Is it right to want to die? The author came to his own conclusion when his ailing mother decided that she had had enough.



Carolyn Bower Solomon and Andrew Solomon

In our family, discussions about euthanasia began long before my mother developed ovarian cancer. We all signed living wills in the early eighties, and talked at that time about how uncivilized it was that the euthanasia option accepted in the Netherlands was not available to Americans. “I hate pain,” my mother said casually. “If I reach the point at which I’m in nothing but pain, I hope one of you will shoot me.” Laughing, we all agreed. We all thought that a quiet death was the best kind — in your sleep, at home, when you were very old. Young and optimistic, I assumed we would all die that way at some point in the very remote future.

The matter remained wholly abstract until my maternal grandmother had cataract surgery. She went in for this procedure in her late eighties, possessed of that acerbic intelligence I had known in her since my childhood. It took five days for her to regain consciousness, and when she did she was a rather tedious little old lady without much of a sense of humor and with no real opinions. For the remainder of her life, my grandmother read no books or newspapers, formed no opinions, and called none of the people who had been her friends. She ceased to show the slightest interest in going out with the family and refused even to come to our house for Christmas Day. She griped about the shortcomings of her food and catalogued endless small aches and pains. That was the extent of her conversation. She was not, however, plagued by agonizing disease, and she did not show the real incoherence of senility. And so there was now something disconcerting about the energy with which my mother talked about euthanasia. “If I ever get to that stage,” she said, “someone come up and kill me.” My father, who adored my mother and seldom took sides against her, was shocked, but my mother never wavered. “She is getting no pleasure from anyone else,” she said. “Nor is she giving pleasure to anyone. Her life is already over, and this thing she’s doing — it’s just a punishment, for her and for me. If I could think of a way to do it, I’d go up there and shoot her this week, and it would be the biggest favor I could do her. Don’t you see that she’s wanted to be dead ever since that surgery?”

When my grandmother died, eighteen months after the cataract surgery, my father was astonished at how devastated my mother was. “You wanted her to die,” he kept reminding her. And my mother retreated into a kind of angry sadness: now that my grandmother was dead, my mother could give vent to her loss. It is clear to me in retrospect that my grandmother hung on for those eighteen months only because she thought that it was expected of her — that she had to wait until one of her durable organs gave up. But, despite my mother’s rhetoric, none of us considered helping my grandmother to die, and it never occurred to my grandmother to do anything about her wish to have things over with.

Reconciling individual experience and universal principle is bound to be problematic, but the gap yawns particularly wide here; nor does it narrow as the right-to-die movement gains momentum.

Three years after my grandmother’s death, my mother’s suicide — in the late stages of terminal cancer — did not appear to be a political act. Final Exit, a best-seller with do-it-yourself instructions for people who have had enough of life, was not yet in broad circulation; and though Dr. Jack Kevorkian, the inventor of a suicide machine for suffering patients, had stumbled across the television screen, his slouchy figure and taste for theatrics seemed tangential to our isolatingly private experience. Compelled in part by that sense of isolation, I began a sporadically autobiographical novel, A Stone Boat, which is most true to life in its description of my mother’s death. By the time the book came out, I had become accustomed to the idea that I was participating in the great American euthanasia debate, and I checked to see whose side I was on. I was alarmed to discover how little connection there was between the experiences that had led to the point where I, with my father and my brother, watched my mother kill herself and the public controversy into which I had been plunged. Legislation and legal decisions on the right to die have changed rapidly; though it is less than four years ago that my mother died, none of us could then have conceived of Oregon’s Measure 16, which passed last year and, if it is upheld in the courts, will make physician-assisted suicide legal for the first time ever, anywhere in the world.

There is a divide in the current discourse on euthanasia between, on the one hand, the emotional arguments put forward by people who have participated in the euthanasia process and, on the other, the libertarian rationales for legislative support of euthanasia as a civil right. Though the media have made the political and legal debate into headline news, the terms of that debate fail utterly to capture the emotional resonance of any planned death. Reconciling individual experience and universal principle is bound to be problematic, but the gap yawns particularly wide here; nor does it narrow as the right-to-die movement gains momentum.

The word “euthanasia” may be used to cover a spectrum of events (assisted suicide, physician-assisted suicide, voluntary active euthanasia, passive euthanasia, and involuntary active euthanasia) and to substitute for a variety of politically-loaded euphemisms (the right to die, aid-in-dying, physician-assisted death, and end-of-life decision-making). Talk of euthanasia provokes sometimes irrational responses on both sides, and these responses center on the emotional issue of who should control a life. The person whose life it is? The person’s doctors? The person’s dependents? The state? Some elaborately negotiated balance of these? In China, you in effect need the permission of the government to start a life: it is generally illegal for couples to have more than one child, and those who ignore this law are subject to heavy penalties. In America, you have an absolute right to bring into this world a child to whom you intend to give neither love nor material support. Surely if you can start another life without permission, you ought to be able to terminate your own?

Yet the view persists that to wish for one’s own death, in any form, is crazy, and that the person who holds such a wish must be cured of his or her “depression” or “distorted view.” Social convention says you must always protect the suicidal from themselves. It is true that many suicides are the irrational result of treatable depression, but I am persuaded that there is also such a thing as a rational decision to give up life. This belief marks me as a euthanasiast. Unfortunately, many who believe in such rational decision-making — and they include both Kevorkian and Derek Humphry, the author of Final Exit — seem to think that “rational” means “straightforward.” It is not easy to arrive at this rational decision. Doing so is a slow, tangled, peculiar process, whose convolutions are as madly individual as those experiences of love which can lead to marriage. The moderates, for their part — the legal philosopher Ronald Dworkin and the physician Timothy Quill among them — draw an obsessively careful distinction between “rational” suicides and all others. The fact is that a suicide is a suicide — overdetermined, sad, somewhat toxic to everyone it touches. The worst and the best kinds lie at either end of a continuum; they differ in degree, not in essential quality. The narrator of Dostoyevski’s The Possessed asks whether there are people who kill themselves from reason. “Lots,” Kirilov replies. “But for prejudice there would be more; many more; all.” What has changed in the last few decades is the shape of that prejudice.

It is true that many suicides are the irrational result of treatable depression, but I am persuaded that there is also such a thing as a rational decision to give up life.

Even those least constrained by that prejudice, in all its protean shapes, agree on the need for parameters for euthanasia. But what should they by? Must the patient’s death be imminent, or can he have a debilitating but not imminently fatal condition, such as Alzheimer’s or Lou Gehrig’s disease? Must the patient have exhausted all available treatments? Is there such a thing as a terminal mental state, in which someone who has received lots of treatment and remains unhappy may be assisted to die even if he or she is not physically ill? In the autumn of 1993, in accordance with a long-term pact, an elderly couple, married for many years, took a combination of barbiturates and other drugs sufficient to kill themselves. They had both suffered painful conditions, and now she was developing symptoms of terminal disease. When they were found, she was dead, but doctors at a Bay Area hospital were able to resuscitate him. “You get sent in to help someone like that,” a psychiatrist said to me at a party in San Francisco last November. “What can you do?” A colleague said, “They’ll give someone like that pills and therapy to ameliorate depression, but his wife is dead, he’s old, sick, in constant pain, and his suicide didn’t work. I gather he’s been in pretty much the same state for six months. I treat depression. What he’s got, it’s not that kind of depression.”

