a n d c o m p a ssio n in sh o w in g th e w a y
A n n a S te p a n o v n a P olitkovskaya
In m e m o ry o f
Caren J e n n in g
The
Peaceful Pill
eHandbook
Dr Philip Nitschke
with
Dr Fiona Stewart
E X IT IN T E R N A T IO N A L US
P u b lis h e d b y E x it In tern atio n al U S
PO B ox 4250
B e llin g h am W A 9 8 2 2 7
USA
contact@exitinternational.net
P h ( + 1 ) 248-809-4435
T H E P E A C E F U L P IL L H A N D B O O K . N o v e m b e r 2011
C o p y r ig h t D r P h ilip N its c h k e a n d D r F io n a S te w a rt 2011
T h e P e a c e f u l P ill e H a n d b o o k
F irst p u b lis h e d b y E x it In tern atio n al U S L td , 2 0 0 8
T ec h n o lo g y s u p p lie d b y w w w .Y u d u .c o m
P rin ted b y O rig in a l W ritin g L td
IS B N 978 -0 -9 7 8 8 7 8 8 -4 -9
w w w .p e a c e fu lp ill.co m
w w w . e x i t i n t e r n a t io n a l .n e t
W h a t th e C ritics sa id a b ou t
Killing M e Softly:
Voluntary Euthanasia & the Road to the Peaceful Pill
D r P h ilip N itsch k e & D r F io n a S tew art
P en g u in - 2005
Nitschke has never been shy about speaking out against the
establishment and w as already no friend o f the medical one.
The B ig Issue
D isclaim er
www.peacefulpill.com /forum
Preface
T h e P e a c e fu l P ill e H a n d b o o k h a s b e e n c r e a te d a t a tim e
w h en there are v e ry f e w p la c es w h e r e S en iors an d those w h o
are serio u s ly ill can g et in fo rm a tio n a b o u t th eir en d -o f-life
choices.
O n each s e p a ra te o c c a s io n , th e c o m p u te r p re s e n te d a short
series o f questions:
The Deliverance machine built by the author. Used by four people in the
Northern Territory between 1996 - 1997.
Now on display at the British Science Museum
The P eaceful Pill H andbook
Acknowledgements
A W ord o f C a u tio n
H o w to G et th e M o st from y o u r eB ook
N o te : P u rc h a se rs o f th e P rin t ed itio n
P eaceful P ill H andbook are e n title d to a
U S $ 10 cashback should th ey choose to elect
to u p g ra d e to a subscription to th e online
P eaceful P ill eH andbook.
O n ce a r e a d e r u p g ra d e s b y ta k in g o u t a
subscription at www.peacefulpill.com , email
E xit w ith p r o o f o f p u rc h a s e a n d w e will
credit $ 1 0 to y o u r P aypal account.
1
End o f Life Considerations
O u r A g ein g P o p u la tio n
T he Q u e stio n o f S u icid e
A B r ie f H isto ry o f S u icid e
T h e link b e tw e e n s u ic id e a n d d e p re ss io n r e m a in s a v e x e d
issu e w ith m illions o f d o lla rs in g o v e rn m e n t fu n d in g devoted
to ra isin g th e c o m m u n ity 's a w a re n e s s o f su icide, esp ecially
a m o n g st th e y o u n g a n d s o m e m in o rity g ro u p s (eg. farm ers).
A n d there can be n o d oubt. P eople w h o suffer from clinical
d epression are clearly a t risk o f suicide. S ev ere d ep ressiv e
states can rob a p erso n o f th e ability to m a k e rational decisions
and these p eo p le n eed care an d treatm en t until th ey are once
again able to resu m e control. Yet illness o f this severity is not
co m m o n a n d needs to b e d istin g u ish ed fro m a larger g roup o f
p eo p le w h o s h o w o ccasion al sig n s o f d epression but w h o are
in full control o f th eir actions.
The P eaceful P ill H andbook
T h e re is a s ig n ific a n t d iff e r e n c e b e tw e e n a p e rs o n h a v in g
m o m en ts o f feeling d o w n o r h av in g a transitory feelin g that
th eir life h as lost p u rp o se an d the person w h o h as severe clinical
d epression , w h e re ev en the m o st basic d aily d e c is io n s o f life
b e c o m e problem atic.
T h is is quite different from an eld erly o r serio u sly ill p e rso n 's
d esire to form ulate an en d o f life plan; a p lan w h o s e sole aim
is to m ain tain control o v e r their final days. P eople w h o like to
b e p rep ared an d w h o are n o t d ep ressed sh o u ld n o t b e v iew ed
in p sychiatric term s.
A n g e l i q u e F l o w e r s d i e d v o m i t i n g u p f a e c a l m a t t e r a f te r
e x p e rie n c in g an acute bo w el blo ck age. Just as h er d o c to rs h ad
w arn ed , h er death w a s s im p ly aw ful. T h e y h ad told h er that it
c o u ld be sho ck ing , an d it was.
S o m e o f th e se p e o p le a r e so w e a k that they c a n n o t m o v e
u n a s sis te d . O th e rs h a v e s h o rtn e s s o f b reath w h ic h m a k e s
in dep en dent livin g im possible. F o r a significant n u m b e r o f
p eo p le, it is n o n-m ed ical issues that h ave m o s t im p act upon
the q u a lity o f th eir life.
T h e T ired o f L ife P h en o m en on
To W h o m it M a y C o n cern
S id n ey a n d M arjorie C roft
E x it W ork sh op s
C o n clu sio n
I n f o r m a t i o n is th e m a i n r e a s o n w h y p e o p l e j o i n E x it
International. Inform ation is certainly the m ain reason w h y our
w ork sh op s are b o o k ed o u t m o n th s ahead. People w an t to know
h o w to en d th eir lives peacefully, relia b ly an d w ith dignity.
M o s t p eo p le k n o w th a t they m a y n e v e r u se this inform ation.
All are com fo rted, how ever, in k n o w in g that i f thin gs ' turn
b a d ' a s th e y put it, th e y h av e a plan in place.
E xit W o rk sh o p s
S in c e th a t ti m e w o r k s h o p s h a v e o n l y g o tte n b ig g e r, n o w
attracting o v e r 100 particip ants at each m eeting. B ecause Exit
can still n o t k eep u p w i t h p e o p le 's d esire to o b tain en d o f life
inform ation, th is b o o k h as b een c re a te d . W elco m e to E xit's
n e w global w orkshop.
C o n clu sio n
I n f o r m a t i o n is t h e m a i n r e a s o n w h y p e o p l e j o i n E x i t
International. Inform ation is certainly th e m ain reaso n w h y
o u r w o rk sh o p s are b o o k e d o u t m o n th s ahead. P eople w a n t to
k n o w h o w to end th eir lives peacefully, reliably an d w ith dignity.
M o st p eo p le k n o w that they m a y n e v e r u se this inform ation.
All are com forted , how ever, in k n o w in g that i f things ' turn b a d '
a s th e y p u t it, they h av e a p lan in p la c e .
In M ic h ig a n , th e la te D r J a c k K e v o rk ia n w a s in c a rc e ra te d
for a lm o s t a d ecad e fo r the assisted suicid e o f his term inally
ill p atien t, T h o m a s Y ouk. In M a rc h 1999, K e v o rk ia n w a s
c o n v ic te d o f s e c o n d d eg ree m u rd e r an d s e n te n c e d to 10 to 25
y ears jail.
Suicide a n d th e Law
I f t h e y q u a lifie d , th e y o b ta in e d th e r ig h t to r e q u e s t lawful
assistan ce fro m a d o c to r to die. O th e r law s (O reg o n , H olland
etc) h ave also set o u t to define e x a c tly w hich g ro u p o f people
can h av e help to die. In all cases, eligibility is tightly controlled.
W h il e s o m e p e o p le m a y w i s h to in v o lv e d o c to r s in th e ir
deaths, o th ers do not. O u r point at Exit is that death n eed not
be a m ed ical event. It is also arg u ab le w h e th e r th e m edical
profession s h o u ld b e given th e role o f arbiter, o f w h o gets the
rig h t to d ie w ith dignity, an d w h o d o e s not.
