CONTENT WARNING: This story discusses assisted suicide and mental health issues.
Sean Davison is already well known for his involvement in four assisted suicides. But there have been others, too, he tells Chris Cooke, as he prepares to take on a new role that will again thrust him into the international spotlight.
Sean Davison never imagined that one day he’d be helping numerous people end their lives. Born in Auckland, raised in Hokitika, and educated in both New Zealand and South Africa, he hadn’t expected that’s where his PhD in microbiology might take him. But circumstances intervened.
Davison shot to public prominence in 2010 when police decided to prosecute him for helping his terminally ill mother to die. But the full extent of his own journey through an ethical minefield, and how his views about euthanasia have evolved since then, have remained hidden until now.
He is now convinced it is not just people suffering from physical pain, but also those in mental pain, who should have access to assisted dying. Our brains, he believes, do not differentiate between the two.
“I support the fundamental belief that a person has a right to determine their own death at their own time – if they’re over 18 and have a rational mind,” he explains. “No one has the right to say another person can’t end their life; to say, ‘No, you’re not suffering enough.’ It’s an individual’s choice.”
He reveals that among the people he’s helped to die was a 21-year-old suffering from depression and having persistent thoughts of committing violent sexual crimes. The young man was distraught after years of treatment hadn’t worked, and his parents supported his decision to end his life. They were present when he died.
Unlike most psychiatrists, Davison believes that people who are mentally unwell can still make rational decisions. “I think no one should judge someone who’s answering the pleas of a loved one begging for assistance to die, until they have put themselves in the same position and asked: ‘What would I do?’ I believe any humane person would want to help.”
He would like to see more liberal laws allowing assisted death, along the lines of what is already available in countries like Belgium and Switzerland.
In 2019, Davison pleaded guilty to three charges of murder in South Africa. One of the cases involved him directly administering a lethal drug to a severely disabled man who could not move any of his limbs and wanted to die. The man’s family were there when it happened. “It was nowhere near murder,” Davison argues. “Anybody who could see the details of the case could see that.”
He reveals there have been at least two other deaths where he was present that he has not been prosecuted for, including that of the 21-year-old. And he admits that while in South Africa, he was illegally importing a lethal drug and supplying it to dozens of people “who were desperate for it”. In his eyes: “This highlights the fact that there should be a law. I shouldn’t be in the position of dishing it out.”
Helping mum
Not a day goes by, says Davison, when he doesn’t think of his mother.
Patricia Davison was a GP and psychiatrist who, according to the youngest of her four children, had “a zest for life; for art and culture”. They were close.
For his PhD at Otago University, Davison specialised in DNA analysis. In the early 1990s, his work took him to Cape Town where he established a DNA forensics laboratory at the University of the Western Cape. He was involved in identifying the remains of anti-apartheid activists and set up “The Innocence Project” to help people claiming they were wrongfully convicted.
In 2006, he returned to New Zealand to care for his mother, who was then 85 and in the final months of her life. Dying from cancer, she decided to go on a hunger strike, but after 35 days was still alive and experiencing immense pain. She pleaded with her son to help her die by overdosing on morphine.
Davison says he was appalled that her GP wasn’t able to help, so agreed to his mother’s request. In 2009, he published a book, Before We Say Goodbye, about his mother’s death, but withheld his direct involvement in it. Soon after its release, a newspaper obtained a copy of his original unedited manuscript with the full story and published extracts from it.
A year later, on a visit to New Zealand from South Africa, the police arrested and charged him with attempted murder. Archbishop Desmond Tutu, who was then the chancellor of his university, wrote to the judge vouching for Davison, and he was released on bail, allowing him to return to his family and job in South Africa. He says he was flooded with messages of support, including people seeking his help to die.
“I thought my mother’s death was something that didn’t happen very often. When I became aware it was happening all over the place, I thought: ‘Something has got to be done’.”
