It's a one-size-fits-all, hood-shaped plastic bag, and it's fast becoming one of the most prescribed forms of euthanasia worldwide.
Called an Exit Bag, not a suicide bag, it's easily operable, inexpensive and, most importantly, a device that can be legally sold. The world's largest right-to-die organizations are recommending it to their members.
Advocates admit the idea of death-by-plastic-bag is shocking, especially to those to whom the Exit Bag is recommended. Most patients seek fatal medication, which can be expensive. An Exit Bag goes for only about $30.
"Most people object to the horrible and grotesque death by tying something around your neck," said Dr. Philip Nitschke, leader of Exit Australia. "It's not physiologically distasteful, but it is an aesthetically distasteful death."
Physician-assisted suicide is only legal in a handful of places around the world, most notably Holland and Switzerland. In the United States, the Supreme Court has ruled that assisted suicide is not a constitutional right, leaving the decision to the states. The issue has come to referendum six times in five states — Maine, Washington, Oregon, California and most recently, Hawaii, where the motion passed the state's House but failed in the Senate.
The referendum in Oregon in 1997 led to the nation's first Death with Dignity law. In April, a federal judge thwarted the U.S. Justice Department's attempt to have the voter-approved law overturned.
Exit Australia announced plans to manufacture the industrial plastic bags in Brisbane, the state capital of Queensland last week. The bags had been available over the Internet from a similar Canadian group, but Exit Australia officials said they were worried the Australian government would ban their import.
Nitschke said he hopes to produce about 500 Exit Bags starting at the end of August, "modified a bit here and there" from the Canadian prototype. But government officials and the local church have expressed discomfort and outrage with Exit Australia and its intentions.
Bags Used With Drugs
Nitschke said the bag works easily and efficiently. With the help of a sedative drug, often Nembutal, the patient falls asleep with his or her head in the bag. An adjustable collar lets the patient tighten the bag firmly around the neck. While unconscious, the patient uses up all the oxygen in the bag — a death from hypoxia, which Nitschke said is the sickness airline passengers feel when air pressure isn't properly adjusted at high altitudes.
Death-by-bag is even preferred to the more common forms of euthanasia, such as an overdose of medication or the inhalation of carbon monoxide gas, Nitschke said, because the Exit Bag doesn't expose the body to a poison that it will try to repel.
"Nobody comes to me and says, 'I want to stick my head in a bag,'" Nitschke said. "It's a poor person's alternative."
Exit Australia's announcement, which came via an inter-group newsletter, did raise some eyebrows. Physician-assisted suicide has been illegal in Australia since 1997, when the federal government overturned a law that had made the Australian state of the Northern Territory the first region in the world to permit the practice. The government's action sparked the formation of Exit Australia, which Nitschke has had 2,300 members.
Steve Bishop, a spokesman for the Queensland Premier Peter Beattie, whose jurisdiction includes Brisbane, where the bag production is proposed, said the issue of euthanasia divides people much like the abortion debate. He dismissed Nitschke's efforts as little more than a stunt.
"We'll wait and see how this unfolds, make sure whatever [Exit Australia] does fits in with the existing legislation," Bishop said, emphasizing the government's support of respite care centers for the terminally ill.
Exit Australia has faced tougher opposition from the local Catholic church, which has taken a hard line against the movement's efforts.
"The question about whether the suicide bag is painless or not, in fact, has no bearing on my judgment or that of the Church about the morality of its use or especially of assisting people to use it," Bishop Michael Putney told ABCNEWS.com in an e-mail.
Putney said groups like Exit Australia target depressed elderly women who are vulnerable to suggestion, but he said the church has no strategy for approaching the group other than to spread its own message.
Nitschke insists there are many in Australia who support Exit Australia and he is confident the nation's euthanasia laws will be overturned eventually. But for now, he said, the issue is too controversial for public officials to defend his cause.
The Great Beyond
The Exit Bag is not an Australian phenomenon. Proper instructions for its use were detailed in a book by right-to-die guru Derek Humphrey in 1991. In the late 1990s, the Right to Die Society of Canada began taking orders for Exit Bags over the Internet.
In the United States, the Denver-based Hemlock Society, founded by Humphrey, serves many of the same functions as Exit Australia — educating the terminally ill about their death and lobbying state legislatures to adopt physician-assisted suicide laws.
Since 1998, members of the Caring Friends program of the Hemlock Society have visited patients and educated them about their options concerning death — among them, the availability of Exit Bags.
Most recently, the Hemlock Society has taken up a battle with the U.S. Justice Department after Attorney General John Ashcroft vowed to overturn Oregon's Death with Dignity law.
Of the more than 100 patients who have sought assistance from Caring Friends before their death since it was created in 1998, most have used an Exit Bag, said spokesman Ryan Ross. Ross declined to discuss where Hemlock members obtain their Exit Bags, or even how the bags work, for fear of the device's misuse.
"Death is the biggest taboo we have left," he said.