C o n clu sio n
In tro d u ctio n
D r Philip N its c h k e
F ifty y e a r s o n a n d it is p e n to b a r b ita l ( N e m b u ta l ) t h a t is
fav ou red as an ideal P eaceful Pill. N em b u tal is a m e m b e r o f
th e barbiturate fam ily o f d ru g s that are m a d e fro m th e salts o f
barb ituric acid. T h e se a c tiv e b arb itu rate salts h a v e b een used
m e d ic a lly fo r m a n y y e a r s , m a in ly a s se d a tiv e s o r slee p in g
tablets.
Yet f e w p e o p l e w o u l d r e s o r t to s u c h m e a n s i f t h e y h a d
a n y real c h o i c e . M o st s e r i o u s ly ill o r e l d e r ly p e o p l e w h o
are c o n s id e r i n g death,
s e e k a m e t h o d that is
peaceful, dignified a n d
p a i n free. C o m m o n l y
this is e x p r e s s e d as, 'I
s i m p l y w a n t t o g o to
sleep a n d die'
In 2 0 0 4, Exit
International undertook
a m ajor study o f our
supporters' attitudes
to v a r i o u s m e t h o d s
of dignified dying
( n = 1163).
Fig 3.2; Survey of Exit Members
Methods of Self Deliverance
The P eaceful P ill H andbook
C o n clu sio n
P r im a ry C riteria
P e a c e fu ln e ss (P - 1 0 )
S e co n d a r y C rite r ia
A vailability (A)
Preparation an d A d m in istration (Pr)
U n d etectab ility (U)
S p eed o f Effect (Sp)
Safety to O th e rs (S a)
S torage - S h e l f Life (St)
A v a ila b ility (A - 5)
To be o f an y u se th e m e th o d m u s t b e a v a ila b le . T h e m o s t
p eacefu l an d reliable d ru g is o f n o u se i f it is unavailable.
S a fety to O th ers (S a - 5)
S to ra g e - S h e lf life (S t - 5)
Test F a c to r Score
Reliability: R =8/10
T h is is g o o d , b u t tech n iq u e is im portant
Peacefulness: P=7/10
T h e re is s o m e sh o rt term a w aren ess an d alarm
Availability: A = 5 /5
N e c e s sa ry item s are readily available
Preparation: Pr=l/5
Item s req uire a sse m b ly an d coo rdination
U ndetectability: U=5/5
I f item s rem oved, totally undetectable,
e v en in th e e v e n t o f an au to p sy
Speed: S p = 5 /5
U n co n scio u sn ess an d death o c c u r qu ickly
Safety: Sa=5/5
T h e m e th o d p resen ts n o risk to o th ers present
The E xit R P Test
Storage:
E q u ip m en t do es n o t d eteriorate an d testing S t= 5 /5
readily available
A N o te o f C a u tio n
T h e R P T e s t s c o r e s e r v e s o n l y a s a g u i d e . I n d iv i d u a l
c ircu m stan ces an d p referen ces will alw ay s influence a p e rso n 's
d ecision. T h e re are p e o p le for w h o m a plastic E xit b ag o ver
th eir h ead will n e v e r be a v iab le o p tio n , n o m a tte r h o w peaceful
an d reliable th e m etho d.
In tro d u c tio n
A n d th is is w h y w e s h o u ld b e w a ry o f m e d ia r e p o r ts that
rein fo rce this confusion. F o r ex am p le, w h en referrin g in 2001
to th e im portation o f C an adian Exit b ag s, th e M u rd o ch press
( The A u stra lia n n ew sp ap er) rep o rted these bags as ' rem in iscent
o f th e K h m e r R o u g e 's s h o p p in g b ag ex ecu tion s in C a m b o d ia 's
killing f i e l d s '. Such rep orts s h o w a lack o f u n d erstan d in g o f the
p ro c e ss a n d h ave d a m a g e d the im ag e o f th e Exit Bag.
T he H y p o x ic D eath
T h e R o le o f C a rb o n D io x id e (C O 2)
A P eacefu l D eath
A s e c o n d issu e o f c o n c e rn is th e s iz e o f th e se c o m m e rc ia l
c y lin d e rs. C o m m e rc ia l c o m p r e s s e d g as cy lin d e rs a re often
large, h e a v y an d difficult to transport. S u sp icio n m ight arise if
an elderly o r v e ry sick p erso n is seen leasing a c y lin d e r from
th eir local B O C g as outlet. I f so m e o n e else w e re to collect the
cy lin d er for th em , this o th er p erso n m a y w ell b e c o m e legally
im plicated in a ssistin g in a suicide. T h e se c o n c e rn s turned
m a n y p eo p le a w a y fro m u sin g high pressure, c o m p re s s e d inert
g as w ith an E xit bag.
T h e O p tim a l G a s F lo w R a te
Fig 5.2: Exit Bag CO2 &O2 concentration levels for the first 5 minutes
H ypoxic D eath & th e E xit Bag
1. H elium
In N th A m e r i c a , B a llo o n T i m e c a n i s te r s a r e a v a il a b l e a t
A m azo n ' s onl i ne store ( h ttp ://w w w .la tim e s.c o m /n ew s/n a tio n w o rld /w o rld /
d isp o sab le -he liu m -ta n k -w ith -p a rty -b a llo o n s-3 0 ---5 0 -p ac k ) a s w ell as C linton
C ards an d T escos h o m e stores.
In A ustralia an d N e w Z e a la n d m any, b u t n o t all, Spotlight stores
stock B alloon T im e canisters.
Fig 5.3: Packages disposable Helium containers: Left - 420 litre, Right - 250 Litre
The P eaceful P ill H andbook
Fig 5.4: Flow Rate, Pressure and Volume of Helium with Time for 420 & 250 litre Cylinders
using the Exit Gas Control Jet Assembly
H ypoxic D eath & th e E xit Bag
2 . A rg o n
3 . N itrogen
Fig 5.6: Filling a 4Kg LPG cylinder with 400 psi of Nitrogen
H ypoxic D eath & th e E xit Bag
A b e t t e r s t r a t e g y is to p u r c h a s e an e m p t y h i g h p r e s s u re
alu m in ium cylinder. W hile so m e g as outlets will fill this typ e o f
cylinder w ith nitrogen fo r you, others will not. T hese alum inium
cy lin d ers (see F ig 5 . 6 .1) are av ailab le in the U S by mail order
from the B everag e Factor) at: http://bit.ly/jp A 5 9 Z T h e 2 2 cu
ft (6 5 0 litre) cy lin d er pictured has a rated se rv ic e pressure o f
u p to 22 0 0 P S I/1 5 0 BA R.