He set up a lobby group, Dignity South Africa, to fight for an assisted-dying law, and returned here to face trial the following year. He now regrets pleading guilty to an alternative charge of “counselling and procuring an attempted suicide”, as he believes a jury would not have found him guilty of attempted murder.
After five months of home detention in Dunedin, Davison returned to his family in South Africa in May 2012, and faced intense media coverage. Once again, people flooded him with requests to end their suffering.
Desperate remedy
Dr Anrich Burger became a quadriplegic in a car accident in 2005, aged 34. Previously an athletic man, he endured a lot of pain and made no secret of the fact he wanted to die. When he tried to take his own life, he was admitted to hospital.
Davison says he only agreed to meet Burger because he was so persistent. Initially, Davison planned to accompany him to a clinic in Switzerland, but then Burger decided he wanted to die in his home country. He asked Davison to help him.
“That was a bridge I crossed — quite a crucial step and a crossroads in my life. The logic seemed very reasonable. It was the same medication [as in Switzerland]. He was a medical doctor and said he’d get it and I just had to be there. It wasn’t difficult to say yes.”
In 2013, they booked a suite at a hotel overlooking the Cape Town harbour. Burger made a video with a message to his friends and family, then another where he stated his wish to die.
Davison said he made the video to show exactly what happened. After helping Burger take the medication, he called reception to tell them there had been a death, and left. He then passed on the video to Burger’s fiancée, who handed it to the police.
Davison decided to speak to the media and confess he was present when Burger died. “The police had everything – my confession, and the video – but were not interested. So, then I became quite relaxed about helping people to die.”
A friend publicly described Davison as “untouchable”, and he started to believe it. He admits it made him less hesitant to respond to the many requests for help that he was receiving from strangers.
‘It was cruel’
One of those requests came from Justin Varian. Previously a social person, Varian was slowly dying of motor neurone disease. He’d lost practically all muscle movement and couldn’t speak. “It was cruel; he was so tormented. At 52, he looked much older,” says Davison.
He agreed to help Varian end his life, and again, a video was made. Using his letter board, Varian spelled out the words: “I want to die.” They used a gas causing deoxygenation but it took longer than they’d anticipated. “I had no experience with it.”
Davison says in the end, Varian did die peacefully. “But the fact that it didn’t go well highlights the tragedy of not having an assisted-dying law,” he argues. “Desperate people are having to do this because there is no law.”
Varian died on July 15, 2015. Still thinking the police had no interest in prosecuting him, Davison then helped Richard Holland die. A well-known South African triathlete, Holland was hit by a car while training in Dubai. The 29-year-old suffered spinal injuries leading to him developing locked-in syndrome, meaning he was fully aware mentally but was unable to talk and could barely move.
His sister later stated that her brother was in “extreme pain” that could not be alleviated with medication, and had indicated on several occasions a desire to die. In early 2015, he asked that Davison be approached to help.
Davison says Holland’s situation was “a tragedy” and his life was unbearable. “If he doesn’t qualify for an assisted death nobody does – living the rest of your life, the next 50 to 60 years, as a head on a lifeless body.”
He says he agonised for days over the request from Holland’s family that he intervene, but eventually agreed, administering a fatal drug that he was illegally importing. Holland’s mother, sister and stepfather were present at his death on November 8, 2015, and it was also recorded on video. Meanwhile, Davison continued his efforts to have an assisted-dying law introduced in South Africa.
Under New Zealand’s current law, none of the three men would have qualified for an assisted death as they were not expected to die within six months. Davison feels cases such as Holland’s, where someone is completely incapacitated, should be at the top of the list, even ahead of the terminally ill. “Unlike him, the terminally ill mostly are capable of some type of suicide if they wish.”
Mental anguish
It took another three years before Davison faced murder charges for all three deaths. In hindsight, he believes he was naive to think the police did not have him in their sights.
