TIME: Almanac 1993/TIME Almanac 1993.iso/time/081991/0819620.000

Text File | 1992-08-28 | 6.3 KB | 128 lines

                                                                                ETHICS, Page 55

Do-It-Yourself Death Lessons


A manual on suicide becomes a best seller, sparking new debate on
whether the terminally ill have the right to die

By WILLIAM A. HENRY III -- Reported by Daniel S. Levy and Leslie
Whitaker/New York


    Most how-to books instruct readers in ways to refinish
furniture, profit from a recession, communicate with one's
in-laws or cook some exotic ethnic casserole. But one of the
hottest tomes of the moment -- it has sold out its first
printing of 41,000 copies and will top next week's best-seller
list of how-to and advice volumes in the New York Times --
explains, step by step, how to end a human life.

    The book, Final Exit, is a manual for committing suicide
or helping someone else to do so. It includes charts of lethal
dosages for 18 prescription drugs, primarily pain killers and
sleeping tablets; it debates and debunks the merits of cyanide;
it offers abundant practical advice about asphyxiation by
plastic bag or auto exhaust. Seemingly every detail is
addressed: mixing pills with yogurt or pudding so that the
patient does not vomit or pass out before ingesting a lethal
amount; not turning off the telephone or message machine,
because "any changes will only alert callers to something
unusual happening"; having family members avoid any direct
physical assistance, so they cannot be prosecuted; and, if
concealment of the cause of death is sought, telling heirs to
object to an autopsy.

    Even more jarring to critics, the book exhorts doctors and
nurses actively to abet the "self-deliverance" of the terminally
ill. Author Derek Humphry contends that such assistance is
common but tacit. "Part of good medicine is to help you out of
this life as well as help you in," he argues. "When cure is no
longer possible and the patient seeks relief through euthanasia,
the help of physicians is most appropriate."

    Humphry proudly asserts that he has assisted three family
members in ending their lives when they faced intolerable pain
or debilitation: a brother whose life-support machinery was
disconnected and a wife and father-in-law who took sleeping
pills. A former journalist with the London Sunday Times and Los
Angeles Times, he now makes his living promoting the right to
die. He is the author of three previous books on the subject and
founder and executive director of the Hemlock Society, a group
based in Oregon that claims 38,000 dues-paying members. Its
motto: "Death with Dignity."

    One committed member, publisher Steven Schragis of Carol
Publishing Group, a small New Jersey house that is distributing
the book, urged Humphry to move beyond philosophical arguments
to practical guidance. Schragis says, "At some point you have
to make a decision: Should people be able to have this
information? This is our way of making a statement that they
should." Alan Meisel, professor of law and director of the
Center for Medical Ethics at the University of Pittsburgh, sees
the publication as a significant change. "People are very
worried that their dying is going to be prolonged and painful,"
he says. "With this book, it's clear we have entered a new phase
of the right to die."

    The book was published in April but at first languished
unnoticed. Then, after a Wall Street Journal feature and stories
on ABC's Good Morning America and CNN, sales skyrocketed. Says
Humphry: "People want to take control of their dying. My book
is a sort of insurance, a comforter there on the bookshelf that
they could make their escape from this world if they were
suffering unbearably." According to bookstores, many customers
who seek the book are elderly; some others appear to be
health-care professionals or AIDS patients. To date, apparently
no one has been publicly identified as having relied on the
manual to complete a suicide.

    Given how controversial the topic is, Final Exit has
generated surprisingly little heat. No prosecutor has attempted
to suppress it. The National Right to Life Committee criticizes
it in interviews but is not actively campaigning against it. A
few booksellers decline to carry it, generally on moral and
religious grounds. Says Ruth Holkeboer, owner of the Bookworm
in Grand Rapids: "My father was a doctor, and my brother is a
doctor. I was raised in the atmosphere of caring for life and
saving life. My sales staff felt the same way. They said they
could not put such a book in a customer's hands when they didn't
know how it would be used." Some physicians are offended. Lonnie
Bristow, a trustee of the American Medical Association who
practices internal medicine in San Pablo, Calif., says, "For
doctors to on one hand be of help and on the other be harboring
ideas of dispatching their patients would destroy the
therapeutic relationship of trust."

    Some critics have contended that the book might encourage
suicide among the unstable. But the text is full of cautionary
statements about the value of counseling. Humphry distinguishes
between "rational" suicide, undertaken by the irreversibly
handicapped or the terminally ill, and "emotional" suicide by
those who are depressed, of which he disapproves. He says, "My
book pleads with the depressed to go to a psychiatrist. But it's
addressed to the 6,000 people who die every day, not the handful
who commit suicide." Others have been concerned that the book's
data on lethal doses might make suicide -- or murder -- easier.
Yet the U.S. is a society in which guns can be obtained with
less paperwork than automobiles, and almost every kitchen
contains some lethal cleanser.

    Humphry argues that he will not make suicide easier --
just more reliable, less painful, less messy and above all less
solitary. He urges those who choose suicide to gather family and
friends around them for solace as they slip away. That gesture
might require the biggest social and cultural change of all.
Many people who could accept the idea of ending a loved one's
pain would find it impossible to watch, and be complicit in,
the actual suicide. For the one who dies, there may be a final
exit. But those who live on might have to dwell with ceaseless
doubt, guilt or scorn. Even if a suicide is rational, mankind
remains emotional.