A suicide bag, also known as an exit bag, 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. Right-to-die groups recommend this form of suicide as certain, fast, and painless, according to a 2007 study.
The "Exit Bag" was described as a large plastic bag with an adjustable velcro strip around the neck area. Different models of the "Exit Bag" were described in Hemlock publications, and the use of helium was specified. Philip Nitschke has stated that nitrogen has a lower risk of an adverse reaction by the body, but did not specify with regard to what other gas. Nitrogen has been advocated as a replacement for helium not because of reactions to helium, but because, due to a "temporary restriction on the availability of disposable helium in Australia (and New Zealand), helium has been difficult to procure."
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. Bruce Dunn wrote about the use of inert gases and a hood in the same volume, 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. 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.” 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, and publishes materials such as workshop handbooks. Nitschke also promotes other related methods such as masks and tents.
The Australian-based euthanasia group EXIT International attempted to market a manufactured version of the bag in Australia in 2002. 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. The bags are known as "Aussie Bags".
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. 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).
Different methods of bag-making are analyzed and compared in a 2013 publication, Five Last Acts - The Exit Path by Chris Docker.
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. 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.
Suicides using this method are well documented in the literature. In the study "Asphyxial suicide with helium and a plastic bag" (Ogden et al.), 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.
A 2010 study in the Journal of Medical Ethics found that helium in a bag or hood caused death in a quick and painless manner, and could play a role in "demedicalising assisted suicide". 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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)
- "Patience and Plastic Bags", Rita Marker, The Human Life Review, Spring 2003
- "The Nitrogen Alternative" (PDF). Exit International. January 2009. Retrieved 2011-07-28.
- 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.
- Chapter 7: Nitrogen and Other Inert Gases, ibid
- "Dr Death attempts to dodge film law". stuff.co.nz. 2011. Retrieved 25 July 2011.
- 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.
- Connell, Tim (2011). "Dr Death ignites right to die debate - Local News - News - General - Great Lakes Advocate". greatlakesadvocate.com.au. Retrieved 24 July 2011.
- "Dicing with death - smh.com.au". smh.com.au. 2011. Retrieved 24 July 2011.
- Denton, Andrew (2011). "Enough Rope with Andrew Denton - episode 157: Philip Nitschke (19/11/2007)". abc.net.au. Retrieved 24 July 2011.
- "Outrage over suicide bag giveaway – smh.com.au". www.smh.com.au. 2002-07-09. Retrieved 2008-12-19.
- CMAJ: Australian physician advises advance planning for final exit CMAJ (2010) 182(18):E815-E816
- "Helium in an "exit bag" new choice for suicide". www.canada.com. Retrieved 2008-12-19.
- Associated Press (2011). "Helium, hoods used by assisted suicide group". msnbc.msn.com. Retrieved 27 July 2011.
- Docker, Chris (2013). "Helium". Five Last Acts - The Exit Path. ISBN 9781482594096.
- 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.
- Federal agents raid California suicide kit seller Yahoo News.
- Ertelt, Steven (2011). "Oregon Governor Signs Bill Banning Sale of Suicide Kits". lifenews.com. Retrieved 27 July 2011.
- 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.
- Maryam, A.; Elham, B. (Jul 2010). "Deaths involving natural gas inhalation.". Toxicol Ind Health 26 (6): 345–7. doi:10.1177/0748233710369122. PMID 20430818.
- 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.