Suicide bag

Diagram of a suicide bag.

A suicide bag, also known as an exit bag or hood,[1][2] is a device consisting of a large plastic bag with a drawcord used to commit suicide. It is usually used in conjunction with an inert gas like helium or nitrogen, which prevents the panic, sense of suffocation and struggling during unconsciousness (the hypercapnic alarm response) usually caused by the deprivation of oxygen in the presence of carbon dioxide. This method also makes the direct cause of death difficult to trace if the bag and gas canister are removed before the death is reported.[3][4][5] Right-to-die groups recommend this form of suicide as certain, fast, and painless, according to a 2007 study.[6]

History

The suicide bag was first widely mentioned in Derek Humphry's book Final Exit in 1992,[7][8] and its use with inert gases mentioned in a Supplement to Final Exit published in 2000.[9]

The "Exit Bag" was described as a large plastic bag with an adjustable velcro strip around the neck area.[10] Different models of the "Exit Bag" were described in Hemlock publications, and the use of helium was specified.[10] Philip Nitschke has stated that nitrogen has a lower risk of an adverse reaction by the body than helium. Nitrogen has been advocated as a replacement for helium not because of reactions to helium, but due to a "temporary restriction on the availability of disposable helium in Australia (and New Zealand), helium has been difficult to procure."[11] In 2015, some suppliers of helium began mixing 20% air into their "party balloon" tanks, due to a global shortage of helium, making the tanks unsuitable for use with suicide bags.[12]

The "Customized Exit Bag" was described and briefly marketed in 1995 by the Right-to-Die Society of Canada in its privately distributed book, Beyond Final Exit.[13] Bruce Dunn wrote about the use of inert gases and a hood in the same volume,[14] and the idea was developed by ERGO.

Richard MacDonald, the medical director of the Hemlock Society, advised in 2003 that reduced barbiturate availability led to promotion of suicide bags.[10] The Human Life Review reported in 2003 that Caring Friends, a Hemlock Society program, shifted to promoting them as a result and published advertisements stating that "how-to guides such as Final Exit and Departing Drugs also recommend the use of plastic bags for self-deliverance.”[10] Australian doctor Philip Nitschke, a euthanasia advocate, promotes suicide bags with films, such as "Doing it with Betty" – in which an elderly woman describes how to make a plastic 'exit' bag,[15][16] and publishes materials such as workshop handbooks.[17] Nitschke also promotes other related methods such as masks[18] and tents.[19]

The Australian-based euthanasia group EXIT International attempted to market a manufactured version of the bag in Australia in 2002.[20] Up until that time, "exit bags" were available on the internet from Canada right-to-die advocates (The Right to Die Society of Canada) to Australians. Canadians stopped shipping them when the Australian government indicated in 2001 that it planned to review their importation.[20]

In 2007, Canadian press reports indicated that the combination of a bag and inert gas was becoming the most popular method of suicide, but had not led to an increase in suicides.[21] Two years later, four members of the Final Exit Network were arrested in Atlanta, Georgia and charged with assisted suicide in the death of a man who had had disfiguring cancer surgery. Investigators said the organization may have been involved in as many as 200 other deaths around the country. Members of the Network are instructed to buy two new helium tanks and a hood, known as an "exit bag" (suicide bag).[22]

Different methods of bag-making are analyzed and compared in a 2013 publication, Five Last Acts - The Exit Path by Chris Docker.[23]

The world's largest manufacturer of disposable helium cylinders, Worthington Industries, announced in 2015 that helium cylinders will guarantee only 80% helium, with up to 20% air, making them inappropriate for use with a suicide bag.[24]

Legal restrictions on sale

In 2011, the Gladd Group of El Cajon, California, owned and run by a 91-year-old woman who sold suicide bags by mail, was raided by the FBI and her operation ceased.[25][26] In July 2011, this raid caused Oregon to be the first US state to pass legislation prohibiting the sale of kits containing suicide bags or hoods.[27]

Medical and bioethics literature

Suicides using bags or masks and gasses are well documented in the literature.[3][28][29][30][31][32][33][34][35][36][37][38] In the study "Asphyxial suicide with helium and a plastic bag" (Ogden et al.),[5] the authors described a case involving a 60-year-old woman with a diagnosis of adenoid cystic carcinoma. The woman died in September 2000, in South Carolina after using a suicide bag and helium.