R eg u la tin g th e F lo w o f N itrogen
Fig 5.6.1
(a) 650 litre Al cylinder
(b) Nitrogen regulator
(c) Gas cylinder ready to
connect to Exit Bag
The P eaceful P ill H andbook
T he Exit Bag
1. M a k in g an Exit Bag
a re a so n a b le size
a suitable s o ft plastic
a n eck b an d o f elastic that allo w s th e bag to m ak e a snug,
b u t n o t tight, fit a ro u n d a p e rso n 's neck
Plastic
b ag - p o ly ester ' o v en b a g ' av ailab le in su perm ark ets
is a g o o d size (L arg e 3 5 cm x 4 8 c m ) ' A & B'
1m etre o f 10 m m w id e elastic, ' D'
1toggle to ad ju st elastic length
1 roll o f 2 0 m m stick y tape C (M ic ro p o re o r equivalent)
1 sm all roll o f ~ 35 m m plastic du ct tape
Pair o f sh a rp scissors
Fig 5.8: Exit Bag Manufacture Fig 5.9: The completed Exit Bag
G a s F lo w C o n t r o l
Fig 5.9.2
High pressure
nitrogen regulator
with click flo w
rate output
Fig 5.9.1
LPG regulator
and 2mm jet
used to control
nitrogen flow
The P eaceful P ill H andbook
Fig 5.13:
Helium cylinder with
pressure gauge attached
to flow control assembly
Fig 5.14: Positioning, Inflating & Using the Exit Bag with Helium
H ypoxic D eath & th e E xit Bag
G as P u rity
T h e P roced u re
C o n c lu d in g C o m m e n ts
T H E R P T E S T S C O R E - Exit B a g + H elium
R eliability (R = 8/10)
T h e m e th o d is reliable b u t tech n iq u e is im p o rtan t
a n d a d eg ree o f co o rd in atio n an d dex terity is required
A vailability (A = 5/5)
All co m p o n e n ts are re a d ily available
Preparation ( P r = 1/5)
C o n sid era b le a sse m b ly a n d setting u p o f eq u ip m en t
Speed (S p = 5/5)
L oss o f co n scio u sn ess c o m e s quickly
Safety (S a = 5/5)
T h e m e th o d presents n o d a n g e r to others
Storage (S t = 5/5)
C o m p o n e n ts d o n o t deteriorate w ith tim e. G a s
p ressu re test can re a d ily establish helium cy lin d er is full
T H E R P T E S T S C O R E - Exit B a g + H elium
C h a p te r 5: F r eq u e n tly A sk ed Q u estio n s
C an a fa c e -m a sk b e u se d in ste a d o f th e E x it B a g ?
Carbon M onoxide
Introd u ction
PPM T im e S ym p to m s
[C O ]
35 8 hours M axim u m e x p o s u r e a l l o w e d b y O S H A in t h e w o r k p l a c e o v e r a n
e ig h t h o u r period .
Fig 6.2
a) RKI sampling multi-gas meter
b) TPI 707 high level monoxide analyser
c)TPI 770 monitor with sampling probe
C arbon M onoxide
G a u g e s u s e d b y E x it a re s h o w n in F ig 6.2. T h e m u lti-g as
s a m p l i n g m e t e r (R K I E a g le ) e n a b l e s t h e m o n i t o r i n g o f
carbon m o n o x id e levels, carbon dio xid e levels a s well as the
concentration o f av ailab le o x y g en . T h is g a u g e retails for ov er
U S $20 0 0 an d is p rim a rily u s e d a s a research tool. A sm aller
h an d -h eld d ev ice (TPI m od el 701 carbon m o n o x id e analyser)
that m e a su re s asp irated g as o f u p to 10 ,0 0 0 ppm is also show n.
T h is useful g a u g e co sts ~ U S $ 600. A c h e a p e r T P I g au ge used
b y E xit w ith a m o d ified 10:1 sa m p lin g p ro b e (TPI m o del 770)
costs ~ U S$200.
S ou rces o f C a r b o n M o n o x id e
Vehicle E x h au st Gas:
C arb o n M o n o x id e is p ro d u c e d a s an ex h a u s t g a s from internal
c o m b u s tio n eng ines. T h e c o n c e n tra tio n o f th e m o n o x id e in
th e ex hau st g as varies, d ep en d in g on a n u m b e r o f factors and
e stab lishin g this is critical.
U sin g F o rm ic A c i d :
C a rb o n M o n o x id e is p r o d u c e d b y a ch e m ic a l reactio n that
o ccu rs w h e n th e form ic a c id ( H C O O H ) is b ro k en d o w n into
w a te r ( H 2O ) an d c arb o n m o n o x id e (C O ). T h e catalyst for this
b reak d o w n is c o n c e n tra te d su lp h u ric acid. T h e su lp h u ric acid
r e m a in s c h e m ic a lly u n c h a n g e d b u t is d ilu te d b y th e w a te r
released.
U sin g O x alic A c i d :
C oncentrate sulphuric acid can be used to b reak do w n anhydrous
oxalic acid to pro d u ce c arb o n m o n o x id e (an d c arb o n dioxide).
A g ain th e su lp h u ric acid re m a in s c h e m ic a lly u n ch an g ed but
is d ilu te d b y the w a te r p r o d u c e d in th e reactio n . L ess heat
is g e n e ra te d in th e re a c tio n a n d th e r e is less lik elih o o d o f
con tam ination w ith v a p o u r from th e su lp h u ric acid. O n e m ole
o f oxalic acid (~ 9 0 g m ) pro du ces equal m o la r am o u n ts o f carbon
dioxide a n d c arb o n dioxide.
U sin g Z in c an d C alciu m C a r b o n a te :
P o w d ered zinc can b e m ix e d with calciu m carbonate an d heated
to produce carbon m onoxide, along w ith calcium and zinc oxide.
H eat is n eed ed fo r the p ro c e ss a n d this o ffers the o p p o rtu n ity o f
con trolling th e p rocess (u sin g an electrical heater).
Fig 6.5
The early CoGen
C arbon M onoxide
Fig 6.6. COGen 4 on fume cupboard test bench with acid bottles and CO monitor
The P eaceful P ill H andbook
How th e C O G e n W orks
T h e V id eo sh o w s th e C O G e n b e in g a r m e d an d p la c e d in a
small car. T h e c arb o n m o n o x id e co n cen tratio n in th e c a r w a s
c o n tin u o u sly sa m p le d w ith a p ro b e p ositio ned n e a r th e head
o f th e m an n eq u in . T h e g raph (F ig 6.8 ) sh o w s the m easu red
concentration in p p m , p lo tted o v e r th e first 30 m inutes. Lethal
concentratio ns w e r e re a c h e d a few m in u te s after s w itc h in g on
th e generator. A p eak level o f ~ 3 % C O w a s recorded.
S ou rcin g th e Acids
S a fety N o te
O th e r te s ts w e r e c a r rie d o u t u s in g a s e a le d 2 0 f t s h ip p in g
co n tain er as the clo se d en v iro n m en t. A brazier w a s loaded with
1.5 K g m o f g o o d q uality charcoal w h ic h w a s then set alight
and p laced in the cen tre o f the floor. T h e c o n ta in e r d o o rs w ere
shut (see F ig 6.10). A gain, the c arb o n m o n o x id e concentration
w ith in th e co n tain er w a s c o n tin u o u sly sa m p le d fro m outside
u sin g a sa m p lin g probe.
C o n clu sio n
E xit R P Test f o r C a r b o n M o n o x id e
C rite ria S co re
R e lia b ility 8 /1 0
P ea cefu ln ess 7/10
A vailability 3/5
P reparation 1/5
U n d etecta b ility 1/5
Speed 5/5
S a fe ty 1/5
S to ra g e 4/5
T o ta l 3 0 (60% )
7
Cyanide
T h e d e a th o f S p a n ia r d R a m o n S a m p e d r o in 1998 a n d th e
s u b se q u e n t a w a rd -w in n in g film T he S ea In sid e h as fo cu sed
attention on th e u se o f cy an id e a s an effectiv e m ean s b y w h ich
a serio u sly ill person can p u t an en d to their suffering.
S o m e b a ck g ro u n d to cy a n id e
In 1814, th e c a r b o n - n itr o g e n (C N ) r a d i c a l c o m m o n to a
n u m b e r o f c h e m ic a l s u b sta n c e s w a s iso la te d a n d g iv e n the
n a m e c y a n o g e n b y th e French ch em ist J o sep h G a y Lussac.
T h e su b seq u en t n am e th e b lue g e n e ra to r referred to th e p lace
o f th e C N radical in a n u m b e r o f ch em icals that w e re u sed as
Cyanide
O n s o m e o c c a s i o n s , h o w e v e r , a v i o le n t ( a n d p r e s u m a b ly
p ain fu l) death w a s ob served. T h is m eth o d o f ex ecu tio n w a s
largely ab an d o n ed in th e U S in 1994 w h e n th e A m erican Civil
Liberties U nio n too k a successful action a g a in st th e C alifornia
D ep artm en t o f C orrectio ns. In their action, th e A C L U argued
successfully that the g as ch am b er violated the U S C o n stitu tio n s
b an a g a in st cruel an d u nu sual p u n ish m en t, b ecau se it inflicted
n eedless pain an d suffering.