The medical community has been grappling with the issue in an increasingly public way. In 1991, Timothy Quill published, in the New England Journal of Medicine, the details of his decision to give a patient who had refused treatment for acute leukemia a prescription for barbiturates sufficient for suicide. “I wrote the prescription with an uneasy feeling about the boundaries I was exploring — spiritual, legal, professional and personal,” Quill wrote. “Yet I also felt strongly that I was setting her free… to maintain dignity and control on her own terms until her death.” The patient — Diane, he calls her — died having persuaded her doctor and her family that her decision was rational. Quill signed a death certificate that listed acute leukemia as the cause of her death, “to protect Diane from an invasion into her past and her body, and to continue to shield society from the knowledge of the degree of suffering that people often undergo in the process of dying.”

Quill’s account was by no means the first of its kind to appear in the medical journals. A few years earlier, an unsigned article called “It’s Over, Debbie” had been published in the Journal of the American Medical Association. It was an account by a medical resident of his having given morphine to a cancer patient who had said, “Let’s get this over with.” The general feeling was that the resident had had no right to kill someone he didn’t know. But Quill’s story was cause for much deeper examination. After publication, various charges were considered against him, including manslaughter. The grand jury failed to indict, but only after Diane’s body had been autopsied and photographers had set up camp outside her family’s house. “It was media torture,” Quill told me. At the moment suicide is legal throughout the United States; assisted suicide is specifically criminalized in thirty-two states and is criminalized through common law in eleven more; the law is unclear in seven states.

In his pellucid book, Death and Dignity, Quill advocates “comfort care” (the phrase is a variant of “hospice care” or “palliative care”), in which sick people are made as comfortable as possible and allowed a natural death — but he also supports legal aid-in-dying where comfort care fails. Every doctor has to make decisions about when to use “heroic measures” with a patient, when to let the patient die — and when to do something in between. Quill discusses the “double effect” of supplying pain relief that also hastens death; he explains the “slippery slope” argument, according to which any program of aid-in-dying can lead to coerced or involuntary euthanasia — to people knocking off their relatives for financial gain or emotional relief. “Physician aid-in-dying should be possible, but not easy,” Quill says. “We cannot circumvent the richness of the decision-making process. Doctors must agree on a policy of non-abandonment, and stay with their patients through whatever decisions those patients make.” In the Netherlands, where physician-assisted death is illegal but is not prosecuted if it falls within stated guidelines, patients usually have lifetime relationships with primary-care physicians. In America, we tend to die in the hands of specialists who never saw us healthy. Quill’s central argument is that there should be a close relationship between doctor and patient, and that the decision to provide aid-in-dying must grow out of that intimacy.

Young doctors tend to support euthanasia. “If you go to medical school now, you’ll see we’re nowhere near caught up socially with where we are technically,” Roberta Parks, a young internist, told me. “End-of-life decisions often rely heavily on language,” she went on. “If you say to the family of a man who is dying, ‘Do you want me to do everything for your father?’ they almost always say yes. But if you say ‘Do you want me to limit artificial intervention and let nature take its course?’ they will also say yes.”

The fact is that a suicide is a suicide — overdetermined, sad, somewhat toxic to everyone it touches.

My mother’s ovarian cancer was diagnosed in August of 1989. During her first week in the hospital, she announced that she was going to kill herself. She was not at that time speaking of a considered agenda of terminating her own symptoms — she had scarcely any symptoms — but rather was expressing a sense of outrage at the indignity of what lay ahead and a profound fear of losing control of her own life. She then spoke of suicide as people disappointed in love may speak of it — as a swift and easy alternative to the painful, slow process of recovery. It was as though she wanted vengeance for the snub she had received from nature: if her life could not be as exquisite as it had been, she would have no more of it.

The subject lay low as she went through an excruciating, humiliating bout of chemotherapy. When, ten months later, she went in for exploratory surgery to assess the results, the regimen proved to have been less effective than we’d hoped, and a second round was prescribed. After the surgery, my mother lingered for a long time in a state of resistance to consciousness. When she finally began to speak again, a flood of anger came out of her, and this time when she said she was going to kill herself it was a threat. Our protests were thrown back in our faces. “I’m already dead,” she said as she lay in her hospital bed. “What’s here for you to love?” Or else, “If you loved me, you’d help me out of this misery.” Whatever meagre faith she had had in chemotherapy was gone, and she laid down as a condition of her accepting further punishing treatments that someone get her “those pills,” so that she could stop whenever she was ready.

It is striking to me in retrospect that we never talked about her jumping off the Empire State Building or putting her head in a gas oven, both options that she could have explored on her own. There’s no shortage of trains in front of which to throw yourself if you’re a Russian literature fan. In general, terminally ill patients want to die a nonviolent death, and people who arrive at a rational decision to kill themselves do not want to do it alone. The convention now is that such nonviolent death should be brought about by barbiturate sleeping pills, though it is likely that the easiest and best method would be lethal injection. The problem with lethal injections is that they cannot be administered euphemistically: the doctor who prescribes sleeping pills pretends that they are for sleep, and the patient requesting them tends to allow him this formality. A lethal injection is a lethal injection, and no one can pretend that you wanted it for any purpose other than death.

The problem with barbiturates, though, is that they don’t always work. A classic Hemlock Society death has involved giving someone an overdose of barbiturates, and then, when he is asleep, covering his head with a plastic bag and securing the bag with rubber bands to make sure that he suffocates. People who do not have access to barbiturates may get full instructions on self-deliverance by means of over-the-counter medications combined with a plastic bag, from a manual recently published by ERGO! (the Euthanasia Research & Guidance Organization). Featuring photo illustrations that are vaguely reminiscent of the safety cards on airplanes, it explains everything in meticulous detail. Step 11, for example, reads: “Place the plastic bag (or bags) over the head and draw the elastic bands over the bag, securing it firmly at around the adam’s apple area. There must be no leaks.”

In general, terminally ill patients want to die a nonviolent death, and people who arrive at a rational decision to kill themselves do not want to do it alone.

In the past few years, I have heard from dozens of people that there is no need to change laws, since “this kind of things goes on now anyway.” It goes on anyway, and it frequently goes wrong. Speaking to those who had assisted in suicides — I have talked to several hundred such people throughout the United States — I heard of suicides that were as grueling as the diseases they were meant to terminate. In some cases, irreplaceable pills were regurgitated. “My husband had to just eat his vomit,” one woman said. “He was that determined. But then he threw up again. We waited about an hour; then he downed it all again and I put a plastic bag over his head so he would suffocate before he got sick, and he finally died. He’d been through so much, and that whole disgusting, humiliating business was the living end.” In The Myth of Sisyphus, Camus writes, “The body’s judgment is as good as the mind’s and the body shrinks from annihilation.” Even at the end of a terminal illness, the body shows an alarming imperviousness to its own anguish. It is the mind that must insist when enough is enough.

Without AIDS, we would not have seen the radical transformations of the last ten years. Many who are suffering from that disease have helped others through it and are therefore unusually well informed about its progress. H.I.V. testing allows people to arrive at end-of-life decisions before the onset of disease. Because AIDS appears always to be terminal, you can avail yourself only of whatever happiness can coexist with treatment; because AIDS tends to create its own community as much as it cuts people off from other communities, P.W.A.s may find approbation for the decision to end life where sufferers from other diseases find resistance. The persistent questioning of authority by AIDS activists and their skepticism toward “standard medical practice” have resulted in a throwing off of that medical snobbery which insists on life at any cost.

