Homage to Humphry

 
Derek Humphry and the Right-to-Die
  Fifty years ago, Mr. Humphry put a lethal amount of substances into his wife's coffee, along with some sugar to sweeten it, and she died within an hour. She was grateful because she was suffering and he was undoubtedly nervous since he faced years in jail and had to worry about their three children. They both believed in "assisted suicide" or "voluntary euthanasia", which was against the law in Britain. As he later said, "some laws are made to be broken." The case against him was dropped and Mr. Humphry made his way to the United States and later to Oregon where he just died at the age of 94. In that state he could have exited earlier if he chose to do so. Those of us who are grateful to have access to the MAID option, limited though it is, should pause to thank Derek Humphry. 
  I am doing so because it seems to me that the opponents of MAID get far more press than the proponents, particularly in the National Post. While I have not combed through all the MAID stories, there was this one from a few days ago which suggests that we should not celebrate the 10th anniversary of the Supreme Court decision which made MAID possible: "A Decade of MAID Expansion: Slippery Slope "Became a Cliff," Yuan UYi Zhu, National Post, Feb. 1, 2025. 
"February marks the 10th anniversary of the Supreme Court of Canada's decision in Carter v. Canada (Attorney General), in which the court unanimously ruled, against both basic logic and its own precedents, that the right to life, guaranteed by the Constitution, included the right to a state-assisted suicide through what came to be known euphemistically as Medical Assistance in Dying (MAID)."
Apparently if we are allowed to make the individual choice to die, there will be many other people eager to to take advantage of the opportunity to kill many more.
   That interpretation was bluntly put by a non-ethicist. I am in favour of MAID and have indicated that in this post - Dementia Rising, which also mentions that the issue is a complex one, except perhaps for those who wish to deny us the personal right to die when we choose. Perhaps some additional perspective is provided by looking back 50 years, although the slopes were seen to be slippery even back then.

"Derek Humphry, Champion of Assisted-suicide Movement, Dies at 94: Mr. Humphry, a Former Journalist, Co-founded the Hemlock Society Years After Helping His Cancer-stricken Wife Take Her Own Life, Brian Murphy, Washington Post, Jan.25, 2025.
   Jean Humphry’s cancer had spread to her bones, and drugs could no longer control the pain. She was 42. “She picked up the mug of coffee on her own volition and drank it down and just before she passed out she said, ‘Goodbye, my love,’” recalled Mr. Humphry Fifty minutes later she was dead, and Mr. Humphry was left with three young children and the knowledge that he broke British law by assisting his wife to take her life. The moment also set Mr. Humphry on a path to become one of the leaders of the right-to-die movement in the United States — co-founding the Hemlock Society, writing the bestseller “Final Exit” (1991) and helping push through a landmark law in Oregon in 1994 to legalize physician-assisted suicide."

‘Founding Father’ of Right-to-die Movement, Derek Humphry, Dies at 94 in Oregon; author of ‘Final Exit’," Kristine de Leon, The Oregonian, Jan. 28, 2025.
"In November 1994, when 51 percent of Oregon voters approved the Death with Dignity Act, supporters of medically assisted death could trace their first-in-the-nation victory to Humphry, “a British-born journalist with a soothing voice,” The Oregonian wrote that year….Some of Humphry’s views were considered extreme, even among supporters in the movement. For example, he supported physician-assisted death for severely ill people — not just terminally ill people. And he agreed philosophically with the most polarizing figure of the time, Dr. Jack Kevorkian, that euthanasia by lethal injection — sometimes called “voluntary” euthanasia — should be an option for people. Opponents called both of these stances slippery slopes."

"Derek Humphry," The Times, Jan. 23, 2025.

  "Humphry believed that Jean would have died naturally about a month later. But by helping to hasten the end he had committed a crime punishable by up to 14 years in prison and one to which he openly admitted with the publication in 1978 of Jean's Way, an account of her assisted suicide.

   The book shone a spotlight on a taboo subject, with Humphry arguing it was absurd and unjust that the Suicide Act of 1961 decriminalised suicide in England and Wales while deeming assistance illegal. His response to Jean's request was, he affirmed, "a duty of love between spouses".

  The book triggered attention and debate and the director of public prosecutions ordered a police investigation into Jean's death. Interviewed by detectives, Humphry handed them a written confession but sensed they were more interested in the doctor who supplied the drugs. He refused to divulge the physician's identity and six months later the case was dropped…..