T h e A vailability o f C y a n id e
T h e M a n u fa c tu re o f S o d iu m C y a n id e
In t h e first p r o c e s s th e
P r u s s i a n B l u e is f i r s t
c o n v e rte d to sodium
ferrocyanide. Th is is done
b y a l l o w i n g it to r e a c t
with caustic sod a in water.
Iron o x id e is precipitated
a n d s o d iu m ferro cyan id e
o b t a i n e d . T h i s s o d iu m
ferro c y a n id e (Y ellow
Prussate o f So da ) is then
c o n v e r t e d to s o d iu m
cy a n id e by a l lo w ing it to
react w ith conce ntrate d
sulphu ric acid.
Fig7.1: Forge reduces sodium cyanate with carbon
C y a n id e - R P Test
In te r m s o f P e a c e fu ln e ss , th e m ix e d a c c o u n ts m a k e th is a
difficult characteristic to assess. C le a rly th e size o f the dose
m atters, i f o n e is to m in im ise s y m p to m s. Preparation is also
im portant. T h e toxic effect is p ro d u c e d w h en sto m ach acid acts
on th e salt p ro d u cin g H C N w h ic h is th en a b so rb e d by the gut
into the b lo o d stream . T h is pro cess is facilitated b y dissolving
th e salt in c o ld w a te r a n d drin king on an e m p ty sto m ach w here
th e gastric acid co n te n t is high.
L o o k in g a t th e M in o r Criteria:
E xit R P Test
C a n o n e in h a le th e h y d r o g e n c y a n id e g a s r a th e r th a n
d r in k in g th e d isso lv e d c y a n id e s a l t ?
Detergent Death
S in c e 2 0 0 9 , E x i t h a s r e c e i v e d
re q u e ste d for in fo rm atio n on the
so -c a lle d D e te rg e n t S u ic id e
m eth o d o f e n d in g o n e 's life. W h ile
a n s w e rs w e r e p r o v id e d to th o se
a s k in g th e q u e s tio n s , it w a s not
thought necessary to include details
o f the m e th o d in T h e P e a cefu l P ill
H and book.
T h is d e c is io n h as b e e n r e v ie w e d in 2011 an d th is ch a p te r
included. W e stress h o w e v e r that th e m eth o d scores p o o rly on
the Exit RP test, an d h as little to re c o m m e n d it. It is in effect
a c h e a p a n d n a sty suicide strategy, an d re a d e rs are a d v ise d to
c o n s id e r o th er b e tte r altern ativ es o u tlin ed in this book.
T h e M eth o d
T h e m e th o d m a k e s u se o f the toxic n atu re o f th e g as hydrogen
sulfide (H 2S) a n d its e a s e o f g e n eratio n fro m re a d ily available
(u n re s tric te d ) h o u s e h o ld c h e m ic a ls. H y d ro g e n S u lfid e
(c o m m o n ly k n o w n a s ' rotten eg g g a s ') is ex trem ely toxic w hen
inhaled. T h e m e c h a n is m o f actio n is sim ilar to that o f hydrogen
c y a n id e (C h a p te r 7) w h e re the g as b in d s w ith an d d estro y s the
function o f m ito c h o n d ria w ith in living cells. T h e g as is a s toxic
as h y dro gen cyanide, b u t accidental e x p o su re is u n c o m m o n
b e c a u s e o f th e stro n g a n d u n p le a sa n t smell n o te d w ith even the
sm allest c o n cen tratio n s o f th e gas.
D etergent Death
2H C l + CaS H 2S + CaCI
P r o b le m s w ith th e m eth od
T h e E xit R P Test
E xit R P Test
Introduction to Drugs
Introd u ction
T h e R o le o f the D ru g O v erd o se
D r u g s a n d V om itin g
D r u g s & A lcoh ol
Secondly, alcohol p lay s a useful role in ' p o ten tiatin g ' the lethal
drug. To fo llo w th e dru g w ith an alcoholic drink w ill usually
enh an ce its s p e e d o f action an d potency. T h is is true o f m o s t o f
the c o m m o n ly -u s e d lethal, oral drugs.
D ru g T o leran ce
S lo w R elea se D rugs
N a s o g a s t r i c tu b e s a r e a lso
o ccasio n ally u sed to provide
f l u i d s to s o m e o n e w h o is
h av in g difficulty sw allow ing.
T h is te m p o ra ry p ro c e d u re
s e e s a sm a ll d i a m e te r tub e
p o sitio n ed th ro u g h the nose
a n d d o w n the throat into the
s to m a c h . It is p o s s ib le to
d e liv e r fluids directly into the Fig 9.2: Intravenous drug
administration
sto m ach th ro u g h such a tube.
In tra v en o u s D ru g s
O th e r c o m m o n ly -u s e d d r u g s h ave a m u c h lo n g e r w in d o w
p e r i o d w h e n i n t e r v e n t i o n c a n o c c u r . F o r th e c o m m o n
p ro p o x y p h e n e /o x a z e p a m co m b in atio n (see C h a p te r 11), this
w in d o w p e rio d m a y b e a m a tte r o f h o u rs. T h i s m e a n s that
con siderable p lan n in g m a y be n eed ed to reduce th e ch an ce o f
d iscovery d u rin g this time.
T h e S h e lf L ife o f D ru g s
It is in th e m a n u f a c tu re r s ' in terest to m a k e th is a s lo n g as
p ossible. T h is is n o t to say that a d rug w ill not b e effectiv e after
th e stated expiry date. Rather, this date m erely indicates that if
sto red correctly, no significant c h em ical, physical o r m icrobial
deg rad atio n o f the d ru g w ill h av e o c cu rred before this date.
O f c o u r s e , th e o n l y c e r ta in w a y o f e s t a b l i s h i n g w h e t h e r
significant d eg rad atio n h as taken p lace is b y c a rry in g o u t a
chem ical assay on th e p rod uct. F o r d ru g s that are hard to obtain
an d difficult to replace w ith fresh sam p les, an a ssa y m a k e s a
lot o f sense.
C o n clu sio n
It is th e adm in istratio n o f the pain -relievin g drug that cau ses the
d o u b le effect; it relie v es pain but it also cau ses death. A s long
a s th e stated p rim a ry intention is th e treatm en t o f the p erso n 's
pain , th e d o cto r is legally safeguarded.
F o r th e s e r e a s o n s , f e w p e o p le o p t f o r s lo w e u th a n a s ia as
th eir preferred ch o ice for a peaceful, dignified death. M ore
co m m only, it is an option o f d esp eration , w h en few alternatives
exist. In such d ire c ircu m stan ces, i f a d o c to r d o es offer help
(u su ally through a nod, a w in k a n d an u n d erstan d in g ), patients
will g rab the ch an ce, reaso n in g correctly, that this is better than
nothing.
A s k in g f o r S lo w E u th a n a sia
A patient m ight even im agine that the doctor is saying that w hen
things deteriorate I w ill g ive y o u access to lethal d r u g s . In
reality, this is h ig h ly unlikely. F e w m edical do ctors w o u ld risk
de-registration an d a significant ja il term . T h e only assistance
likely fro m the doctor, is fo r th em to initiate s lo w euthanasia,
w ith th e p a tie n t b e in g a d m itte d to an in stitutio n , a hospital
o r h osp ice. A n d th ere m a y w ell b e a rg u m e n t a b o u t w h en the
p ro c e ss sh o u ld co m m ence.
T h e R o le o f O p ia te s and O p ioid s
M an y v ery sick people receive these drugs for the pain o f serious
illness an d so m etim es g o to g reat leng th s to sto ck p ile tablets
believing that they will soo n acqu ire a lethal dose. But know ing
h o w m a n y m o rp h in e tablets to ac c u m u la te is like a sk in g the
length o f a p ie c e o f string?
T h e U se o f H eroin
C o n clu sio n
W h i l e a s in g l e o v e r d o s e o f m o r p h i n e m a y c a u s e d e a th ,
individual sensitivity a n d to leran ce to these d ru g s m ak e this an
u n certain a n d u n p redictab le p ro cess. T h e o p iates are best used
to do th e j o b they are d esig n e d to do, co ntrol stro n g pain. T h ere
are b e tte r eu thanasia optio ns available.