Assisted suicide at the end of AIDS, however, can be particularly difficult, because many P.W.A.s, weakened though their bodies may seem, have had such high doses of barbiturate painkillers for so long that they have built up resistance. Most stories of euthanasia and AIDS involve more active intervention. Russel Ogden, a Canadian social worker and researcher, has written a book entitled Euthanasia, Assisted Suicide, and AIDS, which is full of disturbing statistics, and which includes stories of those who, having attempted suicide unsuccessfully, had to repeat their farewell speeches a second time to the same intimates. He describes an AIDS patient who had asked two friends to help him die. He took his pills, and when he was out cold his two friends secured a bag over his head, holding it with a ribbon. One of them became frantic. “I can’t deal with this,” he said. “Well, don’t quite now,” said the other. “We’re in this together.” At that point, the dying man suddenly snapped into consciousness. “Hey, guys, what’s going on?” he asked. They removed the bag and comforted him; he passed out again, the bag was put back over his head, and he suffocated. “I will never forgive myself,” said the friend who had weakened, “for leaving him with that last memory, of us arguing.”

You tend to accommodate the very, very sick. There was no answer to my mother’s rage and despair after her surgery except to say yes to whatever she demanded. I was living in London at that time, but now came to New York every second week to see her. My brother was in law school in New Haven, and he drove down often. My father neglected his office to be at home. We were all clinging to my mother, who had been the center of our close family, and we wavered between the lighter tone that had been our customary mien and a darker solemnity. Still, when my mother had relaxed into a facsimile of her usual self, the idea of her suicide, though it had gained resonance, once more receded. Her second round of chemotherapy seemed to be working, and my father had researched half a dozen more treatment options. My mother made her remarks about suicide on occasion, and we continued to tell her that it would be a long time before such measures could be relevant.

At four o’clock on a blustery September afternoon in 1990, I called home to check on some test results. We would continue with this therapy while we explored other options, my father told me, trying to sound upbeat. I had no doubt what other options my mother would be exploring. So I should not have been surprised when she told me, in October, over lunch, that the technical details had been taken care of — she now had the pills. In the early stages of her illness, my mother, stripped of disguises, had suffered as a side effect of her treatments a loss of beauty so obvious that only my father could contrive to be blind to it. She had found the physical damage of chemotherapy intensely painful — her hair was gone, her skin was allergic to any makeup, her body was emaciated, and her eyes were ringed with perpetual exhaustion. By the time of that October lunch, however, she had begun to take on a pale, illuminated, ethereal beauty, completely different in its quality from the all-American looks she had had during my childhood. The moment when she actually sought the pills was also the moment when she accepted (perhaps prematurely, perhaps not) the idea that she was dying, and this acceptance afforded her a radiance, both physical and profound, that seemed to me that day more powerful than her decay.

Everything that had been intolerable to my mother was made tolerable when she got those pills, by the sure knowledge that when life became unlivable it would stop.

I protested, as we ate, that she might still have lots of time, and she said that she had always believed in planning carefully. Euthanasia is a deadline matter, and I asked what her cutoff would be. “As long as there is even a remote chance of my getting well, I’ll go on with treatments,” she said. “When they say that they are keeping me alive but without any chance of recovery, then I’ll stop. When it’s time, we’ll all know. I won’t do anything before then. Meanwhile, I plan to enjoy whatever time there is left.”

Everything that had been intolerable to my mother was made tolerable when she got those pills, by the sure knowledge that when life became unlivable it would stop. I would have to say that the eight months that followed, though they led inexorably to her death, were the happiest months of her illness; and that in some obscure way — despite, or perhaps because of, the suffering in them — they were the happiest months of our lives. Once we had all settled the future, we could live fully in the present, something that we had never really done before. Euthanasia offers a remarkable liberation, for the imminence of death, once it is fully acknowledged, can be the basis for a stripped and pure honesty that is not possible under ordinary circumstances. I should emphasize that the vomiting, the malaise, the hair loss, and the adhesions were all relentless; that my mother’s mouth was one great sore that seemed never to heal; that she had to save up strength for days to have one afternoon out; that she could eat almost nothing, was a mess of allergies, and shook so badly that she was often unable to use a fork and knife — yet the excruciating business of the continuing chemotherapy seemed suddenly unimportant, because these symptoms were permanent only until she decided she could take no more, and so the disease was no longer in control of her. In A Short History of Decay E.M. Cioran writes, “What greater wealth than the suicide each of us bears within himself?”

Many ill people seek out barbiturate prescriptions but never use them. Quill writes of a man with H.I.V. who insisted on keeping a cache of pills in a blue sock under his pillow. He refused to go on any hospital visit without them, but lived through the most painful and degrading AIDS-related infections without taking them, and ultimately died from the disease. “Knowing that you could get dependable, legal aid-in-dying,” Quill says, “might allow people to defer the decision longer, resulting in more life.”

In the first century, Seneca wrote, “I will not raise my hand against myself on account of pain, for so to die is to be conquered. But I know that if I must suffer without hope of relief, I will depart, not through fear of the pain itself, but because it prevents all for which I would live.” Renaissance thinkers spoke of death as settling the meaning of life, and the fifteenth-century religious treatise “Ars Moriendi” does not speak of suicide, neither does it fetishize life as today’s Catholic Church and the American Medical Association have: it does not call for heroic measures, or life support, or desperate battle to the last breath. In the centuries since the Renaissance, the theme of suicide’s appeal has surfaced regularly, preoccupying Schopenhauer, and dominating the work of Sartre and Camus, for both of whom the absurdity of life was not quite sufficient reason for terminating it. Their arguments are central to the alienated modernist’s willingness to live, and take the place of the religious arguments that had previously defined a value for human life.

In our secular era, we still cling to the idea of brave self-sacrifice, and build monuments to those who have died for their country. Seppuku is an act of nobility to many Japanese; suicide terrorism can win you a place in Heaven if you are Muslim. But what if the good cause is neither God nor country but simply the love of the people around you, whose helplessness in the face of your pain makes that pain unbearable? And what if you simply abhor pain?

Proponents of euthanasia began organizing here after the First World War. The Euthanasia Society of America was founded in 1938, and within a year it had drafted a proposal to legalize “the termination of human life by painless means for the purpose of avoiding unnecessary suffering.” Though the cause stalled immediately after the Second World War — the word “euthanasia” having been too closely associated with Nazi Germany — it picked up momentum again during the revolutions of the sixties. In 1967, the Euthanasia Society started a tax-exempt Euthanasia Education Fund, and also opened discussion of the “living will,” in which a person may record his wish not to receive treatment for late stages of illness.

