In early November 2008 a woman in her 30s who lives alone in London decided that she wanted to die. She was depressed. She felt that she only suffered and caused suffering to others, and that she did not deserve to live. Yet from the outside her life seemed fulfilling and successful. A graduate building a career as a writer, she was still going about her daily affairs pretty much as normal, but she was unable to be happy and she could see no way out of her predicament. She was not sleeping well and had lost interest in food.
She investigated ways to die. The internet provided her with detailed instructions on how to kill herself using a plastic bag filled with helium which is reported (by advocates) to deliver a painless and certain death. On Friday 21 November she ordered a large disposable helium cylinder from an online retailer.
The cylinder cost £25 with £6 delivery in three days or £20 for next-day delivery. She wanted the next-day delivery, but there was not enough money on her pre-pay card so it was ordered for Monday 24 instead.
On Saturday 22 November she followed the instructions and made the bag using household objects.
On Sunday 23 November a friend phoned. They chatted (she could cover up her sadness for a while) and when they said goodbye she realised that that conversation would be their last and regretted this. This was the first doubt about dying she had had for many weeks.
Next morning, the day she had decided to die, she was full of conflict and ambivalence. Life was not worth it, but never seeing her friends or her family again was not desirable either. She had thought about it for much of the night in her own silent agony. The early morning sounds of the street outside gave her a nudge, and she walked the short distance to her local accident and emergency department for help. She was seen by the psychiatric team there and was able to tell her whole story to a friendly and patient psychiatric nurse. She felt a little better.
Later in the day she was taken home by one of the team of nurses who would care for her there as part of the home treatment service. On the doorstep was the helium cylinder. It had been delivered at 9am, an hour after she had left for the hospital. The woman would not touch it and asked the nurse to take it away. The next day I saw her, and while I was there I asked about the bag. She gave it to me, relieved to have it out of her home.
A week later I asked her how she felt about these events. She told me she was still shocked by it all, but was getting back to her writing, was seeing friends a little, exercising, and working out what she wanted to do with her life, which she was now glad to have. She told me that it was scary how close she came to dying, that her death had seemed so inevitable then. She was happy that the combination of factors which kept her alive that weekend had come together as they did. She listed them – not having enough money for the overnight delivery of the cylinder, her friend phoning, the cylinder not being delivered until she had already left for the hospital. “I’m lucky to be alive.” she said.
When I heard the director of EXIT International, Philip Nitschke, talk in October, (something I blogged about at the time), I learned that the instructions placed on the internet by organisations such as his are primarily intended to help terminally ill people prepare to commit suicide.
People with suicidal feelings are nearly always deeply ambivalent, and their commitment to the act often fluctuates. This is as true for terminally ill people as it is for other groups. Public health measures to reduce suicides largely concentrate on reducing access to the means of suicide, the opposite strategy to that advocated by EXIT International. I was worried that these instructions would be used to tragic effect by someone at whom they were not aimed. I am glad that on this occasion I am writing about a patient who is still alive.
William Lee is an MRC Research Training Fellow at the Institute of Psychiatry and a Specialist Registrar in Adult and Old Age Psychiatry in London.
Competing Interests: The author has experience of working in palliative care. The author has no religious affiliation.
Patient consent obtained.