M orphine & Slow Euthanasia
T h e E x it R P T est fo r M o rp h in e
E x it R P T e s t - M orp h in e
In tro d u ctio n
Fig 11.1
Propoxyphene capsules (Doloxene)
D rug O ptions - Propoxyphene
T he V ariou s F o r m s o f P ro p o x y p h en e
P ro p o x y p h en e is m a rk e te d u n d e r a n u m b e r o f nam es, e x a m
p les include D arvo n, D o lo x en e, a n d D epronal.
W h en is P r o p o x y p h en e P rescrib ed ?
H o w L eth a l is P ro p o x y p h en e?
T h e R o le o f O x a zep a m
W h en is O x a z e p a m P rescrib ed ?
T ak in g P r o p o x y p h en e
Fig 11.3
100mg pink Doloxene Capsules
The P eaceful P ill H andbook
S h e lf L ife o f D o lo x en e
T h e F u tu re o f P r o p o x y p h en e
R P T est for P ro p o x y p h en e
R P Test fo r P ro p o x y p h en e
A m itrip ty lin e
In su lin
In S u m m a r y
N o t reliable en o u g h to re c o m m e n d i f su b c u ta n e o u s injection is
the o n ly m eth o d o f a d m in istratio n available.
I a m h o p in g to g e t a c c e s s to y o u r 'p e a c e fu l p i l l ' - n o t
fo r im m e d ia te use, bu t to h a v e o n h a n d s h o u ld m y health
d e te rio ra te to o m u ch in th e fu tu re . A rthur, 77 years
In tro d u ctio n
T h e barbiturate S o d iu m Pentobarbital is th e d ru g th a t co m es
closest to th e c o n c e p t o f th e P eaceful Pill. Exit defines the
P eaceful P ill a s a pill, tablet o r m ix tu re that can b e taken orally
a n d that is g u a ra n te e d to p ro vide a peacefu l, dignified death at
a tim e o f o n e 's choosing.
In th e first h a l f o f th e 2 0 th C en tu ry ,
b arbitu rates w e re m a n u fa c tu re d around
th e w o rld , w ith p ro d u ctio n p e a k in g in
the 1950s. B y then there w e re m o re than
2 0 m a rk e te d form s o f b arb iturates, with
m o s t sold as slee p in g tablets.
Fig 11.2: Pentobarbital
(Nembutal) sleeping tablets
The Peaceful Pill Handbook
A lo n g w ith th e o r ig in a l V eronal,
there w a s Barbital, A m ytal, Seconal,
S o n e ry l, N e m b u ta l an d several
others.
B a rb itu ra te s a s D ru g s o f A b u se
A s te rile f o rm o f N e m b u t a l h as a l s o p e r s is te d a s a u sefu l
co m p lete anaesthetic a g e n t that can q uick ly ren d er an anim al
unconscious for surgery. Pentobarbital continues to p lay a role in
veterinary practice to this d ay even though its u se by the m edical
profession h as all b u t disap peared . A d e v e lo p m e n t that h as led
to a resurrection o f these o u td ated d ru g s is th eir increasing use
as th e d ru g s o f ch o ice for v o lu n ta ry euthanasia.
W h e n th e R ig h ts o f the
T e r m in a lly Il l A c t w a s
p a s s e d in th e N o r th e rn
T e rrito ry , I h ad th e
ch a lle n g e o f d e c id in g
w h ic h d ru g o r substance
w o u ld p ro d u ce th e m o st
hum ane, peaceful reliable
death.
Fig 11.4: The Deliverance euthanasia machine
Fig 11.5:
Sterile veterinary
Nembutal
The Peaceful Pill Handbook
A v a ila b le F o rm s o f N em b u ta l
T h e s te r ile fo rm o f th is
v eterinary barbiturate (fig 11.5)
is m a r k e t e d in s m a ll, s e a le d
10 0 m l bottles that are protected
w ith a m etal seal. T h is m etal
cap m a k e s tam p erin g obvious.
T h e N e m b u ta l inside is a clear
liquid w ith co n cen tratio n o f 60
m g/m l. Each 100ml bottle has
a total o f 6 g m o f N e m b u ta l -
enough to p rov id e a peaceful
death.
N o n - s t e r i l e N e m b u t a l liq u id
Fig 11.6: Non-sterile coloured
(L e th a b a rb F ig 11.6) is used veterinary Nembutal (Lethabarb)
for anim al euthanasia, is colour
d y e d f o r sa fe ty , a n d h a s a m u c h h i g h e r c o n c e n t r a t i o n o f
b arb itu rate (3 0 0 m g /m l). 30m l taken o rally is lethal.
Since 2010, the pow dered form o f the drug (sodium pentobarbital)
has b e c o m e in creasin g ly available a s an a ssa y g ra d e laboratory
reagent. F o r d etails o f this useful form o f the d ru g - see C h 12.
P e n to b a rb & P h e n o b a r b - C o n fu sin g N a m es
S o u r c e s o f N em b u ta l
T h e c o m m o n e s t s o u rc e o f life -e n d in g b a rb itu ra te s in m o st
w estern co u n tries is th e v eterin ary profession, a n d even this
s u p p ly is likely to d im in ish in tim e. T h e re is n o legitim ate or
p lau sib le reason fo r a v e t to p rov id e this d ru g to an y m e m b e r
o f th e public. You can h ard ly tell y o u r vet that y o u 'r e plan nin g
to op erate on the cat this w eekend!
N em b u ta l and Vets
I f a v e t w e r e e v e r to p r o v id e
N em butal - know ing w h a t the person
has in m in d - th ey could face a charge
o f assisting a su icide o r ev en murder.
D e - re g is tra tio n a n d a priso n term
w o u l d be th e lik ely c o n s e q u e n c e .
In 2001 th e A u s tra lia n V eterinary
B oard b ecam e c o n c e rn e d about
th e i n c r e a s i n g u s e o f v e t e r i n a r y
N e m b u ta l a s a h u m a n e u th a n a s ia
o p tio n a n d p u t o u t a w a r n i n g to
its m e m b e r s u rg in g ca u tio n in the
s to r a g e a n d u s e o f th e d r u g (see
Fig 11.7: Non-sterile veterinary
Veterinary S u rg eo n s Board, 2003).
Nembutal (Valabarb)
A C a se S tu d y in N em b u ta l
N em b u ta l and th e B la ck M ark et
Note: T h e ' Exit Spot Test K it' only p rovides qualitative evidence
o f th e p r e s e n c e o f th e dru g. Q u a n tita tiv e te s tin g (ie . dru g
co ncentration an d strength) is n o t y et av ailab le as a h o m e test.
T h e S h e lf L ife o f L iq u id N em b u tal
A d e t a i l e d d is c u s s io n o f th e s h e l f life o f b o th liq u id an d
p o w d e re d N e m b u ta l can be found in C h a p te r 15.
The Peaceful Pill Handbook
N em b u ta l - S u m m a ry
E x it R P T est - N em b u ta l
In tro d u ctio n
E x it a c k n o w le d g e s th a t th e a v a ila b ility o f N e m b u t a l ca n
c h a n g e w ith o u t w a rn in g . O ld stores close an d n e w stores open.
W eb sites a p p e a r a n d disappear, se e m in g ly o vernight. A s the
w ell-kn ow n expats C arol Schm idt, N o rm a H air an d Roily Brook
w rite o f M exico:
T ypes o f N em b u ta l on Sale
D r u g L a b ellin g
L e g a l C o n s i d e r a ti o n s
L e g a l Iss u e s w i th th e P u r c h a s e o f N e m b u t a l o v e r t h e N et
N e m b u t a l O v e r t h e I n t e r n e t : M e x ic o
N e m b u ta l O v e r th e I n te rn e t: C h in a
M a rk e te d a s re a g e n t g ra d e p e n to b a rb ita l s o d iu m (C A S No.