The first legislative and judicial moves toward liberalization involved comatose patients. In 1976, the New Jersey Supreme Court gave permission for Karen Ann Quinlan‘s parents to disconnect the respirator to which her doctors had connected her after a mixture of alcohol and tranquilizers had put her into a coma. Also in 1976, the California Natural Death Act passed, giving living wills legal standing. In the mid-seventies, the Euthanasia Society changed its name; it is now called Choice in Dying. The founding of the Hemlock Society, in 1980, by Derek Humphry, with Ann Humphry, Richard Scott, and Gerald LaRue, marked the beginning of a more vigorous engagement. The cause is now supported by Hemlock, Choice in Dying, ERGO!, Americans for Death with Dignity, Compassion in Dying, the World Federation of Right to Die Societies, and others. Hemlock has become the center of public debate, in large part because of Final Exit, which, in Humphry’s own words, “legitimized everything by making money.” John Pridonoff, who is now the executive director of Hemlock, has said, “The terminally ill buy it for information, and they get peace of mind.” (Humphry left Hemlock in 1992 and subsequently set up ERGO!; the two societies have a cordial relationship.) Pridonoff is gentle and soft-spoken, a Congregational minister and a moderate. “We take a conservative approach, supporting carefully constructed laws that allow physician-assisted death only under clearly specific conditions,” he said. “That’s more fruitful than insisting on an extreme position.” The society publishes an impressive bimonthly newsletter, TimeLines, which keeps members up to date on legal progress, emerging medical information, and changing philosophies of death.

There are essentially six degrees of euthanasia under discussion in the United States. The most basic is discontinuing artificial life-support systems (ventilators, shunts, etc.) for a patient in an irreversible coma who cannot live without such intervention. The second is discontinuing feeding or hydration for a comatose patient who does not require any other artificial support. The third is withholding (at the patient’s request) treatment that can extend the life of but not cure a severely or terminally ill patient. The fourth is providing pain relief to someone in great pain knowing that the pain medication may hasten that patient’s death (the double effect). The fifth is giving a patient access to means that the patient may use to kill himself in order to escape from severe or terminal illness. The sixth is administering a lethal injection (at the patient’s request) to a patient who is severely or terminally ill. Involuntary euthanasia, which occurs when someone takes it upon himself to “put out of his pain” a patient without that patient’s explicit knowledge or consent, is outside the dominant American dialogue.

Like most other social causes, euthanasia has a broad base of support and a small core of militants. The militants of the euthanasia movement are, by and large, female, white, college-educated, and in late middle age.

The movement’s primary enemy is the leadership of the Roman Catholic Church, which has poured millions of dollars into anti-euthanasia work. Unitarians and the United Church of Christ are at the forefront of religious support for euthanasia. The new Presbyterian Book of Common Worship includes a set of prayers to be said when a life-support system is withdrawn: they begin “God of compassion and love, you have breathed into us the breath of life and have given us the exercise of our minds and wills.” H. Scott Matheney, the Presbyterian and United Church of Christ chaplain of Columbia University, maintains that there are, implicitly, prayers for other kinds of assisted death. “Judaism, which has served as the ethical basis for Western civilization, views assisted suicide as murder,” Rabbi Moshe S. Gorelick, as president of the Rabbinical Council of America, has said, but he also concedes that “to prolong life is a mitzvah, to prolong dying is not.”

The Hemlock Society had the first National Conference on Voluntary Euthanasia in 1983, in a Unitarian church in San Francisco. I went to the eighth national conference, which took place last October at the Holiday Inn Crowne Plaza in Kansas City. Like most other social causes, euthanasia has a broad base of support and a small core of militants. The militants of the euthanasia movement are, by and large, female, white, college-educated, and in late middle age. Most of them are Protestant. Some have assisted someone to die; some have been closely involved with someone who suffered horribly and who they now believe should have had an assisted death; some are approaching illness and want to control their own deaths. The Hemlock Society is partly a support group and partly an information service and partly a social club. “It’s still an upper-middle-class concern,” Quill says, “because Americans who are worried about getting any care aren’t distracting themselves with this.” And yet it is for people without much privilege that legislative change is most urgent; whereas rich people with private doctors and good connections can almost always find the means to kill themselves quietly at home, most others are subject to the philosophies of random overworked physicians.

Looking around at these women in their drab smocks sitting in endless rows in the grand ballroom of the Holiday Inn, I was struck by their unostentatious courage. “No one in this room is afraid of death,” John Pridonoff told me. Carol Presley, the most recent Hemlock chapter leader from Boulder, Colorado, said, “We live in a more tolerant way than the rest of society. Most of the people here are witty, curious, intellectual, rational, and open-minded.” At its most extreme, I found, that openness could be rather disconcerting. “I’ve always liked dying people,” Vicki Bauch, a certified hospice nurse, told me warmly. “It’s like birthing. There’s an emotional intensity and connectedness that you don’t find anywhere else.”

Barbara Coombs Lee, a board member of Oregon Right to Die, was Saturday’s luncheon speaker. Oregon’s Measure 16, which was to be on the state’s ballot in November, is one of several that have been proposed in various states over the last five years; previous initiatives, in California and Washington, were defeated by narrow margins. Measure 16 is a “prescription bill,” which would allow doctors to prescribe pills that they know would be used for a suicide by a terminally ill person; it would also allow doctors to be with patients when they take the pills. But the bill does not allow for lethal injections, which are safer and more effective.

Lee cautioned the audience against speaking too much or too readily to the press. “If the reporter gets frustrated, you’ve won,” she said. “If we reason with them, if we use the kind of well-articulated, carefully reasoned arguments that we’ve heard today, we’ll lose. If we allow the issues to become complicated, we’ll lose. Our job has been to condense arguments and to find every conceivable way to present your arguments in a persuasive way.” She was speaking fluidly and with passion. “For the next two weeks, suspend your own natural intellectual honesty.” That was perhaps the saddest thing I heard while I was working on this article, because it fully acknowledged that there cannot yet be a bridge between the legal issues and the emotional ones — that the ideal to which everyone in that room aspired is still unavailable.

The euthanasia subculture is jagged with pain.

As we finished our lunch, there was a sudden cry from a table in the middle of the dining room, and an old woman fell off her chair and lay prostrate on the floor. The entire roomful of people — euthanasiasts, for whom death held no fear — began running like the bulls in Pamplona. Three men kneeling beside the woman yelled “Give us air! Get back!” A battery of doctors rushed over and shouted contradictory advice. Waiters with trays of uneaten chicken stared in horror. “But did she want to die?” a man next to me kept asking. “Did she want to die now?” And someone who appeared to be his wife said, “Well, at least she’s got it over with.” She sounded jealous. At that point, the prostrate woman sat up partway. She had simply passed out. The crowd was herded through to the next room for the afternoon’s programs, and everyone settled down to eating the hard candies that had been put in little bowls along the conference tables while Adrienne Burnell, Ph.D., R.N., spoke on “The Nurse’s Role in Patients’ End-of-Life Decisions.”

Since my mother’s death, there has been a certain tendency toward denial in my family. My father doesn’t care for sad movies or plays anymore, and in trying to look away from his own loss he tends to overlook a certain sadness in my brother and me, as though he has forgotten that grief unites us. Unlike the uniting sorrow of other deaths, this one has in it the weird legacy of our once secret history. With time, I have come to understand that being active in euthanasia circles is both a means of working through agonizing feelings and a means of holding on to them. “After my father died, I became an activist,” Stephanie Thomas, a vibrant woman in her fifties, told me at the Kansas City conference. “Now I’m on the national board of Hemlock, and I’m the founding president of the local chapter in Bloomington, Indiana.” As she talked about her life, I realized that her father’s death had become the one defining factor in it. The euthanasia subculture is jagged with pain.

