This section is a discussion of inert gases and other possible choices.
Inhaling an inert gas is a third major choice after Medical Aid in Dying (MAiD) and Voluntarily Stopping Eating and Drinking (VSED). VSED and inert gases are Do it Yourself (DIY). Indeed, if someone helps you breathe an inert gas, or initiates VSED on an incapacitated patient, they are committing a crimeIn Nevada initiating Stopping Eating and Drinking by AD (SED by AD) is legal..
Inert gases are oderless, colorless and tasteless. Because of these properties, they are more dangerous than toxic gases: they can painlessly kill in small confined areas by depriving the brain of oxygen without warning. There are seven of them, the most known are neon, radon, helium and nitrogen.
In the past Helium was used for self-deliverance. It was readily available (at party stores for blowing up balloons), and inexpensive (compared to other inert gases and drugs), Unfortunately, in the last few years this simplicity has been complicated by the shortage and the high cost of helium. So the manufacturers started diluting party helium with air. It has been assumed that this dilution will render helium ineffective for self deliverance. For some reason, no one has volunteered to find out if the dilution really matters.
So the right-to-die movement has switched to nitrogen. It too is available, but it is more costly, not as close by as the party store, is heavier than air, and comes highly pressurized. In sum, there are complications.
First, when a nicely dressed lady (or anyone not looking like a welder) walks into a welding supply store to buy a tank of nitrogen, there are questions.
Second, the high pressure means a pressure regulator has to also be purchased, and must be screwed onto the gas tank, assuming the fittings are the same size. The user has to know what pressure to set on the regulator.
Third, there must be enough nitrogen allowed into the plastic bag to force out all of the lighter air. Unlike helium, gravity is a complication not a help.
Fortunately help is available – from the Final Exit Network, also known as FEN. FEN goes back to the helium days. A patient must submit his or her medical record, so that FEN can see why it is she or he wants to end life early. More importantly, it wants to be sure that the patient is mentally competent and not just suffering from depression. After this screening an “exit guide” will, if you want, come to your home to talk about what to buy and how to hook it all up and make it work. The guide will not buy anything for you, and will not assist you to set up the equipment. So FEN does not, for the legal reason discussed above, assist. FEN’s guides have been accused of assisting suicide by district or county attorneys, but, with one exception, those attempts failed because there was no proof of overt assistance; also FEN successfully asserts it right to freedom of speech. The exception was in Minnesota, which has a very broadly-worded assisted suicide statute.
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In this website California’s POLST is discussed, so there are likely minor differences if you reside elsewhere. Check out your state here. The forms are printed in pink to make them standout. But the form need not be colored.
One can have both an advance directive and one of these forms. The two must be consistent.
Forms of this type, being a doctor’s order, override a directive.
The forms allow you to specify medical treatments or levels of treatment you want or don’t want, including options for artificial feeding, similar to choices in advance directives.
EMTs (Emergency Medical Technicians) must comply with these forms; they need not comply with a directive.
These forms are NOT VALID unless signed by an authority designated by state law. In many places, this is your physician and physician assistants and nurse practitioners.
Some people post the original of the form on their refrigerator or other very obvious place.
It is a good idea to distribute copies of these forms in multiple places, on your phone, in your car, to your hospital, etc. just like you will do with your advance directive.
In the opinion of many, including the author of this website, POLSTs and all such forms are over used. Their use is widespread for several, rather weak, reasons.
Drugs can be lethal of course, as the unfortunate abuse of fentanyl demonstrates.
Early in the right-to-die movement barbiturates, which lower your heart rate and blood pressure, were a choice, particularly seconal and pentobarbital (Nembutal). But barriers to their use have developed that change that.
The barriers are:
Then there are other less-effective drugs yet lethal in large qauntities. These are pain medications, antidepressants, sleep aids and tranquilizers. Besides the large quantities needed, there is the issue of how long it will take to die. If the drug fails to kill, the issue of damaging side effects becomes relevant.
There are several opioids, especially MORPHINE and its variants, that can cause death; ALTHOUGH Nitschke Author of the Peaceful Pill Handbook. says the effects of morphine are wildly variable. These pain killers can be effective but only if not used by the patient for some time. That is, effectiveness diminishes with use. It is also subject to the barriers above.
Carbon monoxide (CO) is toxic. Inert gases are not. A failure with CO can leave the patient with severe incapacities. (To top it off, these days it is not easily obtainable by breathing car exhaust; catalytic converters remove virtually all CO from the exhaust once the car has warmed up a few minutes).
A tourniquet tightened around the neck can quickly cause death due to lack of oxygen to the brain. Unconsciousness ensues almost immediately. The weakness in this method is how does an unconscious person keep the tourniquet wound up?
The answer is perhaps by using a stick or long wood spoon handle to do the winding. Then the patient lodges it on the shoulder just before passing out. It is easy to see that this is not reliable method (For more information, see Docker, Five Last Acts – The Exit Path (third edition, 2013).
There are still more methods of self-delivery. Two books that list them are:
Final Exit by Derek Humprey. This book was and still is a best seller, with millions sold around the world. It is easy to read and understand. Be sure to get the current update.
Five Last Acts – The Exit Path by Chris Docker (2013). This 700 page treatise lists yet more methods, and goes into some detail on most of them, including carotid artery compression. It is still available at Amazon.
Page date: 12/26/23
Extensive recent medical research clearly indicates that with a good lifestyle you can prevent developing Alzheimer’s disease. What life style changes? (As many as you can do; the more, the better.)
This list is taken from a class on prevention given at the San Diego Community Colleges in the fall of 2022. You can get similar information from this YouTube video: Ten tips to prevent Alzheimer's, Melissa Batchelor. There are others.