OCT 1995


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD


Self Deliverance as a Security Blanket

Originally published in Colorado's AIDS Newsletter, Resolute! , October, 1995.

Do not reproduce without the permission of the author

"Bill's going to kill himself and he wants me to help. I said I would."



This is a call I got on a recent Saturday from John, a client whose lover was close to dying from MAI, CMV and rapidly spreading KS. Bill, who was also a client of mine since his previous lover's death; had watched this partner linger with wasting syndrome for months, until he was so weak he couldn't lift his head. Bill was terrified this would also be his own fate.

"Wait a minute, slow down here," I said, "How are you gonna do it?"

John replied, "Bill wants me to put a plastic bag over his head, cover his face with a pillow and then sit on him until he stops struggling."

"Bad idea!," I reacted, "It makes you very likely to be charged with manslaughter, let alone what it would do to you emotionally. I'd be treating you for Post Traumatic Stress Disorder! Its too violent and may not actually work."

"What can I do?" John implored, "He is totally obsessed with finding a way to die before he gets too sick and weak. He is still 160 pounds, and thinks if he dies naturally, it will take months."

Bill had come home the previous day from inpatient hospice care. He was bored and restless, and having frequent panic attacks. His roommate was uncomfortably reminiscent of his lingering lover. He also knew the option of self-deliverance wasn't a possibility at the hospice.

The following Tuesday I talked with Bill about a better plan. It involved a waiting period for an "Exit Bag" to arrive from the Canadian Right to Die Society. Afterwards his whole demeanor changed. He actually turned his attention to living his last days instead of being preoccupied with his death. John took him in a wheel chair to the Botanic Gardens and the two of them had several nice talks, reminiscing about their time together.

Self-deliverance is not something you can effectively do on the spur of the moment. If you are at all impulsive about it, its most likely to fail, or be unacceptably violent. According to a study done on assisted suicides, at Simon Fraser University in Vancouver, close to half left permanent injuries or loved ones resorting to suffocation or slashing wrists.

It is actually fairly difficult to kill yourself. There are many stories of people who jumped from buildings only to become quadriplegic, and others who shot themselves only to survive with brain damage. Overdoses seem to be peacefully falling asleep, but usually it leads to having your stomach pumped and surviving. Even if you are not found you are likely to just be asleep a long time and wake up with liver damage and a weakened heart. Even the currently used antidepressants are not lethal.

If you use electrocution you may also electrocute the person who finds you. Gas can blow up your house, and carbon monoxide can kill anyone in the adjacent apartments or in the house if you use an adjoining garage.

Besides what you do to yourself, you must think of the terrible legacy you could leave loved ones whom you involve to help, or have to find your body. As Stephen Levine says, "Its not fair to leave skeletons in other people's closets."

So if you want the option to take your own life at some point in the future, prepare for it now. Read the books I list at the end of this column. There is plenty of specific information out there to help you. You will need a prescription of something that will cause you to be unconscious and difficult to revive when faced with discomfort. Yet obtaining such a prescription may involve deceiving an unsuspecting physician. Even with the array of pills you may have for HIV O.I.'s, you are likely to still not have what you need. This will take some planning and lead time. It is possible your doctor will help if you are honest about your intentions, but it is at considerable professional and legal risk with our existing laws in Colorado. I do know some phys-icians are at least philosophically favorably inclined.

You also need to think about things like mixing pills in apple sauce so you can take them in quantity. Alcohol also exaggerates the effects of most medications. You will need something to keep you from throwing them all up again, probably a suppository. And finally, you will need an "Exit Bag" (sold only if you prove you have read Departing Drugs & Beyond Final Exit). This is a large, clear plastic bag that secures around your neck. Once the pills render you unconscious, the oxygen is turned to carbon dioxide and you die as a result, usually within ninety minutes.

You also need to leave notes to the effect that this action is a self-inflicted act due to a long and terminal illness; without the assistance of anyone else, and that you do not wish to be resuscitated if found while still alive. Having a loved one help you is still manslaughter in Colorado, and you need to protect them. If your death is clearly a suicide an autopsy is required as well as a visit from detectives who investigate the possibility of homicide.

Be cognizant of your state of mind. Self-deliverance is not suicide. It is a rational, premeditated response to a terminal illness whereas suicide is an emotional, impulsive escape from life. Self-deliverance is choosing how and when you die before AIDS ravages you with pain and suffering. However, pain is controllable with hospice care, and most suffering is the result of fear. If depression is your primary motivation, or you are trying to avoid dealing with loved ones in some way it is not self-deliverance, but suicide. Suicide leaves a legacy very difficult for those you leave behind, and because it involves some ambivalence the failure rate is much higher than the actual death rate. Be clear of your reasons, and discuss them with a therapist who can support self-deliverance as one of the options you weigh.

I relay these details with some trepidation. I know some readers will feel I am condoning, encouraging and providing a recipe for death. I am no Kevorkian. I have seen many PWA's who want the option as a security blanket, and I have seen many comforted by the possibility -- although only a small percentage actually use it. Many tell me "If xyz happens I will kill myself." But when they get to that place, the line drawn in the sand shifts, as they find xyz isn't so difficult to live with. Stephen Jamison, a Ph.D. in the sociology of death and dying describes it similarly: "A terminally ill patient draws a line which he simply will not cross. He then arrives at that line, crosses -- and draws a new line that he is equally certain he will never cross."

In Bill's case, he died peacefully and naturally after returning to the hospice only two weeks after devising a plan. He knew when he was readmitted that self-deliverance was no longer an option. Near the end, however, he was off and on with delirium alternating with lucid periods . He sat up at one point and anxiously asked John, "Did it come yet?"

"What? What?" John asked.

"The bag," Bill replied.

By then of course, it was too late to use and he couldn't have done it by himself. But it was a comforting thought. The bag arrived seven days after Bill died from his body naturally succumbing to his multiple infections.


Humphry, Derek. (1991). Final Exit: The Practicalities of Self-Deliverance & Assisted Suicide for                     the Dying. N.Y.: Dell.


Stephen Jamison (1996). Final Acts of Love: Family, Friends & Assisted Suicide.

      N.Y.: Putnam & Sons.

Shavelson, Lonny. (1995). A Chosen Death: The Dying Confront Assisted Suicide.NY: Simon &                     Schuster.

Available through The Right to Die Society of Canada, P.O. Box 39018, Victoria, BC, Canada                     V8V 4X8 ($16 each):


      Smith, Cheryl & Chris Docker. Beyond Final Exit. Victoria BC: RDSC, 1995.

      Smith, Cheryl & Chris Docker. Departing Drugs. Victoria BC: RDSC, 1993.


"AIDS Impact on the Right-to-Die Movement"

"Dignity Dead in Committee"

"Assisted Suicide -- Gone Wrong"




The Hemlock Society


Choice in Dying



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.