57-3 3-0) this w ater-so lub le, w h ite crystalline so lid is stated as
h av in g a purity o f better than 99% . A dm inistration is a m atter o f
dissolving ~10g m o f the p o w d er in ~ 50m l o f w a te r an d drinking.
W hile the source com panies h av e long claim ed that their product
is pu re, it w a s n o t until m id 2011 that E xit w a s able to verify,
th ro u g h lab o rato ry testing, that th e N e m b u ta l s h ip p e d from
th e so u rc e s listed in this book is p u re an d h as not b een diluted
or ad u lterated pu rity stated. I f ingested in th e reco m m en d ed
am o u n ts th is N e m b u ta l leads to a relia b le an d peaceful death.
(See C h a p te r 15 for th e full discussion o f th e lab oratory test
results u n d ertak en b y Exit).
M o s t re p o rts re c e iv e d by
Fig 14.14: Nembutal from 3B Scientific
E xit s h o w th a t p o w d e re d
International
N em b u tal fro m th e sou rces
listed u s u a lly s h ip s at a m in im u m q u a n tity o f 2 5 g m . T h e
m in im u m lethal d ru g d o s e is 6 g m . I f th e su b stan ce is pure, a
p u rch ase o f 2 5 g m o f 9 5 % pu re so d iu m pentobarbital is m ore
th an en o u g h for tw o adults.
In 2 0 1 2 th e p o w d e r is b e in g s h ip p e d in o n e o f tw o w ay s.
E ith er p a c k a g e d in small plastic screw -to p con tainers holding
ap p ro x im a te ly 12 gm (see F igs I 4 . 1 4 & 1 4 .15) o r th e p o w d e r is
sh ip pin g flat-packed. Here th e p o w d er is o ccasio n ally v acu u m -
sealed flat in foil p ack ag in g , o r m o re c o m m o n ly as a sim ple soft
p lastic s a c h e t a n d sent on to its d estination a s a letter in either
re g u la r m ail o r b y co u rie r (S ee F ig s 14.15, 14.16 & 14.17.)
The P eaceful P ill H andbook
http://peacefulpill.com
The P eaceful P ill H andbook
http://peacefulpill.com
N o n -r e sp o n d e r s - no lo n g er re sp o n d in g to em ail enquiries
B M C h e m ic a l, H a n g zh o u
W e b : w w w .b m ch em ica l.co m
C h e m h e re C h em ica ls,
W e b : w w w .ch em h e re .co m
C h e r r y C h em ica l, H a n g zh o u
W e b : w w w .ch errych em ica l.co m
E m ail : ch e rry c h e m ic a ls@ g m a il.com
Q in g d a o H en ley C o , Q in g d a o
Em ail : in fo @ sin o h en ley.co m
W eb: w w w .sinohenley. com
L o tu s C h em ica ls, C h o n g q in g
W e b : w w w .lo tu sch em .co m
3 B Scientific C o r p o r a tio n , W u h a n*
Em ail: sw c h sj@ h o tm a il.c o m o r helen .xia o @ 3 b sc.co m
W e b : w w w .3bsc.com
N in g b o E st C h e m ic a l C o. L td., N in gb o*
T h is c o m p a n y has recently a d v ise d Exit that it on ly supplies
for laboratory purposes.
The P eaceful P ill H andbook
M azatlan
E jercito M e x ic a n o N o. 5
(n ear Playa N o rte ) area o f M azatlan
P lay a del C a rm en
I told the owner I had a large dog with Displazia and he was
sympathetic and produced a 100 m l bottle o f Barbital which I
purchased fo r about US$40.
I already have a test kit fro m Exit International which I w ill use
when the tim e comes. The bottle, though, is sealed correctly,
fresh fro m the factory. I w ill keep it in a cool, dry place until
needed - i f it is needed.
V alladolid
O n e s to r e w h e r e N e m b u ta l is a v a ila b le o v e r-th e -c o u n te r is
F arm a c ia V eterinaria Los P otrillos at:
C a lle 41 177-1
Col Valladolid C entro
Yucatan
M exico
A t th is a n im a l p h a rm a c y , th e retail b r a n d o f N e m b u ta l is
P isabental. D o n 't b e su rp rised i f th e sto re d o es n o t h ave any
b ottles o n the shelves. It is n o t u n c o m m o n for a store to send
a m essen g er to the d e p o t f o r collection. F o r th e c u s to m e r this
m a y m ean a return visit in an h o u r o r tw o 's tim e.
O btaining N em butal
Tijuana
Fig 14.22: A Tijuana veterinarian window si gn at the peak of the trade in 2007
O btaining N em butal
A s soon as I hopped o f f the Blue Line tram and crossed the two
footbridges into Tijuana, I g o t it.
O th e r C ities in M ex ico
SO U T H A M E R IC A
L im a - Peru
C u zco - Peru
F i g 1 4 .2 5 : M a c h u P ic c h u
O btaining N em butal
In 2 0 1 1, J e f f fro m C an a d a reported:
Penta-Hypnol as it is
occasionally retailed in Peru
& Bolivia
The P eaceful P ill H andbook
In 20 1 2 , H e a th e r w ro te o f C uzco:
A s it tu rn e d o u t it w a s a ra n d o m s p o t ch eck. I w as s u b je c t to
a cu rso r g o in g -th ro u g h o f m y ba g s d u r in g w hich tim e th ey
o f c o u rse fo u n d m y b o ttles o f N em b u ta l. I w a s n e v e r a sk e d
w h a t th ey w ere for, o n ly i f I h a d b een s ic k fr o m th e altitude.
L a Paz - Bolivia
A S IA
S ince 2009, Exit has receiv ed m an y positive repo rts o f the over-
th e -c o u n te r sale o f N e m b u ta l in Asia. H ow ev er, a s w ith South
A m erica, th e availab ility o f this d ru g se e m s to ch an g e with
a larm in g frequency. W h at w a s true last m o n th , is n o t true now.
B a n g k o k - T h a ilan d
E ieng S e w T u n g D ispensary
4 7 5 /9 R atchap rarop Rd,
M ak k asan , R atch atew e e , B an g k o k 10400
T e l : + 6 6 -2 2 5 1 -1 4 8 2 Fax: + 6 6 -2 2 5 1 -7 2 3 8
Southern Thailand
C o n c lu d in g C o m m e n ts
H o w ev er, w h ile th e p u rc h a s e o f N e m b u ta l m ig h t be q u ic k
a n d legal in so m e co u n tries, the im p ortation o f N em b u tal to
y o u r h o m e co u n try is a lm o st c e rta in ly ille g a l an d m a y attract
penalties. Y ou w o u ld need to ch eck th e p articular law s o f the
ju risd ictio n in w h ic h y o u resid e to be certain.
A v a ila b le f o r m s o f N e m b u t a l
F o r th e past d ecad e, sterile veterin ary liquid has b een the c o m m o n e st form
used for a peaceful death. (F ig 15.2)
Fig 15.1:25gm of
Chinese powdered
sodium pentobarbitol
U sing N em butal
Fig 15.2: Sealed veterinary Nembutal Fig 15.3: Pharmaceutical Nembutal tablets
Testing th e S a m p le B efo re U se
T h e re are a n u m b e r o f r e a s o n s w h y o n e m a y w is h to test
th e q u a lity o f th eir acq u ired N e m b u ta l befo re u sin g it fo r a
p eacefu l death. For ex am p le, the dru g m a y h ave c o m e from a
q uestionable source. O r it m a y h av e b een kept for a n u m b e r
o f y ears a n d m a y b e th e risk o f significant deterio ratio n. The
question o f reliability is o f p a ra m o u n t im portance. P eople do
n o t w an t to take a su b stan ce i f there is an y qu estio n a s to the
o u tc o m e .
U sin g th e C a ssette
B reak o f f th e tip o f th e red cap o f the extraction b u ffer co n tain er
(Fig 15.7b). Place the cassette on a clean su rface an d apply three
or fo u r d ro p s o f th e liquid onto the sam p le w ell o f the cassette.
