* Elderly said to keep suicide drugs "as insurance policy"
* Activists say demand up for option of assisted suicide
* British government to clarify suicide ruling this month
By Farah Master
LONDON, Sept 21 It used to be an issue just for the terminally ill. Now as populations around the world age, governments are increasingly being confronted with the taboo idea of dying as something people can volunteer to do.
"The demand for the option, if not the practice, is growing rapidly," said Dr. Philip Nitschke, 61, founder and director of the pro-euthanasia group Exit International.
The Australian doctor -- nicknamed Dr Death for his work on suicide -- is travelling the world to teach people how to end their lives safely with a suicide drug-testing kit.
"Very few will go down this path, but almost every 75-year old I meet now sees merit in having their own bottle of Nembutal in the cupboard as an insurance policy, in case things get bad," Nitschke told Reuters, referring to the barbiturate used as a sedative.
Nitschke's is an extreme view, but as the proportion of older people increases rapidly in countries such as the United States, Australia, Japan, Germany and Britain, the suggestion of an option to escape indignity could spur political tremors.
Littered with ethical red flags -- particularly around the possibility that families or organisations may encourage the elderly or infirm to end their lives -- the issue of assisted suicide has been forced up the British political agenda.
Calls for reform and a legal decision in July forced the government to promise to clarify the law. Draft guidelines are due this month with a final version by next spring, but Derek Humphry, former president of the World Federation of Right to Die Societies said significant changes in Britain would likely not come until after a 2010 election.
In Britain, nearly 20 percent of the population is over 65 -- a proportion the Office for National Statistics predicts will have grown by 50 percent by 2020.
While assisted suicide is legal in Switzerland and physician-assisted suicide -- where a doctor prescribes a lethal dose the patient may choose to drink -- is legal in the State of Washington, Luxembourg, the Netherlands and Oregon, in Britain helping someone commit suicide is a crime that carries a maximum sentence of 14 years in prison.
Despite the threat of prosecution, British campaign group Dignity in Dying said there is a growing trend of Britons opting for assisted suicide. So far 117 Britons have travelled abroad for an assisted death and 30 more are preparing to go.
Angelika Elliot, 61, said her husband "could not wait". When Dr John Elliott, 79, a medical doctor diagnosed with bone cancer, could no longer bear the pain of his daily life, it seemed the most appealing option.
"When the person you love is suffering, you have to help them no matter what," Elliott said. The Austrian designer, who accompanied her husband from Australia to end his life with the Dignitas organisation in Switzerland, believes governments globally should legalise assisted suicide.
"I think it's about time," she said. "My God, this is the 21st century!"
In 1996, Australia's outback Northern Territory introduced the world's first voluntary euthanasia laws. Four people used the laws to die by injection administered via a computer before the national government overturned the legislation in 1997.
Spain's health minister, Trinidad Jimenez, told El Pais newspaper this month there were no plans to legalise assisted suicide, but the government may propose a law allowing life-support systems to be turned off if a person has previously indicated they do not want their life prolonged artificially in conditions of pain and suffering.
Members of the British public are forcing the government to address the legal anomaly that turns a blind eye to assisted suicide overseas but prosecutes people if they assist a suicide in Britain.
The review was triggered in July when multiple sclerosis sufferer Debbie Purdy asked the court to clarify whether it would prosecute her husband, Omar, for helping her commit suicide.
The issue has polarised British medics: the Royal College of Nursing (RCN), which represents nearly 70 percent of nurses, moved to a neutral position from opposition to assisted suicide, while the British Medical Association -- the body for 70 percent of doctors -- remained strongly opposed to any form of suicide.
The RCN's move may encourage the government to relax its own ruling, but palliative care workers -- who look after the terminally ill -- say more liberal laws could send a dangerous message to disabled people.
Dr Helen Watt, director at Linacre Centre for Healthcare Ethics in London said carers, whether well-meaning or abusive, should never be given permission to help disabled people take their own lives.
"It is good holistic palliative care, not medical killing which is the answer to the real distresses of so many people when contemplating natural death," Watt said.
However, funding is an issue. Palliative care for people with terminal illness relies on nearly 50 percent of its funding from grants and charities, according to the National Council for Palliative Care.
Hospice nurses say donations are drying up and with the National Health Service (NHS) facing budget cuts, funds are likely to be squeezed further.
The government has pledged to spend an additional 88 million pounds ($146.5 million) on end-of-life care in 2009/10, but it remains too expensive for many individuals.
WHAT PRICE DEATH?
Nitschke believes demand for assisted suicide is only going to rise. To help ease the pain of the elderly, his idea is to give them easy access to suicide drugs. His drug workshops have been banned in countries such as Canada and New Zealand, but he said his kits offer a chance to test the drug.
"The test kits allow for testing that it is indeed Nembutal, and at a sufficient strength to provide a peaceful death," Nitschke said.
In Britain, Nembutal is used by vets to put down animals, but its availability is strictly controlled for humans. In Mexico, South America and parts of South East Asia, it is available over the counter.
The drug costs $35 for a 100 ml bottle. People who bring it into Britain risk being charged for importing an illegal substance or assisting a suicide.
"Increasingly people are seeking help from 'agents' to obtain the drug, which pushes the price to around $100," said Nitschke, whose own kits cost $50.
Britons who are members of Dignitas, the Swiss organisation that helps terminally ill people to die, can opt to pay 6,000 Swiss francs ($5,800) for an assisted suicide.
Angelika Elliott's enthusiasm for the system is palpable.
"It is very strict in Switzerland," she said. "If we can follow their laws -- which have existed for over 60 years -- we cannot go wrong and society will be a better place." (Additional reporting by Jason Webb in Madrid and Michael Perry in Sydney; Editing by Kate Kelland and Sara Ledwith)