1. WHAT IS VOLUNTARY EUTHANASIA?

When we hear the phrase voluntary euthanasia people generally think of one of two things: the active termination of life at the patient's request as it occurs in the Netherlands (or similar proposals in other countries); or the Nazi extermination program of murder. Many people have beliefs about whether euthanasia is right or wrong, often without being able to define it clearly. Some people take an extreme view, while many fall somewhere between the two camps. Dictionary definitions avail us little, as there will always be large groups of people that claim it means something else. The apparent derivation a gentle and easy death (from the Greek, eu - thanatos) hardly describes what we mean. Even extending the definition to include bringing about of this, especially in the case of incurable and painful disease (Oxford English Dictionary) hardly covers it - hospices often succeed in bringing about a peaceful death, but they don't perform euthanasia!

In the Netherlands, the only country where euthanasia is openly practised, euthanasia is defined as "the intentional termination of life by another at the explicit request of the person who dies" (Netherlands State Commission on Euthanasia). The argument then often centres on the voluntariness of the request. How can one be sure that it is voluntary? Supporters of the voluntary euthanasia movement generally believe that it would be possible to devise sufficient safeguards to ensure that the request was voluntary and that people could never feel pressured.

The Dutch are critical of their own system and are continually refining and testing it - though generally they feel that it respects human rights and is part of good medicine. They get rid of the word voluntary since the explicit request is part of their definition of euthanasia. An explicit request is objectively observable, whereas voluntariness depends somewhat on interpretation. (Some opponents of euthanasia suggest that the true will is impaired if one is asking to die and that therefore there is no voluntariness. Most people would agree if the person was emotionally distraught over, say, being jilted by a lover, or if the person was psychiatrically of unsound mind, but most of us view more considered statements as voluntary, especially if we are unable to find any evidence to the contrary.

Obviously the Dutch definition needs careful implementation to ensure voluntariness, and the Dutch attempt to do this by a series of safeguards within a close doctor-patient relationship, a high standard and availability of palliative care, and general public support. There is much debate over whether we could have a similar system in, say, Britain, but we feel that the present system is unsatisfactory and so we press for reform.

One of the few certainties of life is death, but in the twentieth century it is still a taboo subject. The "forbidden" nature of death adds to the unnamed fears and worries that most people feel when asked to confront the idea of their own death. Yet once people can overcome their reluctance to discuss the subject, most often what is revealed is not the fear of death itself, but the manner of dying. The difficulty of thinking about "death with dignity" is that it implies that one day you, or someone you love, may be in a position to want that choice.

No one can prevent death finally, but we can and should ensure that the dying process is a gentle and peaceful one. When life consists of a few agonising, drugged weeks, many patients beg their doctors to help them die, and many doctors, mindful of the ethics of their profession, feel forced to refuse. Those who, out of compassion, accede to such a request, know they are breaking the law and putting their careers at risk.

This is the dilemma which faces all of us now. Should we, as potential patients, have the legal right to ask our doctors to help us die when the end of life is in sight and our suffering severe?
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2. WHY THE NEED FOR SOCIETIES?

In England, The Voluntary Euthanasia Society was founded in 1935 by the late Dr C. Killick Millard M.D., DSc. Its principal object was to make it legal for an adult person, who is suffering severe distress from an incurable illness, to receive medical help to die at their own considered request.

In 1980 Scottish Exit (later the Voluntary Euthanasia Society of Scotland or VESS, and, later still, "Exit") became an independent group, and published "How to Die With Dignity". This booklet, by Dr George Mair, was the first guide to self deliverance in the world. An updated version, together with the well-researched modern supplement "Departing Drugs," is still available to members of at least three months' standing, as long as they specifically request it. Members can receive the booklet in Scotland, England or anywhere in the world. EXIT also acts as a centre and focus for research concerning medical decisions at the end of life, and particularly living wills. The EXIT Newsletter is considered a leading source of information. EXIT can provide information and support to members of the public, doctors, lawyers, educational institutions and students, politicians and the media. Individuals should note, however, that while seeking a change of the law, we will only act within the law as it stands.