Davison admitted then that he was present when the three men died. Now he admits there were at least two others, including the 21-year-old suffering from depression, and a man bedridden in his early 40s after a car accident.
The man, who was tetraplegic, struggled for several years to make a decision about his future, but was passionate about the need for a law change, he says. “I was reluctant at first, but we got on very well. He was angry over what happened to him, but extremely intelligent.”
The day arrived when he decided he’d had enough, so Davison helped him drink a lethal drug the man said he’d obtained himself.
Davison accepts that many people, including some right-to-die supporters, disagree with his view that unbearable mental suffering should be a legally valid reason for assisted dying.
In the case of the 21-year-old, he believes the man was unable to find anything that helped, including exercise and medication, and was tortured by his darkest thoughts, which included acting on fantasies about rape and torture.
“Physical suffering is easy to see but what if you’re mentally paralysed?” the man says in a final video. “You don’t enjoy anything any more, feeling numb and your emotions are also numb.”
In the video, the 21-year-old’s parents explain why they are supporting his decision. “I believe this will release him from his suffering,” says his mother. There is a discussion about the lack of a law for assisted dying in South Africa and the hope that this might change. The video ends and the man dies shortly afterwards after taking a lethal drug.
Davison is unmoved by arguments that given time, and the right treatment, such people can overcome their depression. “I think it’s good that people are encouraged to get help, but they might not want it. It’s really up to them,” he replies.
He says the man had decided for a long time that he wanted to end his life after treatment was not successful. “That case comes down to mental competence and the ability to make a decision knowing the consequences of your actions. He clearly fitted that group where he could make a mentally competent decision even though he had a mental illness of some description.”
In a tragic footnote to the case, the mother of the man later took her own life. Davison says he lost contact with the father.
He admits, however, that he supplied fatal drugs to people in South Africa without access to experts to properly assess their mental state. While New Zealand now has a law that allows assisted dying in certain circumstances, South Africa does not.
“The fact that I found myself in situations where I felt I’d no choice but to help a person to die, when I’m absolutely not qualified to do it, highlights the need for a law change,” he says.
Belgium, he notes, allows euthanasia for people with unbearable mental suffering. Under Belgian law, the request needs to be repeated and voluntary, and the applicants are assessed by a physician to ensure they are mentally competent to make the decision. Davison would like to see other countries follow suit.
By 2018, he admits, he was becoming exhausted over his involvement with people seeking to end their life, given that he was still working as a university lecturer, and was a father to three young children. He was also concerned at the high crime rate in South Africa, and took his family to Australia for a sabbatical year.
He was considering various career options and locations, including moving back to New Zealand to do pathology lab work, and had applied to register here as a medical laboratory scientist. But his plans were disrupted when he returned to Cape Town on his own to speak at a conference as president of the World Federation of Right to Die Societies.
Davison was arrested and charged with the murder of Anrich Burger. Two months later, he was charged with the murder of Justin Varian and, early the following year, charged with the murder of Richard Holland. His family was still in Australia.
“I was feeling miserable. Jail seemed a certainty – at least 20 years. I had an all-consuming fear. South African jails are crowded and violent; prison is like a death sentence. I was ready to skip the country and had a yacht lined up.”
He’d managed to obtain a replacement New Zealand passport after his was seized. But when the court consulted the families of those who died, they said they didn’t want him prosecuted, and he was offered a plea bargain: for a guilty plea to all three murder charges he would serve three years under house arrest.
“My kids did not want a martyr sitting in jail. I took the plea deal for the sake of my family.”
He was confined to his property but allowed to work, and the University of the Western Cape continued supporting him. However, he was gagged from speaking to the media or being involved with the campaign for a law change with Dignity SA.
“It was suffocating, not being able to go and do things with the children, and random checks from authorities.”
He ran laps around his house for exercise and went on “camping trips” with his family in the backyard. In addition to house arrest, the court sentenced him to 576 hours of correctional supervision. He spent this time cleaning toilets in prison cells and government offices.