    Resilience was also required as he fought for what he termed "self-deliverance" or "rational suicide", especially after the publication in 1991 of Final Exit, his explicit instruction manual. Some Christian fundamentalists declared him "Anti-Christ of the Month". More moderate voices feared it could be used by the non-terminally ill, such as people with depression, or for planning a murder. But the book became a bestseller in the US. "The more the churches, the ethicists and right-wing columnists railed against the moral implications of the book, the more the public went out to buy it," Humphry remarked. Librarians were less enamoured, since they kept having to order new copies as a consequence of understandably low return rates."

Obituary – "Derek Humphry", by Philip Nitschke, Exit International, Jan.26, 2025.
[Exit International was founded in Australia 1997 by Dr Philip Nitschke under the name the Voluntary Euthanasia Research Foundation (VERF). The organisation rebranded in 2001 to be Exit International.]
  "I knew Derek Humphry for almost 30 years.He was an inspiring and driving force in the modern right to die movement.
   I was delighted when he accepted an invitation to attend the Voluntary Euthanasia Research Foundation (forerunner of Exit) Conference in Broken Hill in outback New South Wales in September 1997.
This was the year we first met. He had published his famous book Final Exit a few years earlier.
 It had become the ‘bible’ of the self-help right to die movement. Indeed it was this book that, in turn, inspired the Peaceful Pill Handbook which he kindly launched for Fiona and I, at the Nu Tech conference in Toronto Canada in September 2005.
 The existence of Final Exit made the publication of the Peaceful Pill Handbook easier (at least internationally, if not in Australia where, to this day, it remains a banned publication)."
Sources:
  I will not include sources in this post, but to save you some time if you are looking for your own options, The Hemlock Society has passed on.
It was refreshing to see that the King's University College Library has copies of Final Exit and Dying With Dignity. If one has a Thanatology department, even in a Catholic college, one should be exposed to diverse views about death and dying. 
Bonus:
   Mr. Humphry assisted his wife. More recently a wife took her husband to court to prevent him from using the MAID option. See: "More Contrarian News for Old Codgers (OATS3)." Luckily, the husband won.

Dementia RISING

Think About It While You Can

   The MAID acronym is a simple one which Canadians will understand, but it is a label for a very complex subject. A large number of ethical issues arise when one discusses medical assistance in dying and the legislation addressing them is constantly changing. A “Special Joint Committee on Medical Assistance in Dying” is looking into the matter (again) as I type. 
  The broad and basic argument over MAID puts in one corner those who think it should be a personal choice, while the combatants in the other bring up all kinds of philosophical and religious objections suggesting the state must be involved. The former say that those suffering horribly should be allowed the right to exit, while the latter feel that the granting of such a right will put us all on a slippery slope, along which legislative guardrails must be put. I am not an ethicist, but will admit that I am liberal about MAID and take a libertarian stance on this issue. If I was an ethicist, here is the narrower question I would address: “Should those fearing dementia be allowed to make an Advance Request for MAID before they become demented?” Given my stance, the answer is an easy one: “Sure.”  I think many, even those in the other corner who have seen someone with dementia, have said, “Please don’t let that happen to me.”
   One of the many problems related to "Advance Requests" is that having arrived at decision time the requestor may have changed his mind (or, lost it.) Fearing such an outcome, does one have to make such a decision early, while one can? Or do you figure that those who knew of your advance wish, will fulfil it for you even if you seem to be happy wandering about talking to people who aren’t there? Who pulls the plug if you can’t? Will the potential plug-pullers be in agreement about what is to be done?
   Before I provide you with sound advice, I will say that I am in favour of MAID and "Advance Requests." Having said clearly in advance that I want to go, you should not listen to me later. Just pull the plug. Christopher Hitchens expressed such a sentiment to those who suggested that even though he was an atheist, he would likely make a death-bed conversion. I was able to find a couple of his rebuttals:
And even if my voice goes before I do, I shall continue to write polemics against religious delusions, at least until it’s hello darkness my old friend. In which case, why not cancer of the brain? As a terrified, half-aware imbecile, I might even scream for a priest at the close of business, though I hereby state while I am still lucid that the entity thus humiliating itself would not in fact be “me.” (Bear this in mind, in case of any later rumors or fabrications.)
And:
"Down the road, if you ever hear me say there is a God, it won’t be me talking, but some hollowed out, terrified shell of who I used to be.”