The history of reform shows that humane and well-argued proposals only tend to pass into law when there is a strong public voice behind them. The people who struggle against inhumanity make their mark by creating a better world. We can't help those who have died in abject suffering, but we can work for the good of those whose death is yet to come - not only by striving for better, caring services, but by restoring control to the individual who has entered the last phase of life.
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3. IS THERE GROWING SUPPORT FOR THE MOVEMENT?

A National Opinion Poll, in April 1993, showed that 81% of Scots agree with our aims for a change in the law. A phone-in after a TV programme gave a figure of 93% in agreement, from a total of 23,000 calls. A survey published in the British Medical Journal in 1994 showed that a considerable number of doctors are already acceding to requests for active voluntary euthanasia. Many more doctors feel that a change in the law is overdue. Yet any move towards legislation of Voluntary Euthanasia has so far been blocked by opponents.

Opposing voices tend to reveal an ignorance of the true nature of VOLUNTARY euthanasia. Misunderstandings abound, and we hope in this leaflet to lift and remove any fears and misapprehensions. If you wish to write or phone, we are also glad to answer any queries.

International support is growing rapidly. A number of countries are actively considering legislative reform. Right-to-Die Societies around the world have increasing support from the swiftly growing numbers of individuals demanding their rights to self-determination.
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4. DOES THE SOCIETY ENCOURAGE EUTHANASIA FOR THE OLD AND INFIRM?

There can be no voluntary "euthanasia" if any persuasion is present. In all humane societies there is proper provision for caring for the elderly and infirm. Such facilities are also paid for out of taxes in a normal working life, and an individual has a right to choose to benefit from these services - the individual has the right to choose the type of care he or she would like, or to decline further treatment. No one should be driven to contemplate suicide through lack of service, care or support.

While it is often the old and infirm who choose self-deliverance, the choice has been made in the light of each individual's quality of life. Love of life is a primitive instinct: no one should be persuaded to die through propaganda. But a conviction, deeply held for whatever reason, that the time has come, should be respected, and everyone should have the right to choose release.
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5. I WANT TO DIE. PLEASE CAN THE SOCIETY HELP ME?

EXIT is not a suicide club. As a pressure group we seek to bring about a change in the law, but we must act, and be seen to be acting, within the law. Neither do we encourage suicide stemming from irrational or emotional impulses. Although we have no formal association with the Samaritans, we urge any emotionally traumatised individual contemplating suicide to get in touch with them. We also stress the importance of clear and full diagnosis of existing conditions if a person is already ill.
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6. WHAT DOES EXIT FEEL ABOUT MALFORMED BABIES, THE MENTALLY HANDICAPPED OR THE INCURABLY INSANE?

EXIT seeks only the legislation of voluntary euthanasia. Handicapped babies, and the mentally retarded cannot make that voluntary decision, and so are not included in our remit. EXIT also presses equally strongly for safeguards against any type of so-called euthanasia that does not stem from a clear, well-informed and voluntary request on the part of the individual. We stand for freedom of choice, and this also includes that of individuals and doctors who are opposed to our views but do not seek to impose those views on others.
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7. WHY DO YOU NEED VOLUNTARY EUTHANASIA WHEN THERE IS THE HOSPICE MOVEMENT?

There have been enormous advances in the care of the terminally ill, and for many, the lucky ones who find a place in a hospice, this has proved adequate to ensure that they come to a peaceful and dignified end.

Unfortunately, even with medical advances and excellent hospice research in palliative care, severe indignity, pain and distress cannot always be controlled. The hospices' most optimistic estimate for pain control is 95%. In practice, in ordinary hospitals, it may be as low as 30%.

There are conditions such as cancer, strokes, acute arthritis, and more recently AIDS, to name just a few, where all the medical skills in the world aren't enough for a particular individual case. If that person, after undergoing all possible treatment, still feels enough is enough, they should have the right to be helped to die.

The phrase "terminal illness" suggests a way of looking at death, not at the moment of brain death, but as a process lasting some period of time; once this more realistic view is embraced, and the fact of dying accepted by the individual, the doctors and the relatives, what can be gained by ensuring that the process of dying is prolonged as much as possible? Now, a dying person's wishes often count as nothing: hence we want a change in the law.
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8. WHY ISN'T THE LAW CHANGED?