House arrest
Davison wrote another book about his experiences, The Price of Mercy, which was released when his house arrest ended last June. It covers the period after he arrived back in South Africa from New Zealand, but the only deaths it mentions are the three men the police already knew about.
This is the first time he has spoken publicly about the other deaths. He believes now that he’s out of South Africa, he won’t be prosecuted. “I’m not the guy they want. They realise I’m more likely to lead to a law change. They want to defend the law.”
He decided he needed to leave South Africa as soon as he could after his house arrest ended. He had hoped to settle back in New Zealand, but this was scuppered when the New Zealand Medical Sciences Council censured him and struck him off in 2020 after they discovered he hadn’t disclosed to them his three murder convictions. Because of the convictions, living in Australia wasn’t possible either. He’s now living in the UK but still contributing to Dignity SA.
Davison is now employed by euthanasia campaigner Philip Nitschke as a director of his organisation Exit International, and he is overseeing the launch of a device called Sarco. The name is an abbreviation of “sarcophagus” – a capsule that fills with nitrogen gas on the instruction of the person inside, causing death from lack of oxygen.
As a medical doctor in Australia’s Northern Territory, Nitschke was involved in the first legal voluntary assisted death in the world in 1996 after a new law was passed there allowing it. He made a device he called the “deliverance machine”, which enabled a man dying of prostate cancer to self-administer a lethal injection. Nitschke helped three other terminally ill people to die in the same way, prompting the Australian media to dub him “Dr Death”.
The law was short-lived. In 1997, the federal Parliament in Canberra nullified it with the passage of the Howard government’s Euthanasia Laws Act. However, all states in Australia have since passed assisted-dying laws.
In 2016, Davison connected with Nitschke, speaking at an Exit International conference in Melbourne. Davison was there in his then-role as president of the world federation, and his attendance signalled a coming together of two previously distinct factions in the right-to-die movement.
Right-to-die organisations have traditionally focused on law changes around a medical model of seeking assisted deaths for people who qualify after they’re diagnosed by a doctor to be physically sick enough. This is the basis of New Zealand’s End of Life Choice Act 2019, which is for people who are terminally ill.
Exit International takes a wider view and insists on the right for mentally competent adults to choose their own end, even if they aren’t terminally ill or suffering a serious medical condition. It also advocates for the right of people to have access to a means to end their life, running workshops for its members and providing information on various methods and how to obtain them.
The information is restricted to people aged over 50, and is often referred to as “old-age rational suicide”, says Nitschke. The organisation claims to have 57,000 members globally, in almost every country.
It remains highly controversial, however, often attracting criticism from religious groups and sometimes from relatives of people who have taken their own lives.
Nitschke disagrees with most doctors’ assertion that anyone wanting to end their life who is not seriously physically ill is in fact mentally unwell, and should be treated as such until they recover. “I think it is rubbish,” he says.
Tired of life
Nitschke points to the case of Professor David Goodall, the 104-year-old Australian scientist who flew from his home in Perth in 2018 to Switzerland to end his life. He wasn’t terminally ill but felt he’d had enough of life.
“I’m not ill. I want to die. It’s not sad particularly. What is sad is if one is prevented,” Goodall told the media at the time.
Nitschke says if people find Goodall’s death acceptable, the same rationale has to apply to a younger person. He’d earlier encountered another academic in Western Australia, Lisette Nigot, who’d decided to die aged 79 in 2002. She was in good health.
“I said, ‘For goodness sake, Lisette, you’re not sick – go on a cruise or write a book.’ She just looked at me and said: ‘Why don’t you mind your own business? It’s got nothing to do with you, doctor. I make this decision, not you.’”
The encounter caused a major shift in his thinking, quite separate from the official position of Exit International. “If you’re a rational adult, which means over 18, and you decide to die, you should have the means and the ability and information on how to carry that out successfully. Now, that’s not particularly popular even within my own organisation,” he says.