R e a d in g th e Test (F ig 15.8)
N e g a tiv e Result: T w o lines appear. A red line in th e control
reg io n (C), an d a red o r pin k line in the test region (T).
Fig 15.8:
Reading Spot Test Results
The P eaceful P ill H andbook
T h e M e ltin g P o i n t T est
Fig 15.9: Digital thermometer with glass melting point capillary attached
U sin g N em b u ta l
M e lt in g P o in t Test
Fig 15.9:a Step by Step test of Nembutal Purity using melting Point Test
by htveld Exit Forum
The P eaceful P ill H andbook
C e r t if ic a t e o f A n a ly s is
F i g 1 5 .1 0 : G C A n a l y s i s o f 4 C h i n e s e s a m p le s a lo n g w i t h s a m p le B A n a l y s is certifa
T ak in g N em b u ta l fo r a P eacefu l D eath
T h e re is s o m e e v id en ce that chronic
h e a v y alcohol u se m a y lead to cross-
t o l e r a n c e a n d s ig n if i c a n tl y im p a ir
th e action o f the barbiturate. A n o th er
instance w o u ld be th e rare case w h ere
s o m e o n e h a s b e e n ta k in g a n o t h e r
Fig15.11: Dilantin 100mg capsules
U sing N em butal
Phenobarbital
N o te : T h is is th e p r im a r y d ru g u s e d in lethal in je c tio n s in
ex ecutio ns in th e US. In N o v e m b e r 2010, a w o rldw id e shortage
o f th e d rug p ro m p te d th e state o f O k la h o m a to investigate using
N em b u tal a s an alternative. See: h ttp ://a b cn .w s/d P u 2 Z r
Pentothal is m a rk e te d as a so lu ble th io p en to n e so d iu m p o w d er
in sterile am p ou les. T h e se are d esig n e d to be m ix e d w ith sterile
w a te r b efo re b e in g a d m in iste re d intravenously.
E x it h a s lo o k e d a t v a c u u m - p a c k i n g 10g m o f d r y s o d iu m
p entothal p o w d e r m ix ed w ith 1g m o f p henytoin so d iu m . T h is
can be readily tra n sp o rted a n d stored.
C o n c lu d in g C o m m e n t
In s o m e o f the a n a ly s e d c ases, th e lo ng c o m a to s e p h a se is
a sso ciated w ith the p ro lo n g e d u se o f an ti-p sy ch o tic m edication
o r chro nic h e a v y alco ho l use, p rio r to tak in g th e barbiturate.
It is p re s u m e d the induction o f liver e n z y m e s b y these drugs
cau ses in creased deg rad ation o f the N e m b u ta l, lo w ering the
c o n c e n tr a tio n in th e b rain . In th e s e s itu a tio n s , in creasin g
th e q u an tity o f drug taken (eg. to 2 bottles, 12gm) m a y not
n ecessarily hasten the death.
E x it h a s e x a m i n e d th e u s e o f s e v e r a l p o t e n t i a t i n g d r u g s
w h ic h m a y b e d isso lv ed into the liquid N e m b u ta l, rem o v in g
a n y possibility o f ex te n d e d co m a. T h e m o st useful, Dilantin,
(p h en y to in so d iu m ) is d iscu ssed in this Chapter.
U sing N em butal
T h e o n g o in g d ifficu lties
in o b t a i n i n g t h e b e s t
euthanasia drug, Nembutal
h a s p r o m p t e d E x i t to
e s ta b lis h an a m b itio u s
r e s e a r c h p r o j e c t - th e
s y n t h e s i s o f o n e s o w n
P eaceful P ill.
T h e P eacefu l Pill P ro je c t h as ru n f o r se v e ra l y e a r s . M an y
strategies have b een ex plo red an d rejected w ith so m e significant
a d v a n c e s m ade. In this C h a p te r w e detail this E xit research
a n d discuss in m o re detail th e u se o f the d rug N em b u tal for a
p eacefu l death.
C h a n g in g Focus
H o w c o u ld th e y m a k e so m eth in g that:
th ey c o u ld take orally
c o u ld b e m a n u fa c tu re d w ith o u t ou tsid e assistance
w o u ld p rov ide a p eaceful an d dignified death
w o u ld b e reliable w ith n eg lig ib le risk o f failure.
Legal Issues
In m ost w estern countries there will also be other laws that m ake
it an o ffence to m an u factu re, p ossess, sell, su p p ly an d im port
certain narcotic an d p sy ch o tro p ic drugs. P enalties w ill depend
up o n th e a m o u n t o f th e d ru g involved, an d again range from
tw o y ears ja il an d a fine, to life im prison m ent. Finally, there
is th e o th er additio nal generic legal question. I f one m e m b e r
o f th e g ro u p e v e r too k th e su b stan ce the g ro u p m a d e a n d died,
w o u ld the re m a in in g m e m b e rs be a c c u s e d o f having assisted
w ith th a t p e r s o n 's suicide?
T h e d i - s u b s ti t u t e d b a r b i tu r a t e s o f p a r t ic u la r in t e r e s t are
am ylobarbital (A m y ta l) an d pentobarbital (N em butal). T h e
p r o c e s s o f a d d in g s id e -a rm s (d i-s u b s titu tio n ) n e e d s to be
u n d ertak en before the c o n d en satio n o f th e m a lo n a te a n d urea.
E q u ip m e n t
S p ecia l D an gers
P recu rso rs
Alkyl sidechains:
an d
Catalyst
S o diu m ethoxide
C A S N o : 141-52-6
or
S o diu m m etal
C A S N o : 7440 -23 -5
&
A b so lute alcohol
C A S N o : 64-17-5
U rea
C A S N o : 57-13-6
The P eaceful Pill
N o n e o f th e c h e m i c a l s r e q u i r e d a r e s u b j e c t to s p e c i f i c
g o v e rn m e n t restriction. A pplication to a rep u tab le chem ical
s u p p lie r for ethyl m a lo n a te an d the c h o sen sid e-ch ain alkyl
b ro m id e s is g e n e ra lly s u ccessfu l p ro v id e d o n e can detail a
legitim ate p u rp o se in th e re q u ire d e n d -u se r statem en t. S om e
e n d e a v o u r m a y be req u ired to o b tain the so d iu m m etal an d dry
ethyl alcohol. A lternatively, th e catalyst so d iu m eth o x id e can
b e purchased.
A c q u ir in g N ecessa ry E q u ip m en t
L o o k in g at th e se steps in m o re detail
S te p 1
In th e case o f th e targ et b arb itu rates, N e m b u ta l o r A m y tal,
th e first sidechain to be attach ed to th e di-ethyl m alo nate is
an ethyl halide, u s u a lly ethyl b ro m id e is u sed . T o form the
mono-substituted m alonic ester, ethyl b ro m id e is h eated w ith the
di-e thyl m alon ate in th e p resen ce o f th e required catalyst - the
b ase, so d iu m ethoxide.
Step 2
S o diu m eth o x id e catalyst is again n eed ed in th e reaction vessel,
and this tim e 4 7 g o f th e m o n o su b stitu te d e s te r fro m S tep 1 is
co n v erted to a d i-su b stitu ted este r b y reflux (or reaction in an
a u to clav e) w ith th e s e c o n d s id e chain. F o r th e sy n th e sis o f
A m ytal, this s eco n d sidechain is l-b r o m o - 3 m e th y lb u tan e. In
th e case o f N e m b u ta l, it is 2 -b ro m o p en tan e, in each case 38g
is required.
Step 3
S o diu m etho xid e is again n eed ed in the reaction vessel. F o r
this final step 5 8 g o f th e d i-su b stitu ted m alon ate fro m step 2 is
allo w ed to react w ith 15 g o f d ry urea that h as b een d iss o lv e d in
h o t d ry alcohol. T h e m ix tu re is stirred an d h eated u n d e r reflux.
A fter 4 hours, th e ex cess alcohol is b o iled o f f an d th e residue
d isso lv ed in w a te r an d acidified (w ith dilute hyd roch loric acid)
to p recip ita te th e insoluble b arbiturate cry stals w h ic h can be
w a s h e d a n d dried.