Striking absent from the Kansas City conference was Jack Kevorkian. Though he is to outsiders the highest-profile figure in the right-to-die movement, his behavior is so erratic and his personality so bizarre that most other members of the movement go to considerable lengths to distance themselves from him. “He speaks to the American need for a quick fix,” Quill says. Kevorkian has helped twenty-two people to die since June 4, 1990, when he hooked up his suicide machine, the Mercitron, to Janet Adkins, then fifty-four, who had known for a year that she had Alzheimer’s disease. Unlike most advocates of aid-in-dying, Kevorkian flouts the law like a showman. But many people are moved by his refusal to speak in euphemisms, and some activists hail him as a necessary precursor to their less flamboyant activities. “We needed a Kevorkian to get here,” Susan Dunshee, the president of the board of Compassion in Dying, said. This group, working in the state of Washington, actually assists in the suicide process: its members will recommend dosages, come to your house, help you deal with the death certificate, and so on. Compassion in Dying helped to generate the suit that led Judge Barbara Rothstein, in May, 1994, to find Washington’s ban on assisted suicide unconstitutional in cases of terminal illness (her ruling was then overturned, and the case may very well go, eventually, to the Supreme Court).

The Washington case was a necessary precursor of Oregon’s Measure 16. On Election Day, I went to Eugene where the Hemlock Society leadership would have to pronounce on the larger implications of the bill. We all met up at Hemlock headquarters — a white clapboard building downtown — and then headed for the Lane County Fairgrounds to watch the results. The Hemlock table had a big sign that said “Death with Dignity,” and I felt a bit peculiar as I sat there next to “We Support a New Library,” “Democrat Sorenson — Senator for District 20,” and “Kathy Sniezko is Not for Sale.” Most of the tables had bunches of balloons, and many had big bowls of popcorn, but John Pridonoff thought that this kind of display would not be in good taste for the Hemlock table. We waited anxiously; the measure consistently appeared to be leading, but by only a slight margin.

The next morning, the air at Hemlock was stale with anticlimax. That feeling has clung: by the time every vote had been counted (on the Friday) and the measure had been accepted by a fifty-one-per-cent majority, the sense of occasion was sapped. And the victory was fleeting. On November 23rd, James Bopp, Jr., attorney for National Right to Life, requested, and won, a temporary restraining order on Measure 16, pending a hearing, which took place last month; a decision is expected soon.

A few days after my mother told me that she had the pills, I had lunch with my grieving father. We talked through the logistics. My mother, in a euphemistic discussion with one of her many doctors, had complained of insomnia. The doctor suggested Halcion. My mother said she had taken Halcion. They had once talked in the abstract about euthanasia; it was not mentioned now, but it seems likely that the doctor knew why only Seconal would do. He wrote a standard prescription for twenty pills. Two months later, he would write another. Meanwhile, there was also discussion with a psychoanalyst my parents knew, whom I shall call Moses Grey. They had previously discussed the matter of euthanasia, and Dr. Grey had provided great emotional support. Now he obligingly prescribed Seconal in response to complaints of sleeplessness. The bottles took up residence in the back of my mother’s medicine chest. In yet another euphemistic conversation, my mother asked a doctor how he would feel about signing a death certificate for someone who “died peacefully at home after a long illness,” and he said, perhaps understanding her meaning, perhaps not, that he had done that before and would be willing to do it again. If a death certificate says suicide, or if an unprepared doctor suspects suicide, there is usually a police autopsy and anyone who was nearby when the suicide took place may be subject to questioning.

We planned it together, much as we had on previous occasions planned parties, family vacations, Christmas.

My parents had bought a book from the Hemlock Society, Let Me Die Before I Wake, which was a less explicit precursor of the volume Final Exit, and was written in a cautious vocabulary of ostensible fictions: “Alan and Ruth were planning a cruise of the Caribbean in a chartered yacht in April, but when Alan noticed traces of blood in his semen he went for a check-up with a urologist,” one story went; it ended, “Dr. Browning gave Alan nearly two dozen injections each of a quarter of a grain of morphine solution.” From this book my mother had worked out details, and my father, who is also given to careful planning, went over the whole thing with me, as though a dress rehearsal would exhaust in advance some of the pain of the event itself. We talked about how my brother and I would come to the house, how my mother would take the antiemetics, and what time of day would be best for this exercise; we agreed to hold the funeral two days after the death. We planned it together, much as we had on previous occasions planned parties, family vacations, Christmas.

My mother talked in that period about how much she loved us all, and unearthed the shape and structure of that love: she contrived in the course of a few months to resolve old family differences. She set aside a day with each of her friends — and she had many friends — to say goodbye; though very few of them knew her agenda, she made sure that each understood the large place he or she occupied in her affections. She recruited me one afternoon to help her buy my ninety-year-old great-aunt a handbag, and though the expedition left her exhausted to the point of collapse for three days, it also renewed us both. She set about having all our furniture reupholstered, so that she would leave the house in reasonable shape, and she selected a design for her tombstone. Perhaps you can talk about euthanasia in public after the fact, but you certainly cannot talk about it in advance, and so we fell into a sort of conspiracy that made us feel like a group of fifties Communists. In the context of my rather conservative and highly reputable family, this was a profoundly strange sensation: we were liberated by our newly clear emotions, but entombed in our collusion. No longer fully honest with friends, we became even sadder and more isolated and more dependent on one another than we had been.

I went this year to see Dr. Grey, and found him careful to distance himself from the technicalities. “I wrote a prescription for sleeping pills for someone who couldn’t sleep,” he said. But when I asked how he had arrived at the decision that he would support my family’s plan he said, “She was in the late stages of an illness that was clearly terminal. She had voiced from the start her intention not to suffer. She had made it clear that she wanted to die with dignity, and that wish seemed to accord with the rest of her character.” He paused. “I did it because it was clear to me, neurosis and complexity aside, that everybody loved everybody in your family.” I was surprised and moved to discover that he had helped my mother for the same reason I had.

He also told me the story of a New York lawyer whose life had been dominated by his father. As the father grew weaker, his only interest was control over his son. The father decided that he wanted to kill himself; he was eighty-five and had a terminal condition. The son helped to make the arrangements but begged not to witness the death itself. The father insisted. “It was a final act of sadism, not out of keeping with the relationship they had always had,” Dr. Grey said. “The father had made an authentic end-of-life decision, but he set up the details to punish his son. It was the opposite of your situation. Doctors and others rationalize their own need for control: you can kill someone out of cruelty or keep him alive out of cruelty.”

It was important that in my mother’s last months on earth we all feel connected, that none of us be left with a sense of secrets kept and intentions hidden.

After my lunch with my father and my lunch with my mother, we didn’t discuss suicide very much. But, though we all wanted to believe in Chemotherapy No. 3 and Chemotherapy No. 4, we also understood that we were really playing for time. Bit by bit, the fact that my mother’s suicide plans would become reality seemed to settle on us. Later, she said that she had considered doing the whole thing on her own but had thought that the shock would be worse than the memories of having been with her for this experience. As for us, we wanted to be there. My mother’s life was in other people, and we all hated the idea of her dying alone. It was important that in my mother’s last months on earth we all feel connected, that none of us be left with a sense of secrets kept and intentions hidden.