Although I am not an ethicist, I do recognize that the answer is not that simple and that I cannot offer one to you. As a former librarian, however, I can help you look for it. Sources are provided below.

 A Conundrum

   This chart appeared in the Globe and Mail on Jan. 12, 2024."Decision Time"

Frances Woolley, Professor of Economics, Carleton University

"About one-third of women over age 90, and a quarter of men, are living with Alzheimer’s or another form of dementia. These diseases create immense suffering for people who gradually lose their minds, and for caregivers who gradually lose their loved ones. The diseases are expensive, too, costing billions in long-term care."

"There is no cure for dementia, but there is an escape route: medical assistance in dying. Yet just 1 per cent of people who chose MAID in 2022 had some form of dementia. Although many of us would, given the choice, prefer a painless and dignified early exit, we often do not have the choice: The dementia diagnosis comes after we have lost our ability to make informed decisions.

For this reason, every province needs to implement regular dementia screening immediately. We might not be able to cure Alzheimer’s any time soon. But with early diagnosis, we do have a way of ending suffering."

Pay Attention While You Can

Sources:

   "Medical Assistance in Dying," Alzheimer Society.
"Medical assistance in dying (MAID) is a complex and very personal issue. The information presented here is intended to assist and support people living with dementia – together with their families and caregivers – in making informed decisions about their care.

Is the Alzheimer Society supporting advance requests for MAID?

The Alzheimer Society of Canada supports the right of people living with dementia to make an advance request for a medically assisted death.

The Alzheimer Society recognizes that people living with dementia are individuals – first and foremost. They have the same rights as everyone else, including the right to participate in decisions about their life and care. We respect the rights of all people with dementia to advocate for their individual best interests, including advocating for access to MAID through advance requests."

   “Most Canadians Want the Right to Plan Ahead for an Assisted Death if they get Dementia. So Why is it so Complicated?”, Erin Anderssen, Globe & Mail, Feb. 18, 2023. This is a very useful article, which may not be behind a paywall.

   "In a late January survey, conducted for The Globe and Mail by Nanos Research, 80 per cent of respondents agreed, or somewhat agreed, that Canadians should be able to make advance requests outlining their conditions for assisted death, for when they can no longer legally give consent....

   Canada’s current legislation requires people to clearly consent to medical assistance in dying, known as MAID, on the day it is provided – with a limited exception. A patient whose natural death is deemed to be “reasonably foreseeable,” and who is suffering intolerably and has been approved for MAID, may waive final consent if they are at risk of losing capacity before their scheduled date. That could be up to six months away, in certain cases, if the MAID provider agrees....

   Canada’s MAID laws give priority to the patient’s voice. Patients say when their suffering has grown intolerable, and when their treatment is at an end. But at the later stage of dementia, a patient’s voice is silent. If advance requests are allowed, a doctor or nurse practitioner, ideally working with a trusted caregiver, would have to assess suffering and decide death’s timing by interpreting instructions from the past.

   The Dutch experience highlights the difficulty of following advance directives that are vaguely worded, or may not fully reflect the future their authors imagined. And it also makes clear the importance of informed third parties who can advocate for patients. A person might say they want euthanasia when they can no longer recognize their family. But which family members, and what level of recognition? (What if, for instance, they are still delighted to see the friendly strangers who keep visiting?)...

   "Why shouldn’t the values of a person’s capable self trump the version that can’t communicate or care for themselves? Ms. Demontigny said she suffers now, not knowing how long her healthy body might last while her mind crumbles and what that will mean for her children.

  An advance directive, she said, would allow her to live today, free from worry about what happens at the end. If that is not allowed, she will have to ask for MAID before she is truly ready, just to guarantee her wishes are respected. “I will lose time,” she said, “but I don’t want to take the risk.”

Geriatric Gems (a useful 2pp. pdf.)
 "Medical Assistance in Dying and Older Adults," Casey, et al

Canadian Family Physician, Vol.68, July, 2022.

Clinical question

"How do changes in legislation pertaining to medical assistance in dying (MAID) affect my patients with frailty or dementia? Are advance requests allowed?