Often the medical profession claim there is no need for legislation. In fact, Lord Dawson of Penn, the royal physician, argued that helping patients to die was part of good doctoring. We now know he had practical experience of this, in timing the end of George V. A Bill promoted in 1936, seeking to permit voluntary euthanasia in certain circumstances and with certain safeguards, was rejected, but public sympathy was with it. Subsequent attempts to reform the law have met with similar fates, including in 1990 an Early Day Motion on the subject of voluntary euthanasia, and a 1993 Select Committee of the House of Lords.

By mobilising public concern this could be changed. You can help by supporting us; you could write to your MP, or open a debate in your newspaper.
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9. BUT SURELY SUICIDE ISN'T ILLEGAL?

Suicide has long been legal in Scotland and, since 1961, in the rest of Britain. However, aiding another person towards his or her own suicide is still illegal, no matter how laudable the motives. It is this situation which makes it impossible for doctors to practise active euthanasia.

There is the added difficulty that by the time many people are driven to contemplate suicide because of their suffering, they are not physically able to accomplish the act. The law is inconsistent inasmuch as it tolerates suicide, but outlaws the means. To deny a person control over his or her own life is immoral. It is an abuse of human rights, and should be illegal.
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10. HOW CAN I HELP PROTECT MY RIGHTS?

One way that we help members to establish their wishes is to provide a form of advance directive known as a Living Will, which an individual signs when in sound mind and body, to specify what they wish to happen should various circumstances arise. It is signed in a common sense, practical way, and not under emotional stress. The form can then be lodged with your doctor as an indication of your wishes. It deals with requests for the withholding of treatment where the situation warrants it. It does not ask the doctor to do anything contrary to existing law, but allows him or her to have access to the considered opinion of the patient. Many doctors are welcoming the fact that patients and those closest to them are willing to share the responsibility of what can be a very difficult decision. The British Medical Association and the Royal College of Nursing encourage the use of living wills and publish a Code of Practice to guide their members.

EXIT also supplies a Living Will Alert Card, to be filled in and carried in your purse or wallet, indicating you have signed a living will. We suggest the use of a values history to help guide doctors should difficult situations arise not adequately covered by your living will.The values history helps you and your doctor to identify those things that, for you, make life worth living. It can also further understanding with those close to you, so they will know what is important to you should you need their support. We publish regular updates in a Newsletter, providing members not only with current academic arguments but with valuable practical advice on their rights within the law.
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11. I AM INTERESTED IN THE PRINCIPLES YOU'VE TALKED ABOUT - WHAT SHOULD I DO NOW?

First of all, register your support on the application form. Your name will also help to swell the already substantial and growing body of opinion worldwide in favour of our humane proposals.

What is required even more urgently is active support. We need more members and more money to increase the momentum needed to change the law. We also need more funds to operate a Support Network and Information Service for members - assessing individual needs and providing information about available options.

All correspondence to members is sent under plain cover and membership is confidential. (Please note: legal considerations require that people wishing to buy the booklet "How to Die With Dignity" must be members of at least three months' standing. This is to discourage irresponsible or unconsidered use of the contents. The price of the booklet is not included in the subscription, and is issued at the discretion of the Society).

The cost of membership is small, but it is an opportunity to stand up for what you know to be right. Take a stand against suffering; protect your own right to choose - and your right to be treated with dignity and compassion in the event of severe, incurable illness. Finally, consider making a donation, large or small, or making a bequest in your will; help us function more effectively and use the coming challenge to ensure proper measures and proper safeguards are enacted. Your money will be well spent.

Neither will you be alone in the battle. Prominent voices have included the late philosopher Sir Alfred Ayer, father of biomedical ethics Joseph Fletcher, journalist and broadcaster Ludovic Kennedy, columnist Claire Rayner, playwright Brian Clark, actor and writer Sir Dirk Bogarde, actress Katherine Hepburn, mountaineer Sir Edmund Hilary, the late scientist and writer Isaac Asimov, and such well-known members of the medical profession as Jonathan Miller, Wendy Savage and Christiaan Barnard.