TALKING ABOUT DEATH AND DYING - Why don’t we talk about death and dying? We can choose so many of our life experiences, but it seems we can have no say in whether we die in pain or at peace. Today we look at the Australian government’s efforts to suppress discussion of euthanasia.

There’s plenty of information available on how to kill yourself violently, so why does the Australian government so vigorously censor information on peaceful methods?

Voluntary euthanasia societies have long been pushing to legalise death with dignity. According to opinion polls, a strong majority of Australians support legalisation, yet Australian governments have been unreceptive. When the Northern Territory government legalised euthanasia in 1996, the federal parliament overruled the law less than a year later.

Philip Nitschke, despairing of the legal route, set up Exit International to enable people to learn how to obtain a peaceful death through their own initiative. Exit publications provide information about obtaining pentobarbital, commonly known as Nembutal, the drug of choice everywhere that death with dignity is legal.

Censorship and response

The Australian government has responded with amazingly draconian censorship. No other government has taken such extreme measures to prevent access to information on peaceful death.

Exit had an information phone line. The government passed a law making it illegal to convey information over the telephone about ending one’s life. Exit responded by putting its phone line in New Zealand.

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Exit has a website. The government banned Australian Internet service providers hosting websites with end-of-life information. Exit hosted its website overseas.

For some years, the government has been pushing for a web filter, ostensibly to block material on paedophilia and violent pornography. The government kept secret its list of websites to be blocked but the list was revealed on WikiLeaks - and it contained euthanasia websites. Exit responded by providing information about using proxy servers to get around the filter.

Philip Nitschke and Fiona Stewart wrote a book, The Peaceful Pill Handbook, with detailed information about peaceful ways to end your life. The book is freely available in most of the world, but the Australian government banned it. This was only the third book banned in Australia in a third of a century. Exit makes it easy to obtain the book, in hard copy or electronic form, from its websites.

Exit produced a short advertisement with the mild message that being able to choose how to die might be a good idea. Prior to filming, it was approved by the regulatory body Commercials Advice.

Afterwards, just before screening, Commercials Advice withdrew its approval. Exit put it on YouTube, where it was free to view, and some Australian media ran the story of how it had been censored:

Exit has also encountered legal threats, last-minute refusals to use hired venues and attempts to block its billboard advertisements.

Many people are keen to obtain the information provided by Exit. Nearly all of those who attend Exit’s meetings are old - the minimum age to attend the members-only segments is 50. Some are seriously ill. They are looking for information on how they can end their lives peacefully, when pain, indignity and suffering become too great. The government is doing its utmost to prevent this.

Violent death

However, the government seems quite complacent about the availability of information about killing yourself violently.

Licensed handguns are legal in Australia, and you can take a course in how to use them. Shooting is one of the common ways men commit suicide. There are plenty of films and television shows with graphic portrayals of suicide by firearm.

The most common method for suicide in Australia is hanging. The technology - rope and something to tie it to - is readily available. Again, there are many media portrayals. For example, The Shawshank Redemption, a film rated very highly by audiences, includes an informative sequence of suicide by hanging.

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It does not require much imagination to figure out how to kill yourself by jumping off a building, drowning or crashing a car, or you can look up suicide methods on Wikipedia. Shooting, hanging and other violent methods are not nice ways to die. They are unreliable: you might survive and end up permanently disabled. They are painful, often agonising. And they are highly distressing for family and friends.

The government is trying to prevent people suffering from terminal illnesses from finding out how to die peacefully. The result is that many of them choose violent methods instead, such as hanging. Yet the government is doing little or nothing to prevent access to information about violent suicide options.

Rationales

It might be argued that the government can’t prevent access to information about means for violent death – that would be censorship. But of course it has shown itself quite willing to censor information about methods for peaceful death.

Another argument is that people shouldn’t be able to choose a peaceful death, because that would make it too attractive. The evidence shows, on the contrary, that having the means to die peacefully frequently enables people to live longer.

Nor is there much risk of accidentally dying with the means described by Exit. Nembutal is extremely bitter, so no one is going to swig down a bottle by mistake. Another option, making an exit bag, requires considerable advanced planning and preparation. It is not a spur-of-the-moment suicide option.

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The standard explanation is that the government is pandering to the religious lobby, which apparently is more concerned about stopping dying with dignity than stopping violent suicides.

The irony is that while physician-assisted suicide remains illegal, there is increased interest in Exit’s approach. So far, Exit has found a way around every censorship technique introduced by the government.

In some cases, the censorship has simply created more visibility for and interest in Exit’s activities. The government seems to have accomplished an unlikely double: appeasing the religious lobby while stimulating the development of ever better information and technology for do-it-yourself death with dignity.

Acknowledgements: I thank Paula Arvela, Trent Brown, Rae Campbell, Philip Nitschke, Russel Ogden and Fiona Stewart for helpful comments.

What do you think of the government’s actions in relation to Exit International? Leave your comments below

This is the first part of Talking about death and dying. To read the other instalments, click on the links below:

Part Two: End of the care conveyor belt: death in intensive are units

Part Three: Caring or curing: the importance of being honest

Part Four: Death and despair or peace and contentment: why families need to talk about end-fo-life options

Part Five: Body or soul: why we don’t talk about death and dying

Part Six: Planning your endgame: Advance Care Directives

Part Seven: A challenge to our leaders – why don’t we legalise euthanasia?

Part Eight: A personal account of life with terminal cancer