Bottom line:
Given their long-term, trusting relationships with patients and their families, 

family physicians can play a critical role in discussions about MAID.The eligibility for MAID has expanded, albeit with qualifiers to protect vulnerable individuals. This article highlights these changes, which are reviewed in greater depth in an article published in the Canadian Geriatrics Society Journal of CME in 2022."

   “Dementia and Assistance in Dying: A Catch 22,” George Szaz, British Columbia Medical Journal, Vol.65, No.7, Sept. 2023. A very sad case.

"Persons suffering from dementia are not eligible for medical assistance in dying, and this is inhumane."

   "For People with Dementia, Changes in MAiD Law Offer New Hope: For People with Dementia, Changes in MAiD Law Offer New Hope, Jocelyn Downie, Policy Options, April 21, 2021.

"People with dementia have been caught in a cruel trap under Canada’s medical assistance in dying law (MAiD) – until now. As their suffering advanced, their decision-making capacity receded, but the capacity to make their own health-care decisions was required at the moment of MAiD itself. Access to MAiD balanced on the knife-edge of reaching an intolerable state of suffering prior to completely losing capacity. People were forced to choose to end their lives earlier than they wanted. With the passage of legislation amending Canada’s MAiD law (Bill C-7), this dilemma will be over for many."

A Headline Today - Jan. 22, 2024:

Health System Urged to Brace For Major Shift in Dementia Demographics," Kelly Grant, Globe & Mail.

"In a study released Monday, the Alzheimer Society of Canada predicts there will be more than 1.7 million people in Canada living with dementia in 2050, nearly three times the estimated 650,000 today. One in four will be Asian, a broad category that includes people with roots in China, Vietnam, Korea, India, Pakistan, Sri Lanka and other countries."

SARCO

 
   The very stylish SARCO pictured above is a streamlined coffin-like contraption, designed to assist you in committing suicide, if you choose to do so. It has been produced in Switzerland, where a lot of other well-designed products are made, and the maker of it would like it to be available globally via a 3D printed design. SARCO, I bet, is highly unlikely to make it to Canada, and not because of the current supply chain problems.

   The designer is the director of Exit International which is a group that supports euthanasia. If you are interested in that subject, and in favour of it, you will be pleased to know that SARCO makes it easier; nitrogen is slowly released into the chamber and the occupant quickly and painlessly ceases to exist. More importantly, this makes DIY dying much simpler, since one can make the choice and not need the assistance of a medical authority to administer a drug.   

   What could go wrong? Well, as a pro-euthanasia, pro-MAID supporter, I am thinking, plenty. It is highly unlikely that I will be able to saddle-up in a SARCO and not because of supply chain issues. There are many anti-MAID proponents and these anti-choice deniers are more adamant than the anti-climate change ones. I am sure that there are already many pro-lifers preparing legal briefs, arguing that if such an option is allowed, there will be a Sarco surge, propelled partially by relatives too eager to purge the planet of their irritating elderly parents. As well, government agents are likely to support Rent-A-SARCO agencies to assist in the elimination of those in public-supported facilities who are draining the public purse.

  Such things do need to be thought about and perhaps SARCO will help. One article notes that this new device "Inflames the Assisted Suicide Debate", but it also notes that:

Others who have studied the ethics of voluntary assisted suicide welcomed the debate that Sarco has inspired. Thaddeus Pope, a bioethicist at the Mitchell Hamline School of Law in St. Paul, Minn., said the debate about Sarco could lead to a new way of looking at end-of-life options, including by legislators.
“That might be bigger or more important than the actual Sarco itself,” he said, adding that Dr. Nitschke was “illustrating the limitations of the medical model and forcing us to think.”
“There are a lot of people that live with illnesses or conditions that they don’t want to live with, but they don’t qualify for medically aided dying where they live,” he said. “If he really goes forward with it, this may get the nonmedical approach to hastening death some more attention.”

Sources:
   If you simply type in "SARCO" in December 2021, you will find many articles, some of which suggested that Switzerland had approved the SARCO, which is not exactly the case. The article I mentioned is: "A 3-D Printed Pod Inflames the Assisted Suicide Debate," Christine Hauser, New York Times, Dec. 16, 2021. 

   More about MAID is found in my post: More Contrarian News for Old Codgers (OATS3)

  For non-Canadian readers "MAID" is an acronym for "Medical Assistance in Dying." Many are opposed to offering such assistance, including some doctors who argue that they should only be delivering MAIL - "Medical Assistance in Living. " For more see: Canada's New Medical Assistance in Dying (MAID) Law.