Cases using suicide bags and gases other than noble gases are recorded, for instance a propane-butane mixture,[39] and methane (natural gas).[40]

A 2010 study in the Journal of Medical Ethics found that in four cases of assisted suicide with helium delivered by face mask, at the Dignitas clinic, the method was potentially quick and appeared painless, and that a hood method might be able to play a role in "demedicalising assisted suicide".[41] A 2011 study found that in recent years information about suicide with helium and a bag has spread rapidly on the internet, in print, and on video.[42]

A case report study in 2015 found that "freedom from discomfort and pain, effectiveness, rapid effect and relatively easy availability of required accessories have resulted in the use of inert gases for suicidal purposes".[30]

There are also documented cases of suicide attempts using the suicide bag that failed.[43] A case report study in 2015 states, "If the process is interrupted by someone, there is no gas or the tube slips out of the bag, there is a high risk of severe hypoxia of the central nervous system."[30]

See also

References

  1. ↑ Williams, Martin (2016-03-30). "Scots assisted death and abortion pioneer dies, aged 89". The Herald (Glasgow). Retrieved 2016-04-18.
  2. ↑ Ogden RD, Hassan S (2011). "Suicide by oxygen deprivation with helium: a preliminary study of British Columbia coroner investigations". Death Stud 35 (4): 338–64. PMID 24501824.
  3. 1 2 Schön CA, Ketterer T (December 2007). "Asphyxial suicide by inhalation of helium inside a plastic bag". Am J Forensic Med Pathol 28 (4): 364–7. doi:10.1097/PAF.0b013e31815b4c69. PMID 18043029.
  4. ↑ Auwaerter V, Perdekamp MG, Kempf J, Schmidt U, Weinmann W, Pollak S (August 2007). "Toxicological analysis after asphyxial suicide with helium and a plastic bag". Forensic Sci. Int. 170 (2–3): 139–41. doi:10.1016/j.forsciint.2007.03.027. PMID 17628370.
  5. 1 2 Ogden RD, Wooten RH (September 2002). "Asphyxial suicide with helium and a plastic bag". Am J Forensic Med Pathol 23 (3): 234–7. doi:10.1097/01.PAF.0000022963.33157.9B. PMID 12198347.
  6. ↑ Schön, CA.; Ketterer, T. (Dec 2007). "Asphyxial suicide by inhalation of helium inside a plastic bag.". Am J Forensic Med Pathol 28 (4): 364–7. doi:10.1097/PAF.0b013e31815b4c69. PMID 18043029.
  7. ↑ Humphry, Derek (1992). Final Exit: the Practicalities of Self-Deliverance and Assisted Suicide for the Dying. New York: Delta Trade Paperback. ISBN 0-385-33653-5.
  8. ↑ Humphry, Derek (2002). Final Exit: the Practicalities of Self-Deliverance and Assisted Suicide for the Dying (3rd edition). New York: Delta Trade Paperback. ISBN 978-0-385-33653-6.
  9. ↑ Supplement to Final Exit by Derek Humphry, 2000 Norris Lane Press and ERGO. "This supplement is an addition to the main volume, explaining the new technique of using inert gases..." (from the back cover)
  10. 1 2 3 4 "Patience and Plastic Bags", Rita Marker, The Human Life Review, Spring 2003
  11. ↑ "The Nitrogen Alternative" (PDF). Exit International. January 2009. Retrieved 2011-07-28.
  12. ↑ Humphry, Derek (2015-04-24). "Australian warning on diluted helium tanks". Retrieved 2015-07-23.
  13. ↑ John Hofsess; Docker C; Smith C; Dunn B (1995). John Hofsess, ed. Beyond Final Exit. Right to Die Society of Canada. p. 112. ISBN 1-896533043.
  14. ↑ Chapter 7: Nitrogen and Other Inert Gases, ibid
  15. ↑ "Dr Death attempts to dodge film law". stuff.co.nz. 2011. Retrieved 25 July 2011.
  16. ↑ de Bruxelles, Simon (May 6, 2009). "‘Dr Death’ Paul Nitschke reveals secrets of a peaceful exit". TimesOnline (London: News International). ISSN 0140-0460. Retrieved 25 July 2011.
  17. ↑ Connell, Tim (2011). "Dr Death ignites right to die debate - Local News - News - General - Great Lakes Advocate". greatlakesadvocate.com.au. Retrieved 24 July 2011.
  18. ↑ "Dicing with death - smh.com.au". smh.com.au. 2011. Retrieved 24 July 2011.
  19. ↑ Denton, Andrew (2011). "Enough Rope with Andrew Denton - episode 157: Philip Nitschke (19/11/2007)". abc.net.au. Retrieved 24 July 2011.
  20. 1 2 "Outrage over suicide bag giveaway – smh.com.au". www.smh.com.au. 2002-07-09. Retrieved 2008-12-19.