Meeting Nitschke was a light-bulb moment for Sean Davison. “I was frustrated by the right-to-die campaigns and the type of laws coming out. There is a big gap between people who should qualify for an assisted death but don’t under the laws. It highlights the need for Exit International,” he says.
In December, he and his family swapped the dry heat of Cape Town for the freezing cold of a UK winter. In his new job, it wasn’t long before Davison was visiting Switzerland. Although the Sarco is likely to be used there first, his initial trips have been to act as a witness for three female members of Exit International, who travelled to Switzerland to end their lives.
Since 1942, it’s been legal in Switzerland to assist a person’s suicide as long as there is no selfish motive and the person ending their life is mentally competent to make the decision without the influence of others. A doctor is legally permitted to prescribe a lethal drug for a person to take themselves. There’s no stated permissible reason, and a person is not required to be facing a serious illness.
Ethical concerns
Separate from the law, the Swiss Academy of Medical Sciences tightened guidelines last year. It says assisted dying is not ethically justifiable if a person is healthy, and there must be physical or mental suffering from an illness that is intolerable for them and treatment options have proven ineffective or have been rejected. They must also have the capacity to make the decision with no external pressure, and this must be assessed over a two-week period.
However, the guidelines are not legally binding and for some doctors there’s been no change in what they’ve been doing for decades.
In Switzerland, there are two key clinics, Dignitas (which most often takes people who have a physical illness) and Pegasos (where physical suffering is not a necessary requirement). Both charge around €10,000 ($17,200) and, together, they deal with around 500 people a year who fly in from all over the world.
Most of those requesting help are women, although Pegasos has been popular for couples who wish to die together. Typically, one is terminally ill and the other can’t bear a life without them.
Davison travelled to support such a case earlier this year, but the husband, who was terminally ill, died before the couple got there. “The wife then applied to the clinic on her own. It was approved but her family opposed it. They would not accompany her to the clinic.”
The woman was in her late 70s and was from the UK. She’d also had a daughter die not long before. “The family could not measure her degree of mental suffering,” argues Davison. “That’s the problem – you can’t see it. Only the person experiencing it knows how much they’re suffering. She had to sneak off alone. It is very sad.”
Sarco pods
The first operational Sarco pod is still being made, although a prototype has already gone on show. The hope is for testing to take place next month and for it to be used for the first time later this year.
It was invented by Nitschke after he was approached to come up with a solution for a man in England who had locked-in syndrome and couldn’t move beyond blinking his eyes. He wanted to end his life, but it was illegal for anyone to help him, so he was looking for a way he could do it himself.
The glass-fronted pod allows a person to lie in it and activate the release of nitrogen gas, either by eye movement or by pushing a button. But first, a series of questions need to be answered to determine whether the person is making a rational decision and fully understands that they’ll die if they take the next step.
A doctor’s prescription isn’t required for the gas, avoiding the complexities emerging for doctors in Switzerland. “Oxygen levels drop right down to less than 1 per cent within 30 seconds. You lose consciousness within one or two breaths and die peacefully shortly thereafter,” says Nitschke. “It will democratise the whole process. That’s really the goal.”
The person can choose where they’d like to locate the 3D-printed pod, as it’s transportable and self-contained. Nitschke’s hope is that anyone with a decent 3D printer will eventually be able to create one. And if it can be made in biodegradable material, it could also be used as a coffin.
A lot of thought went into the design, he says. “We made it stylish and elegant. Like a sort of a vehicle, like you’re travelling somewhere.”
He says the first Sarco will be reusable and will be accessed through a “decentralised autonomous organisation”, a member-owned community of shareholders without centralised leadership. “Anyone who has a share will be able to use Sarco at some stage.”
It is likely to be first made available in Switzerland because there are no laws preventing its use there, says Nitschke. And it will be essentially free.
