11 JANUARY 1992, Page 26

The difficulty of shuffling off

Peter Black

FINAL EXIT by Derek Humphry Hemlock Society, USA, $25, pp. 192,available in the UK through bookshops at £12.95 It is against the law in Britain to publish detailed instructions on how to take your own life, but I had no difficulty in obtaining a copy of Final Exit. This is Derek Humphry's guide to suicide which discon- certed and surprised commentators by jumping at once to a place among the best- sellers. I sent 25 dollars to the address in Oregon circulated to members of the Voluntary Euthanasia Society and in due course the postman brought it up to the house. I had wondered if the British Customs would seize it and prosecute me, but they only stuck a label on the packet to admit that it had been opened.

That it would sell as well over here I do not doubt at all. The power of modern medical technology to keep you going for years on life-support systems after indepen- dence, dignity, self-control, possibility of recovery have gone, has added a fresh and dreaded possibility which has nothing to do with the fear of death.

Anyone who can offer tips on ways of averting it seems to me to be among the virtuous. It is curious that most of the com- mentaries on the book seem to find Humphry a rather creepy person. (We can be sure that the tabloids have opened a file on him.) There is a general reluctance to discuss publicly an essentially private mat- ter. A similar response, when the subject was at the same stage that euthanasia has reached, held up the campaign for birth control.

Humphry's book assumes that the reader accepts in principle the individual's right to choose to die when terminally ill. Of course this right has always existed. There has been no law to stop you killing yourself for 30 years. There is a great deal to make you think twice about it, without going into the ethical argument. The chance of failure carries its own frightful possibilities.

Final Exit finds something to say against all DIY methods, especially the violent ones such as drowning (chance of rescue), electrocution in the bath (might not work), hanging (unacceptably selfish), car exhaust fumes (engine might stop), shooting (messy and lonely). To attempt it with non-

prescription drugs of the sort you can buy over the counter is, he says, a recipe for disaster.

Its 192 pages, of suitably large print, offer sensible advice on the order of the preliminary stages. Sign a living will, or advance declaration, which states that you are of sound mind, that in certain medical conditions you do not want to be kept alive by artificial means. Lodge a copy with your doctor. If you need a helper, make sure it is a very close one. Tell your loved ones what you are contemplating. Leave a message. Make sure nobody finds you for at least eight hours.

You could get this kind of advice from a helpful lawyer. When Humphry turns from the what to the how, his book moves on to shakier ground. Sometimes his opinion goes against his evidence. Of cyanide he says that 40 per cent of chemists who killed themselves chose it. The German Society for Humane Dying is quoted as swearing by its speed and gentleness. Humphry gives a step-by-step description of how to take it, admits it is 'viable' (golly, what a word!) for self-deliverance, but nevertheless comes down against it because if you don't get it right, death can be violent and agonising. Taking hydrogen cyanide instead of potassium cyanide would be very much not getting it right, but armed with his warning, surely such a banal error is unlikely?

His own preference is for various named barbiturates which are fatal taken in excess, particularly if used with a plastic bag securely fastened under the chin. But — 'See chapter 18 on how to get the magic pills,' says Humphry. When you do, you find it is impossible to obtain them without a prescription.

His tip on getting it will raise a bleak smile among patients of the NHS. First you tell your doctor you can't sleep. 'A few weeks later', complain that the pills he gave you don't work. He will prescribe stronger ones, though still not lethal. Return again and ask for something like barbiturates. Store in a cool dry place until you have accumulated the lethal dose. (The question looms; if you had lodged your living will with him, might this harassed, overworked practitioner not guess what you might be contemplating?) On the whole, Humphry's compilation is discouraging, which may have been his intention. His message is: only the co- operation of physicians can give the patient a dignified and loving farewell. Only a law such as Humphry's Hemlock Society and the British Voluntary Euthanasia Society want can give the doctors the protection from liability they must have. Nothing is more certain than that such a law will come. 'Men must endure their going hence even as their coming hither,' but Shake- speare had no need to consider that going hence could mean being wired up to machinery.