This curious tenderness of conspiracy, always particular in its details is one that I have since heard described over and over again by people who have assisted in suicides. A woman from Missouri told me that her husband had been a reformed alcoholic who swore off the bottle the day he married her. “Forty years we were together every day, and he never touched a drop,” she said. “And on his last day it said to take the pills with some alcohol. I went out and found the best bottle of wine I could buy for the occasion. He took a whole lot of it with the pills, and we drank those last two glasses together,” she said. “It was the first drink we had ever had together, and a good one.”

A registered nurse from Arkansas told me she had joined the Hemlock Society years ago. When her mother got sick, “we both knew how we felt on this subject. I knew my mom was getting pain medication that was strong enough for the end. When the day came, I put sublingual morphine under her tongue. A lot of it. After that, my mother closed her eyes for the last time, and I put my stethoscope to her heart and sat there straight through until she died. She’d heard my first heartbeat, and I wanted to hear her last. I waited more than an hour with that stethoscope, but I heard her last breath and her last heartbeat. I remember to this day how they sounded.” She smiled suddenly. “I know some people have trouble with my saying this,” she said, “but it was the most intimate time I’ve ever had with anyone. It was the most intimate thing I’ve ever done.”

If you have never tried it or helped someone else through it, you cannot begin to imagine how difficult it is to kill yourself. If death were a passive thing, which occurred to those who couldn’t be bothered to resist it, and if life were an active thing, which continued only by virtue of a daily commitment to it, then the world’s problem would be depopulation, and not overpopulation. Having been through the whole business, I would put the infrequency of suicide down more to the difficulty of it than the undesirability of its objective. The date my mother chose for killing herself was June 19, 1991, because if she had waited longer she would have been too weak to take her own life, and suicide requires strength and a kind of privacy that does not exist in hospitals. That afternoon, my mother had been to see a gastroenterologist, who told her that large tumors were blocking her intestine. Without immediate surgery, she would be unable to digest food. She said that she would be in touch to schedule the surgery, then rejoined my father in the waiting room. When they got home, she called my brother and me. “It was bad news,” she said. I knew what she meant, but I couldn’t quite bring myself to say it. “You’d better come up here,” she said. It was all very much as we had planned it.

I headed uptown, stopping to collect my brother from his office on the way. It was pouring out, and the traffic was very slow. My mother’s absolutely calm voice — she used as logical a tone as if we were coming uptown for dinner — had somehow made the whole thing seem very straightforward, and when we arrived at the apartment we found her lucid and relaxed, wearing a nightgown with pink roses on it and a long bathrobe. “Couldn’t you wait a little longer?” my brother asked, but my mother said that once her digestive system got blocked she might be unable to take pills. “I’d thought,” she said apologetically, “that I could make it through your birthday” — which was three weeks off — “and do this immediately afterward. But it’s really going to have to be now.” It was too late to argue the logic of suicide; we had all agreed that it was a good logic. “So,” my mother said, “if we’ve settled that, then we might as well get started.”

Suicide requires strength and a kind of privacy that does not exist in hospitals.

I will say only that it might have been illegal for my brother to get her the glass of water she used to take the pills. It might have been illegal for my father to get the pills out of the medicine chest. I would have been within the law in focusing instead on getting her an extra blanket, because she was cold. The euphemistic vocabulary of “Let Me Die Before I Wake” had never seemed more obnoxious: “After a long and thoughtful discussion, the two daughters agreed that it was only right to find some way to help their mother to die. She was, after all, gravely ill. Stella decided to use her status as a nurse to try to get a barbiturate from Mrs. Mercer’s physician.”

My father had pretty much memorized the book, but still we consulted it. “It says here that you have to take the antiemetics first,” he said. His voice was broken, but my mother’s was even. “I’ve been thinking about this for so long that it’s a relief to finally be doing it,” she said. “the only thing I still fear is this not going smoothly.” She finished taking the antiemetics and put down her glass. “What next?” she asked. My father consulted the book again. “You’re supposed to try to have a light snack,” he said. “It helps to keep the pills down.” So we all went into the kitchen, and my mother toasted some English muffins and made tea. At dinner a few nights earlier, my mother and my brother had pulled a wishbone, and my mother had won. “What did you wish?” my brother asked her now, and she smiled. “I wished for this to be over as quickly and as painlessly as possible,” she said. “And I got my wish.” She looked down at her English muffin. “I got my wishes so often,” she remarked. My brother put out a box of cookies just then, and my mother, in the tone of fond irony that was so much her own, said, “David. For the last time. Would you put the cookies on a plate?” I think that there is a certain natural drama to death from natural causes: there are sudden symptoms and seizures or, in their absence, the shock of surprises — of interruption. What was so curious about this experience was that there was nothing sudden or unanticipated about it. the drama lay in the very absence of drama, in the choking experience of no one’s acting out of character in any regard.

Back in her bedroom, my mother apologized again for involving us all. “But at least you three should be together afterward,” she added. Although “Let Me Die Before I Wake” suggested a minimum of fifteen Seconal, it recommended forty to be safe. My mother — who always believed in inventory — actually had twice as much Seconal as she needed. She sat up in bed and dumped forty pills on the blanket in front of her. “I’m so tired of taking pills,” she said wryly. “That’s one thing I won’t miss.” And she began taking them with an expert’s finesse, as though the thousands of pills she had had to take during two years of cancer had been practice for this moment. I hadn’t seen a Seconal since then, but recently I looked at one long and hard, and it was amazing to me how evocative that Day-Glo orange oblong was. I remembered that pile of pills on the blanket, and how my mother scooped them up, virtuoso, swallowing two or three at a time. “I think that should do it,” she said when the heap had vanished. She tried to down a glass of vodka, but said it was making her nauseated. “Sure this is better than your seeing me screaming in a hospital bed?” And, of course, it was better, except that that image was still only fantasy and this one had become reality, and reality in these instances is worse than anything.

Then we had about forty-five minutes, during which she said all the last things she had to say, and we said all the last things we had to say. Bit by bit, her voice slurred, and it was then that the drama of her death came, because as she became hazier she became also even clearer, and it seemed to me that the fact that she had long known what she wanted to say did not take away any of her words’ immediacy, and that she was saying still more than she could have planned. “You were the most beloved children,” she said, looking at us. “Until you were born, I had no idea that I could feel anything like what I felt then. Suddenly, there you were. I had read books all my life about mothers who bravely said that they would die for their children, and that was just how I felt. I would have died for you. I hated for you to be unhappy. I wanted to wrap you in my love, to protect you from all the terrible things in the world. I wanted my love to make the world a happy and joyful and safe place for you.” She held my hand for a second, then my brother’s. “I want you to feel that that love is always there, that it will go on wrapping you up even after I am gone. My greatest hope is that the love I’ve given you will stay with you for your whole life.”

Her voice was steady at that point, as though time were not against her. She turned to my father. “I would gladly have given decades of my life to be the one who went first,” she said. “I can’t imagine what I would have done if you had died before me, Howard. You are my life. For thirty years, you have been my life.” She looked at me — I was crying, though she was not — and her voice took on a tone of gentle reprimand. “Don’t think you’re paying me some kind of great tribute if you let my death become the great event of your life,” she said to me. “The best tribute you can pay to me as a mother is to go on and have a good and fulfilling life. Enjoy what you have.”

In his “Requiem,” Rilke wrote, “We need, in love, to practice only this: / letting each other go. For holding on / comes easily; we do not need to learn it.”