The Bonus: 
  For those of you too busy to research SARCO, it is apparently short for sarcophagus. That word you will have to look up on your own. 
  Those of you on either side of the MAID issue will be interested to know that there is a Museum for Sepulchral Culture in Germany, where they do know a lot about dying. 

                 Making Light of Heavy Things Since 2016.
 

More Contrarian News for Old Codgers (OATS3)

 The News Continues to Be Bad

(The Death of Elaine)

   Loyal subscribers will know that OATS is an acronym for Old Age ThemeS and the themes are typically negative in tone. It is produced to offset the propaganda to which you are otherwise subjected. If, like most of my friends, you are determined to avoid decrepitude and are going to live healthily and happily until you die while exercising at the age of 110, give or take a few years, you should stop reading now.

MAID

   MAID is a Canadian acronym for Medical Assistance in Dying.  Those of us codgers who have a more realistic view of our future generally welcomed the news back in 2016 when it was decided that we had a constitutional right to determine when we might choose to leave. There were those, however, who disagreed and were determined to erect speed bumps so we could not exercise too quickly the right we were granted. The number of obstacles that were to be encountered if you were attempting to pull the plug, were so numerous that you were more likely to die of old age than you were from having a last shot of Single Malt and an injection from your doctor. Even as I type, Bill C-7 is being re-considered in an attempt to make dying easier. But not too easy. 

No Way To Go

   I am actually feeling well and had not been thinking about MAID until I remembered an article from a few months ago. It was about an 83 year old gentleman from Nova Scotia who was suffering from COPD and had had enough. He did all the hard work that is required to overcome the obstacles constructed by those who did not want him to have an easy passage. His MAID request was finally approved, however, and he was good to go. Although it is difficult for Canadians to choose to die, what made this story newsworthy was the fact that another hurdle was erected right before the finish line and placed there by his wife and her lawyers.

Husband Wins - He Dies

   The article from a few months ago which caught my attention was about the efforts of the wife of the gentlemen above, who initiated court proceedings to prevent his passing. About this, he was not happy and they stopped speaking after nearly 50 years of marriage. It was one of those 'He said', 'She said' situations. He said he was suffering and suffocating, she said he was anxious and mentally incapable of making such a decision. More important, one suspects, were her moral objections to MAID. He moved out. I wondered what happened.

  In this case, the husband did have the last word. After a few months of legal proceedings, the wife's request was denied. He pulled the plug. It is a sad story. The ones included in OATS usually are.

Sources:

  "Husband, 83, Dies With Medical Assistance After Wife's Court Bid To Stop Him Fails: Jack Sorenson of Bridgewater, N.S., Died on Saturday Following Legal Battle With Wife Over MAID," Taryn Grant, CBC News, Oct. 6, 2020.

  For Bill C-7 see this recent G&M editorial: "Reasonably Forseeable Litigation," Oct.16, 2020. 

   Given that the Bill attempts to make dying a little easier, there are many who are opposed. See, for example, this statement from the Canadian Conference of Catholic Bishops:
"Today, more than 50 religious leaders from across Canada released an open letter to all Canadians in opposition to Bill C-7 An Act to amend the Criminal Code (medical assistance in dying). This ecumenical and interfaith message is a response by religious leaders to the legislation introduced by the federal government on 5 October 2020 which seeks to expand the eligibility criteria for euthanasia and assisted suicide (euphemistically called “medical assistance in dying”) by removing the “reasonable foreseeability of natural death” criterion currently in the Criminal Code, and by loosening some of the existing “safeguards” allowing patients whose death is “reasonably foreseeable” to waive final consent to receiving euthanasia by making an advance directive."

   If you think MAID is a good idea, support for making the process easier is found here:
Dying With Dignity: It's Your Life. It's Your Choice. 

For the official government web site see MAID. 

For more postings in the OATS Series see here and here. 

The Bonus:

  Usually the OATS postings are accompanied by this image:

  The new one at the top is a painting by Homer Watson, The Death of Elaine. Now you know who the boulevard in Kitchener is named after. The image is from Homer Watson: Life & Work, by Brian Foss. Both the image and the biography are found on the website of the Art Canada Institute.