Assisted dying is not suicide

(not when you consider the broader consequences)

At the time I took the phone call voluntary assisted dying had been legal in South Australia for less than a week. Our service was so new I was still rehearsing how to answer the phone.

“Hello, voluntary assisted dying pharmacy service.” I fumbled, trying desperately to sound approachable without being overly cheery.

“Hello, are you the euthanasia people?”

“We’re the voluntary assisted dying team, yes. What can I do for you?”

“Well, I’m here at a friend’s house cleaning up his estate, and we found his euthanasia kit. It’s ok, he didn’t use it, but I thought maybe someone else might be able to make use of it.”

This was a very strange way to start a Friday.

I took the caller’s details and advised I’d get back to him within the hour. I had no idea what this “kit” involved, but as a pharmacist I wasn’t feeling too comfortable about it being left out there in the wild or ending up in landfill. I was also feeling an immense amount of curiosity about what this kit actually involved.

After a few inquiries and process checks, my colleague and I went to retrieve the kit. A large black duffel bag completely unremarkable from the outside.

Inside was something that turned out to be profoundly emotional.

The bag didn’t merely contain the means to end a life by suicide, it contained the artefacts of how a dying man allocated precious time and energy in his final months of life.

Pages and pages of meticulous research full of highlights and notes scribbled in the margin. Home made apparatus to execute his chosen method. Details of how to undertake a practice run to ensure the logistical processes were sound. Notes on how to plant conversations and doctors visits in the week prior to the chosen date to avoid raising suspicion. Allocation of specific roles to loose acquaintances who would ensure the evidence of suicide was able to be cleared away body discovered without implicating and loved ones.

The sense of loneliness contained within that duffel bag was overwhelming.

As I let this all sink in, the words I’d heard from so many colleagues in the months prior rang through my head — “If they want to die why can’t they just take matters into their own hands and commit suicide like anyone else? Why do they need to put the onus on the doctors and pharmacists to supply it to them?”

This was what taking matters into their own hands looked like.

Someone with advanced terminal illness spending their precious energy coming up with an elaborate scheme to end their life. Making their preparations in near secrecy and planning to die completely alone to protect their loved ones from prosecution. The most precious final moments of life that could have been spent with their loved ones instead.

Until that day, I hadn’t given much thought to how many people with terminal illness died by suicide. As it turns out, it had been so common in Australia that several state coroners conducted inquests into the problem, recommending the legalisation of assisted dying.

This experience made it very clear to me that legalising assisted dying and establishing it as a healthcare service was undoubtedly in the public interest. Because one thing I already knew deeply was that the harm caused by suicide extends far beyond the person ending their life.

I shared my experience of bearing witness to my neighbour’s suicide in a previous post. What I didn’t explore in that piece was how in the years that followed I also bore witness to the harms inflicted on his wife and ten year old son.

What my neighbour’s suicide taught me about grief

Emotional harm, obviously, but also very practical impacts. How their home was a crime scene immediately after the death, with personal belongings taken into evidence. How they weren’t allowed to remove the car from the driveway- for many months it sat there under a tarpaulin just outside their kitchen window. A view they couldn’t escape because they were unable to settle the estate or sell their property because it was held in probate for over a year.

The harms his suicide inflicted on my husband and I. On the first responders who had to clear out the exhaust fumes, care for the body and undertake the investigation. And many more harms beyond that, I’m sure.

This is far from what happens in relation to a death by assisted dying.

Within South Australia most assisted dying occurs via self administration of a lethal oral substance. Because of this the legislation specifies that voluntary assisted dying is not considered suicide under the law. This has a number of practical implications for both the terminally ill individual and their loved ones.

Firstly, it allows loved ones to provide the person with physical and emotional support throughout the entire end of life. They can have their loved ones by their side as they attend appointments and make critical decisions about if and when they use the lethal substance. Their loved ones can be there to hear their final words, hold their hand as they take their last breath and care for their body after death.

There are practical implications for loved ones following death as well. There’s no coronial investigation involving evidence and police reports. Life insurance is not impacted. And no autopsy is required meaning the body can be cared for according to their customs with no further delays.

So yes, the act of ending one’s life by suicide and assisted dying both result in death following the actions of an individual. But the broader consequences could not be more different.

From my perspective, assisted dying is no different to any other harm minimisation public health approach - it’s a necessary feature of a humane and compassionate society.

Photo by Jr Korpa on Unsplash