Then her voice became dreamily torpid. “I’m sad today. I’m sad to be going,” she said. “But even with this death, I wouldn’t want to change my life for any other life in the world. I have loved completely, and I have been completely loved, and I’ve had such a good time.” She closed her eyes for what we thought was the last time, and then opened them again and looked at each of us in turn, her eyes settling on my father. “I’ve looked for so many things in this life,” she said, her voice as slow as a record played at the wrong speed. “So many things. And all the time Paradise was in this room with the three of you.” My brother had been rubbing her shoulders. “Thanks for the backrub, David,” she said, and then she closed her eyes for good. “Carolyn!” my father said, but she didn’t move again. I have seen one other death — someone shot by a gun — and I remember feeling that the death did not belong to the person who died: it belonged to the gun and the moment. This death was my mother’s own.

If you plan to try this at home, you should be aware that it can take a long time to die from an overdose of Seconal. It took my mother almost five hours to stop breathing. “Let Me Die Before I Wake” says that if the Seconal doesn’t work you can smother the suicide victim. Waiting in the kitchen, my father and my brother and I had to discuss this possibility. I had begun to hate the air of secrecy, and wanted to call my mother’s friends, or my friends, but my father said we had to wait until she was really dead. Every half hour, one of us would check to see how she was doing. Her breathing sometime seemed slower, but it was hard to tell.

In his “Requiem,” Rilke wrote, “We need, in love, to practice only this: / letting each other go. For holding on / comes easily; we do not need to learn it.” The discipline of not doing is usually more difficult than the discipline of doing, and, of all the not doing I have confronted, the most painful was the not waking my mother as she slid by slow degrees from sleep to death. To speak to her seemed absurd and theatrical to me; I have never spoken aloud to a sleeping lover or to a child who has dozed on my shoulders, and I felt that it would be affected and sanctimonious to go blathering on to my mother once she had said goodbye. In that room with her, I maintained a kind of empty silence, and wondered what stage of dying she had reached — whether she had passed the point at which she could be fully revived. She had said that what she was most afraid of was waking up, and I didn’t know whether I was most afraid of her waking or of her dying or of this uncanny, flat time of neither one.

Just after midnight, my brother, the most restrained and most reasonable of us, went to check and found that the breathing had stopped. An hour or so later, the doctor signed a death certificate saying she had died of ovarian cancer. Immediately after he left, we called the funeral home my mother had selected, and its staff came and collected her body. We were among the lucky ones: we did not have to resort to plastic bags, or to watch my mother vomit over herself. It was that ideal death which plays out in Hemlock Society publications: the gentle, easeful death.

The aftermaths of assisted deaths are always strange and particular. Stephanie Thomas, from Bloomington, said, “It is a relationship that is not natural, from which there is no recovery — you scar forever.” I met an environmentalist who had grown up in an Ohio military family, and whose grandfather had taught him to hunt. “The first time I ever killed was with him,” he told me. Afflicted with lung cancer, the grandfather called his family into his hospital room. “If I go under,” he said, “do what you have to, but I don’t want to come back up again.” When the old man slipped into unconsciousness the following night, the environmentalist’s father left his son to pull the plug. “It was just my grandfather and me in the room. I locked the door, blocked it, then unplugged the respirator and shut off his I.V.s. I talked to him about hunting and golf. At some point, the dip in his vital signs must have set off an alarm, and there was knocking on the door, but I didn’t respond. I felt a real moment, a little later, when I thought he was really dead and knew he couldn’t hear me anymore. I stopped talking.” He paused. “The problems came afterward,” he said. “I’ve never felt guilty or sorry about what I did for my grandfather. But it was kind of the end of my relationship with my dad. We’d never been very close anyway, but after he refused to pull that plug — well, I got to know myself and my grandfather and my father pretty well that day. I couldn’t really love my father after that.”

But if euthanasia has its aftermath so does the choice not to help someone to die, especially if that choice runs counter to your own deep philosophy. “Often, hearing of sick people undergoing a long martyrdom, I had felt indignant at the apathy of their relatives,” Simone de Beauvoir writes in a description of her mother’s final illness. “‘For my part, I should kill him.’ At the first trial I had given in: beaten by the ethics of society, I had abjured my own. … One is caught up in the wheels and dragged along, powerless in the face of specialists’ diagnoses, their forecasts, their decisions…. I was forced to yield…. A race had begun between death and torture. I asked myself how one manages to go on living when someone you love has called out to you ‘Have pity on me’ in vain.”

By now, most of my mother’s friends know that she killed herself, and I think they will have gathered that the rest of us were there. It is a measure of the general discomfort that the matter is almost never mentioned. No one’s gentle amateur psychologizing has taken note of the Freudian or Sophoclean underpinnings here. Almost no one has asked me how we made the practical arrangements. Nor has anyone asked whether I wanted to be involved in the whole thing. I should emphasize that this is not discomfort with the larger subject of death; I have of late been drawn into as many conversations about cancer as any member of New York Hospital’s oncology unit. Euthanasia, which many people I know support, is in its details a subject nearly as taboo as incest. If you do it, no one really wants to hear about it; people don’t even know how to ask about it. “I call people who have helped others to die ‘the silent shunned,'” John Pridonoff said.

Ronald Dworkin’s brilliant study Life’s Dominion goes some way to explain this social discomfort. “Every creature has an urge to live — it’s Darwinian,” he told me. Dworkin sees the constant battle as taking place between activists who believe that the right to choose abortion or to control your own death is evidence of their belief in an intrinsic or sacred value to life, and those who think that such activists are demonstrating a callow disregard for the intrinsic or sacred value of life. Dworkin places great weight on how life and death connect. He suggests that intrinsic value is best served by a dignified end, because the end is the defining moment that gives meaning to the life. “Death has dominion,” he writes, “because it is not only the start of nothing but the end of everything, and how we think and talk about dying — the emphasis we put on dying with ‘dignity’ — shows how important it is that life ends appropriately, that death keeps faith with the way we want to have lived.” In his scheme of things, the finale is what makes sense of the symphony; get it wrong, and all the meaning of the earlier movements is fragmented, broken, lost.

Euthanasia, which many people I know support, is in its details a subject nearly as taboo as incest. If you do it, no one really wants to hear about it; people don’t even know how to ask about it.

Dworkin is among many who draw parallels between euthanasia and abortion. “Euthanasia is the abortion debate of the next century,” Lee LaTour, Hemlock’s director of public relations, says. The legal issues are closely aligned: back-alley euthanasia appears to be almost as common as back-alley abortion used to be, and the emotional territory of the two subjects overlaps. Once, I impregnated a sexual partner; we agreed that she would terminate the pregnancy. There was no question, either in my mind or in hers, about whether an abortion was the appropriate way to proceed, but the experience was more painful for each of us than I had expected. It has some of the same overtones as my euthanasia experience with my mother, leaving a dangling “what if” in my orbit, a nostalgic recognition that life — mine and others’ — could have been different. Having been through both experiences, I am more strongly than ever pro-choice and in favor of the right to die, but I regret both the lost mother and the lost child. The legal difficulties surrounding euthanasia, however, are thrown into relief here: if the abortion had been cloaked in secrecy, it would have been nearly intolerable.