  21. ↑ "Helium in an "exit bag" new choice for suicide". www.canada.com. Retrieved 2008-12-19.
  22. ↑ Associated Press (2011). "Helium, hoods used by assisted suicide group". msnbc.msn.com. Retrieved 27 July 2011.
  23. ↑ Docker, Chris (2013). "Helium". Five Last Acts - The Exit Path. ISBN 9781482594096.
  24. ↑ Humphry, Derek (2015-04-24). "Warning on diluted helium tanks". Assisted Dying Blog. Derek Humphry. Retrieved 2016-04-17.
  25. ↑ Marosi, Richard (May 30, 2011). "Suicide kits: Woman selling 'suicide kits' reignites right-to-die debate - latimes.com". Los Angeles Times (Los Angeles: Tribune Co). ISSN 0458-3035. Retrieved 27 July 2011.
  26. ↑ Federal agents raid California suicide kit seller Yahoo News.
  27. ↑ Ertelt, Steven (2011). "Oregon Governor Signs Bill Banning Sale of Suicide Kits". lifenews.com. Retrieved 27 July 2011.
  28. ↑ Chang SS, Cheng Q, Lee ES, Yip PS (2016). "Suicide by gassing in Hong Kong 2005-2013: Emerging trends and characteristics of suicide by helium inhalation". J Affect Disord 192: 162–6. doi:10.1016/j.jad.2015.12.026. PMID 26724695.
  29. ↑ Oosting R, van der Hulst R, Peschier L, Verschraagen M (2015). "Toxicological findings in three cases of suicidal asphyxiation with helium". Forensic Sci. Int. 256: 38–41. doi:10.1016/j.forsciint.2015.06.028. PMID 26298854.
  30. 1 2 3 Smędra A, Szustowski S, Jurczyk AP, Klemm J, Szram S, Berent J (2015). "Suicidal asphyxiation by using helium - two case reports". Arch Med Sadowej Kryminol 65 (1): 37–46. PMID 26007160.
  31. ↑ Gunnell D, Coope C, Fearn V, Wells C, Chang SS, Hawton K, Kapur N (2015). "Suicide by gases in England and Wales 2001-2011: evidence of the emergence of new methods of suicide". J Affect Disord 170: 190–5. doi:10.1016/j.jad.2014.08.055. PMID 25254616.
  32. ↑ Cantrell L, Lucas J (2014). "Suicide by non-pharmaceutical poisons in San Diego County". Clin Toxicol (Phila) 52 (3): 171–5. doi:10.3109/15563650.2014.888734. PMID 24580055.
  33. ↑ Austin A, Winskog C, van den Heuvel C, Byard RW (2011). "Recent trends in suicides utilizing helium". J. Forensic Sci. 56 (3): 649–51. doi:10.1111/j.1556-4029.2011.01723.x. PMID 21361949.
  34. ↑ Straka L, Novomesky F, Gavel A, Mlynar J, Hejna P (2013). "Suicidal nitrogen inhalation by use of scuba full-face diving mask". J. Forensic Sci. 58 (5): 1384–7. doi:10.1111/1556-4029.12239. PMID 23899346.
  35. ↑ Cox D, DeRienz R, Jufer Phipps RA, Levine B, Jacobs A, Fowler D (2006). "Distribution of ether in two postmortem cases". J Anal Toxicol 30 (8): 635–7. PMID 17132265.
  36. ↑ Gallagher KE, Smith DM, Mellen PF (2003). "Suicidal asphyxiation by using pure helium gas: case report, review, and discussion of the influence of the internet". Am J Forensic Med Pathol 24 (4): 361–3. doi:10.1097/01.paf.0000097856.31249.ac. PMID 14634476.
  37. ↑ Sharp ME, Dautbegovic T (2001). "Ether: stability in preserved blood samples and a case of ether-assisted suicide". J Anal Toxicol 25 (7): 628–30. PMID 11599613.
  38. ↑ Hiss J, Kahana T, Arensburg B (1994). "Suicidal asphyxia by gas mask". Am J Forensic Med Pathol 15 (3): 213–5. PMID 7825551.
  39. ↑ Zivković, V.; Juković, F.; Nikolić, S. "[Suicidal asphyxiation by propane-butane mixture inside a plastic bag: case report].". Srp Arh Celok Lek 138 (5-6): 376–8. PMID 20607988.
  40. ↑ Maryam A, Elham B (2010). "Deaths involving natural gas inhalation". Toxicol Ind Health 26 (6): 345–7. doi:10.1177/0748233710369122. PMID 20430818.
  41. ↑ Ogden, RD.; Hamilton, WK.; Whitcher, C. (Mar 2010). "Assisted suicide by oxygen deprivation with helium at a Swiss right-to-die organisation.". J Med Ethics 36 (3): 174–9. doi:10.1136/jme.2009.032490. PMID 20211999.
  42. ↑ Ogden, RD. (Jun 2010). "Observation of two suicides by helium inhalation in a prefilled environment.". Am J Forensic Med Pathol 31 (2): 156–61. doi:10.1097/PAF.0b013e3181d749d7. PMID 20216304.
  43. ↑ Maryam, A.; Elham, B. (Jul 2010). "Deaths involving natural gas inhalation.". Toxicol Ind Health 26 (6): 345–7. doi:10.1177/0748233710369122. PMID 20430818.
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