Nitschke, who is 75, is currently touring Australia holding Exit workshops, and says that Davison is a likely successor for the running of the organisation. “He’s a very approachable person and his backstory is a powerful one.”
The admiration appears to be mutual. “Philip Nitschke is an absolute genius. [Sarco] is a very impressive device,” says Davison.
The first person to use a Sarco was intended to be a New Zealander, Bev Hurrelle. I met Hurrelle last year, in a cafe on the Kāpiti Coast. She explained in a raspy voice – due to an unsuccessful throat operation – why she wanted to die. She laughed off any questions about depression and explained that she had simply had enough of her broken body.
Aged in her early 90s, the former social policy researcher loved classical music but had to stop playing the piano due to severe arthritis. She had also endured spinal issues and macular degeneration. She was a long-time supporter of Exit, and campaigned for end-of-life legislation in New Zealand, but was unable to end her own suffering because she wasn’t terminally ill.
Hurrelle had planned to die in the Sarco overlooking Lake Geneva, after attending a performance by her favourite orchestra, the Berlin Philharmonic. But it didn’t happen. She died last October.
Davison isn’t saying who might be next on the list, but he appears re-energised by his new role. He plans to return here to run Exit workshops and speak about the Sarco.
“To me, it’s the Holy Grail of euthanasia. I’ve found my home at Exit International and I’m very happy to be here.”
He has no regrets about the deaths he’s taken part in but hopes he won’t face more charges. “It is human nature not to turn our backs on another human’s suffering. However, I know that there is a fine line between courage and being foolish, and I know where that line is. I do not want to go to jail. I’m a family man and my children want a father, not a hero sitting in prison.”
Mental pain a no-go zone
Should New Zealand’s 2019 assisted-dying law be amended to allow people to end their life because of mental suffering?
The End-of-Life Choice Society of New Zealand, which fought for 40 years for the law to be introduced, doesn’t think so. “We’re very explicit that this needs to be an issue brought on by a medical condition. And therefore it can be relieved, under certain circumstances, with the help of doctors,” says society president Ann David.
David disagrees with Sean Davison’s assertion that some people suffering from depression are still able to make rational choices. That might be the case with some mental health conditions, she believes, but not depression.
“Depression causes a person, as I understand it, to not be able to think rationally. The person must be able to think rationally at the time that they are requesting their assisted death,” she says.
Most psychiatrists, says David, believe depression is reversible. She says if the society were to be contacted by someone saying they were depressed and seeking an assisted death they would recommend the person approach professionals for help.
Nor does the society support assisted dying for elderly people who have just had enough of life, she says.
However, it would like to see some changes made to the End of Life Choice Act. At present, the law is available only to adults who have an illness that is likely to end their life within six months. They must also be in an advanced state of irreversible decline in physical health, have unbearable suffering that can’t be relieved in a way they find tolerable, and be able to make an informed choice.
You can’t be considered if you have a mental disorder or illness – including dementia – or are elderly but otherwise in good health. People with a disability are also excluded, unless they meet all the other criteria.
The society would like to see the six-month prognosis removed, extending the law to anyone with unbearable suffering from an irreversible medical condition that cannot be relieved.
Where to get help:
If it’s an emergency and you feel that you or someone else is at risk, call 111.
· Need to talk? Free call or text 1737 any time for support from a trained counsellor
· Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
· Lifeline – 0800 543 354 (0800 LIFELINE) or free text 4357 (HELP)
· Youthline – 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat
· 0800 What’s Up - 0800 942 8787
· Samaritans – 0800 726 666
· Depression Helpline: 0800 111 757 or free text 4202 to talk to a trained counsellor, or visit depression.org.nz
· Anxiety New Zealand - 0800 269 4389 (0800 ANXIETY)
· Healthline – 0800 611 116
· Additional specialist helpline links: https://www.mentalhealth.org.nz/get-help/in-crisis/helplines/