Doctors readily concede that they are deliberately helping their patients to die when they write prescriptions for lethal doses of Seconal, but then they ask not to be quoted by name. The subject is addressed openly at conferences, in books, and in articles such as this one; but precisely what you can acknowledge or do is always unclear. It is an American habit to turn complex moral problems into technical legal ones. The case against Quill was not dropped for humane reasons, and more alarming still is the case of William F. Meyer III, who told a journalist from Connecticut Magazine how he had helped in the death of his father, an advocate of assisted suicide who had advanced colon cancer. After the story was published, last August, the State’s Attorney brought charges of second-degree manslaughter, and the case dragged on through mid-December, when Meyer was given two years of special probation but no prison sentence for his crime. The State’s Attorney said at the trial, “Whether he did the right thing or the moral thing is going to be decided by a power higher than myself or Your Honor. What I can say in this case is there was a violation of the law.” The moral implications of the case were sidestepped. “Doesn’t exactly make you want to come out of the closet,” said Virginia McLeod, an elderly Hemlock member.

One of the objections to euthanasia often brought forth is the optimistic credo of the imminent cure. What if you let people kill themselves in the early stages of AIDS when a cure might in fact be around the corner? There is a general assumption, born in this century, that disease is curable, and that those diseases which cannot be cured are treatable, and that treating diseases is as logical as eating when you are hungry. It was striking to hear over and over again, in the ACT UP demonstrations of the late nineteen-eighties, declarations that if only the White House would release the funds AIDS could be conquered. This creed is foolish and naïve: until the discoveries of the microbe hunters, everyone accepted the idea that lots of diseases were incurable — that people got them and died, and all you could do was watch and be sad. The arguments against euthanasia are inextricably bound up with our sense that if only you treat disease appropriately it will go away, or at least be mitigated. Euthanasia acknowledges not only the physical weakness of the individual but also the weakness of humanity in the face of disease, and that second admission is anathema to most of us. The doctors who resist euthanasia are in many instances people who entered medicine to conquer their own fear of disease or death: to them anything short of the most aggressive intervention seems like a betrayal.

There is no question that if euthanasia is legalized it will be abused. Some people will kill themselves because of family pressure to do so. Some will kill themselves in depression. Some will kill themselves too soon, and lose precious time on earth. The question is whether these abuses represent a greater crime against life than does keeping alive people who want to die. Is denying the chance to express love through their own deaths better than denying people the chance to express hatred through the same medium?

To assist in a suicide is to lose a fragile virginity; and the experience is the more enormous because it compromises an innocence of which you had never thought to take note. Euthanasia is a legitimate way to die, and at its best, it is full of dignity. But it is still suicide, and suicide is the saddest thing in the world. Insofar as you assist in it, it is still a kind of murder, and murder is not easy to live with. It will out, and not always in savory ways. I have not come across anything about euthanasia by anyone who took part in it that was not at some profound level an apologia: the act of writing or speaking about your involvement is, inevitably, a plea for absolution.

It is a striking fact that two of the four founders of the Hemlock Society committed suicide. Derek Humphry and Gerald LaRue are alive and well, but Ann Humphry and Richard Scott are dead by their own hands. Nor did they die at the end stages of terminal illness. Ann Humphry had been suffering from cancer but was not terminal at the time she killed herself, and her suicide note and her behavior around the time of her death are ample evidence that this was a full-blown suicide, born of depression, despair, and rage. Richard Scott did not even have the “excuse” of cancer. Perhaps he had spent too much time dwelling on the subject of death, or perhaps he had dwelt on the subject because he himself yearned too strongly for death. On August 6, 1992, at the age of fifty-four, in a severe depression, he shot himself in the head.

Euthanasia acknowledges not only the physical weakness of the individual but also the weakness of humanity in the face of disease, and that second admission is anathema to most of us.

When I stumbled on the stories of these two suicides — which had not been previously connected to each other — they did not surprise me. Euthanasia is a toxic subject: if you think about it too much, it will begin quietly to poison you. “All true believers in euthanasia believe in the right to suicide in general,” Derek Humphry told me. After my mother’s death, I was the one who took on the cleaning up of my parents’ apartment, sorting through my mother’s clothes, her personal papers, and so on. The bathroom was thick with the debris of terminal illness: instruments for the care of wigs; salves and lotions for allergic reactions; and bottles and bottles and bottles of pills. Back in their corner of the medicine chest, behind the vitamins, the painkillers, the drugs to calm her stomach, the ones to rebalance certain hormones, the various combinations of sleeping pills she had taken when disease and fear conspired to keep her awake — behind all of them I found, like the last gift out of Pandora’s box, the rest of the Seconal. I was busy throwing away bottle after bottle, but when I got to those pills I stopped. Fearful myself of both illness and despair, I pocketed the bottles, took them home with me, and hid them in the farthest corner of my own medicine chest. I remembered the October day my mother had said to me, “I have the pills. When the time comes, I’ll be able to do it.” In my grieving empathy, I went for an H.I.V. test, half hoping that it would be positive and I might find in the result an excuse to take them.

Ten days after I finished clearing out my mother’s bathroom, my father called in a rage. “What happened to the rest of the Seconal?” he asked, and I said that I had thrown away all my mother’s pills. I added that he seemed very depressed and that it disturbed me to think of his having ready access to the drug. “Those pills,” he said, his voice breaking, “you had no right to throw away.” Then, after a long pause, he said, “I was saving them for myself, in case someday I was ill also. So I wouldn’t have to go through that whole process to get them.” I think that for each of us it was as though my mother lived on in those orange pills, as though whoever possessed the poison by which she had died retained also some strange access to her life. It was as though by planning to take the remaining pills we were somehow becoming reattached to my mother — as though we could join her by dying as she had died. Our one comfort in the face of her loss was to plan to repeat its details on ourselves.

After my father and I spoke, I threw away those pills, to obviate the lie I had told him: each of us will have to start anew if the time comes. He and David and I have never sat down to discuss our own deaths, but I know that we all assumed (more and less consciously), from the day my mother took those pills, that we would die as she had died. If we are not hit by cars or stray bullets, if we do not suffer heart failure or fatal strokes, then, in keeping with our last inheritance from my mother, we will certainly all kill ourselves. Not one of us plans to go through the final agonies of terminal illness, and not one of us plans to live out the isolation of terrible age beyond the death of friends. We are signatories to a sealed pact of the conscious soul, a pact I entered into when I was so distracted by a more immediate grief that I hardly noticed what I was doing. That unwitting agreement governs all other conditions of my life. The terms of my own suicide are entirely clear to me; it is not something I plan to undertake anytime soon, but it would surprise me to die any other way. When the time comes, I will not have to seek farther than to obtain the pills themselves, because in my mind and my heart I am more ready for this than for the unplanned daily tribulations that mark off the mornings and afternoons. Having seen the simple logic of euthanasia in action and witnessed the comfort of that control, what astonishes me is how many people die by other means.

This is the one thing that I seem to have in common with everyone of similar experience whom I’ve met. Maybe there are people who have reacted to their involvement in euthanasia differently, but, if so, they are well-hidden, and I believe that they are few in number. Euthanasia breeds euthanasia. Now that so much has been written about the physiology of death, we can go on to the more interesting questions. How we die is, in fact, the least of it. Why we die, the question from which religion springs, we will never understand, and so we leave that matter in the capable hands of the philosophers. But when we die — this is a powerful business, and it is here that, at last, we are beginning to discover our heady dominion.