The P eaceful P ill H andbook
T esting th e P rodu ct
In tro d u ctio n
T h e r e is o n l y a h a n d f u l o f
p l a c e s in t h e w o r l d w h e r e
Voluntary E u th an asia an d / or
A s sis te d S u ic id e is cu rren tly
legal.
S w itzerla n d - L a w s a n d L oo p h o les
Dignitas
D ignitas w as established
b y L u d w i g Minelli in 1998
as a S w iss, n o n -p ro fit
organization.
A W ord o f W arn in g
T h e first s te p to u s in g th e D ig n ita s s e r v ic e is to jo in th e
organization. F o r a o n e - o ff jo in in g fee o f E uros 50 an d a yearly
m em b ersh ip fee o f E uros 25, a person can b e c o m e a m em ber.
F ro m there the person can c h o o se to a p p ly to m a k e use o f the
service at so m e tim e in the future, w h e n / i f the n eed sh o u ld arise.
N o te - S w is s a u th o ritie s in s is t th a t a t le a s t s o m e o f th e se
d o c u m e n ts a re c e r tifie d extra cts, a n d s o m e m a y n e e d to b e
w itn e sse d b y a J u s tic e o f th e P e a ce o r P u b lic N otary. O thers
m a y n e e d to h a v e b een is s u e d w ithin th e la s t 6 m onths. B e
p r e p a r e d to d o a f a i r b it o f r u n n in g a r o u n d to g a th e r th e
p a p e r w o r k together.
U p on A rriv a l in Z u rich
T h e F in al A p p o in tm e n t
T his ap p oin tm ent can take p lace quite qu ickly after the m edical
review, so m e tim e s th e fo llo w in g day. T w o D ig n itas s ta f f will
b e present.
The Drugs
T h e a m o u n t co n s u m e d is ~ 50 m ls w h ic h is no m o re than a few
m outhfuls. N ote: T h is d ose differs significantly in concentration
from the sterile v eterin ary anaesthetic N e m b u ta l. A naesthetic
N e m b u ta l h as a co n centratio n o f 6 0 m g /m l, about 5x w e a k e r
than that used by Dignitas.
D y in g at D ignitas
A fraid that h e w o u ld
v o m it, J o h n n eed ed
som e re a ssu ra n c e
and w as pleased
w h en he w a s able to
c o n s u m e th e 5 0 m l
drin k w i t h little
d ifficu lty . P rep ared
fo r a bitter a fte r-
taste, he finished the
Nembutal, saying
that d id n 't taste too
b a d .
Because John's
fa v o u rite d rin k w a s
cognac, everyone
Fig 17.5: Dr John Elliott and his wife Angelika in Switzer- sh ared his final
land shortly before his death
moments with a
toast. N o t only d id the c o g n a c take a w a y th e d r u g s after-taste,
it m ad e th e N e m b u ta l w o rk faster.
A fte r i t s O ver
O nce all questions are answ ered an d the officials are com fortable,
th e fam ily an d friend s o f the d ec e a se d person can leave. The
b o d y is then re m o v e d to th e funeral hom e, in preparation for
eith er crem ation o r tran sp ortatio n b ack to th e p e r s o n s country
o f origin.
F in a lly , D ig n ita s is u n iq u e in t h a t it r e p r e s e n t s th e o n ly
legal o p tio n fo r dignified d y in g f o r p eo p le livin g outside o f
ju risd ic tio n s w h e r e v o lu n tary e u th an asia a n d a ssisted suicide
are legal. In E x it's o pin io n th e p op ularity o f th e serv ice is likely
to con tin ue, alth ou gh the d istan ce those suffering m u s t travel
en s u re s that D ignitas will n e v e r be first ch o ice fo r those in the
so uth ern hem isphere.
The Sw iss Option
D ig n ita s F u tu re
A ddress:
P O B ox 9, C H 8127
Forch, S w itzerlan d
T elephone: 0 0 1 1 41 4 4 9 8 0 4 4 59
F ax : 0 0 1 1 41 4 4 9 8 0 14 21
E m ail: d ign itas@ d ign itas.ch
W ebsite: http://w w w .d ig nitas.ch
18
Introd u ction
B a ck g ro u n d to G r a e m e W ylie
T h e S u ic id e N ote
T he P rocess o f a D eath
C lea n in g A w ay
H ow ev er, i f th e p erso n w h o h as d ie d w a s n o t k n o w n to be
suffering fro m a life th re aten in g illness, th e a c t o f clean ing
aw ay m a y cause m o re pro blem s. In th e case o f G ra e m e W ylie,
b e c a u s e there w a s n o illness (o th er than d em en tia), th e fact that
there w a s n o o b v iou s c a u se o f death on ly serv ed to h eigh ten the
m y ste ry o f h o w he died?
The P eaceful P ill H andbook
I f a person en ds th eir life using an Exit B ag, then the clean ing
a w a y will in v o lv e the rem o v al o f the b ag fro m the p e rso n 's
h e a d a lo n g w ith th e helium c y lin d e r an d tubing. O ccasion ally
at H eliu m d eath s th e b ag , g as control fitting an d tu b in g a re
all that is rem o v ed . I f the b la c k an d w h ite plastic n o zzle that
c a m e w ith the balloon kit is re-attached, th e cy lin d er re-b ox ed
an d re-sto red in th e cup bo ard , it is u n lik ely th e c y lin d e r will be
linked to the death.
F o r a death to a p p e a r n o rm a l, there m u s t b e n o e v id en ce o f
eq u ip m en t that c o u ld h av e been used in the suicide. W h ile som e
p eo p le m ight not care w h e th e r their death is listed as s u ic id e or
n a tu ra l, th e legal risk to o thers will b e h ig h er i f it is know n
a s u ic id e has taken place.
C le a n in g A w a y and th e L aw
D ea th C ertificates
D y in g w ith o u t Trace
A u to p sies
E v e n th o u g h a u to p s ie s a re b y no m e a n s ro u tin e , a n d their
u se is b e c o m in g less frequent, th ey can n e v e r be ru le d out
( O C on n or, 2004). Still, in th e case o f a serio u sly ill person
w h o tak es an o v e rd o se o f prescription p ro p o x y p h e n e th ey have
had prescribed, a n d leaves the e m p ty p a c k e ts b y the bed, a n d
a su icide note, there is little likelihood o f an a u to p sy being
perform ed.
A fter it's O ver
G r ie f C ou n sellin g
P r iv a te c o u n s e l l o r s list t h e i r s e r v i c e s in m o s t c o u n t r i e s '
telep h o n e directories an d o f c o u rs e online. C o m m u n ity health
centres a lso c o m m o n ly o ffer c o u n sellin g a s p a rt o f th eir range
o f health s e rv ic e s . T h e re are also often c o m m u n ity telephone
h elp lines.
The P eaceful P ill H andbook
C o n c lu d in g C o m m e n ts
R e lia b le (10) 10 10 8 4 9 9 10 8 10
P eac efu l ( 10 ) 0 2 7 10 7 7 5 7 10
A v ailab le (5 ) 5 5 3 3 3 4 2 5 2
P r e p a r a tio n (5 ) 2 4 1 5 3 3 5 1 5
U n d e te c ta b le ( 5) 0 0 1 2 3 3 3 5* 4
S p eed (5 ) 1 5 5 2 2 2 5 5 4
S afety (5 ) 5 0 1 5 5 5 3 5 5
S to ra g e (5 ) 5 4 4 3 3 3 5 5 4
T O T A L (50) 28 30 31 34 35 36 38 41 44
R a tin g 9 8 7 6 5 4 3 2 1
* N itro g e n o n ly
The P eaceful P ill H andbook
References
A ustralian B u reau o f S tatistics (2 0 0 0 ) S u ic id e Trends, A u s
tra lia , 1 9 2 1 -1 9 9 8 . Cat. N o. 33 09 .0 , C an b e rra, A B S .
A b o u t F io n a S te w a rt
www.peacefulpill.om/fo ru m