Patience and Plastic Bags E-mail
2003 Spring
Tuesday, 08 September 2009 10:40


“We are nowhere near where we thought we would be.” That statement, by Emory University Law lchool Professor David Garrow, epitomizes the sentiments of assisted-suicide advocates.

In 1994, Oregon became the only place in the world with a law that specifically made assisted suicide a “medical treatment.”1 When it went into effect in 1997,2 assisted-suicide activists expected a domino effect. They were certain that, within five years, state after state would have similar laws on the books and that they would be well on their way to reaching their real goal—legalized euthanasia and assisted suicide on demand.3

They were wrong.

Since passage of Oregon’s law, activists have been trying to extend assisted-suicide tentacles beyond Oregon. Additional initiative campaigns have been waged. Court cases have been filed. Legislative proposals have been introduced. With each new effort, these activists have sought and received financial backing from deep-pocket donors. Each time, they have predicted victory. Each time they have met with failure. They have only a string of losses to show for their labors and for millions of dollars in expenditures.

Both frustration over these failures and a dogged determination to forge ahead were evident at two recent assisted-suicide conferences. But just how to proceed is becoming a matter of considerable debate within the ranks of the pro-death lobby. On one side are those who view past efforts as investments that should be used as building blocks for repeat attempts in target states. This faction wants to continue to focus primarily on achieving victory through legislative and judicial channels. On the other side are the movement’s militants—who want to defy or circumvent the law.

"Conspiracy to Suppress"

“We are here to commemorate the five year experiment in the State of Oregon, and it has worked!” With that proclamation, Estelle Rogers,4 executive director of the Washington D.C.-based Death with Dignity National Center, opened the “Fifth Anniversary Forum: Results of the Oregon ‘Experiment.’” The conference—held in Portland, Oregon on October 24, 2002—attracted about sixty assisted-suicide advocates, many of whom are the movement’s most influential strategists and planners (but are little known outside academic and professional circles).

Speakers at the conference praised Oregon’s assisted-suicide law over and over again, pointing to official reports as evidence that the law is working flawlessly.5 At the same time, however, they expressed dismay that it had not been replicated throughout the country, and gave various reasons.

One of the most bizarre explanations was advanced by Charles Baron, a Professor of Law at Boston College Law School and Hemlock Society activist,6 who said Oregon’s law “has been more successful than any of us could have dreamed,” but that other states haven’t embraced it because assisted-suicide opponents have suppressed news of the law’s success. He didn’t explain how this information blockade has been accomplished, but Baron believes it exists and sees it as a conspiracy to keep other states from learning about Oregon’s law, thus preventing others from wanting what Oregon has. He compared his perceived assisted-suicide information blackout to slave owners’ actions and to modern-day racist opposition to minority success. “The State of Virginia would give freed slaves six mules to pick up and leave,” he said, because if other slaves saw those who were free, they would want the same freedom for themselves. Referring to instances when successful African-Americans have experienced racism and bigotry, Baron said that opponents of assisted suicide can’t tolerate the successful “living example” of death with dignity in Oregon.

The “Good Things” and the “Bad Things”

Like Baron, conference speaker David Garrow also noted his disappointment that the expected bounce from the Oregon law has not materialized, as he walked his audience through the “good things” and the “bad things” that have occurred during the last five years.

Among the good things was that implementation of the Oregon law had been tremendously successful, since “we haven’t had any train wrecks.” He also explained that two U.S. Supreme Court losses7 have been almost universally depicted as an endorsement of state laws permitting assisted suicide. “That was a tremendous victory, even though we lost unanimously.”

Turning to the disappointments, Garrow described the failure in 2000 to pass a voter initiative in Maine8 that was identical to the Oregon law. He said the question of religion was vastly less visible in Maine than it had been in Oregon, so one couldn’t argue that those who opposed assisted suicide there were trying to impose their religious views on others. He also noted that the opposition ran a vastly more professional campaign than it had in Oregon. Nonetheless, he said, “Maine was a campaign we should not have lost.”

State court rulings have also been disappointing. “I expected that we would win independent state constitutional arguments in state courts,” he said. “We lost in Florida9 and Alaska,10 two of the most liberal courts in the country, second only to Montana.”

Another “bad thing” was the failure to pass any measure at the state legislative level, although progress was made in Hawaii in late 2002 when, for the first time in any state, an assisted-suicide proposal made it out of committee to the full legislative body.11

“To reach beyond Oregon, it may be many more years than we had expected,” Garrow said. “The timeline is significantly longer that it was five years ago.” Since he considers prospects in the legislative arena to be dim, he said that “this issue will inevitably have to go back into a constitutional litigation trap. . . . If you’re not able to win on a matter politically, in order to face the issue, you may have to have a constitutional case.”

Garrow then proposed a bold move. Suggesting a new angle for the next venture into the courts, he described a case in which a doctor would risk a murder conviction by assisting a suicide or performing euthanasia. Such an approach would require a patient with a classic “hard case” condition and a physician with appeal—as one participant remarked, “Kevorkian put the wrong face on the issue.”

The location for the case would be equally important, and Garrow noted that Montana might fit the bill: “Montana has a wonderfully, radically libertarian state supreme court.”

If a willing physician and poster-perfect patient can be found there, it’s possible that, sooner rather than later, Montana will be in the spotlight. The makeup of the state’s supreme court, in combination with the Montana constitution’s right to privacy provision, could make Montana an important judicial battleground. The state could also be the site of a legislative proposal or a voter initiative. Recently, assisted-suicide activists have made a number of trips to Montana for organizational and informational meetings.

Eli Stutsman of Oregon Death with Dignity put by far the most positive spin on past losses. He described the resources, time and efforts that his organization and the Hemlock Society put into the failed 2000 Maine initiative campaign as an “investment.” Although they didn’t win, he claimed they hadn’t done any damage to the movement and had, in fact, built an organization that could be used in the future. Similarly, he depicted the 2002 Hawaii legislative defeat as only a temporary setback.

He explained that both states had been targeted for action ever since 1997. When research identified them as states with the greatest potential for passing Oregon type laws, activists began planning, preparing, and organizing. By the time Hawaii’s governor—a strong advocate of assisted suicide—called for assistance, Stutsman said, “We were spring-loaded to help. We delivered funding and resources and made multiple trips ourselves.” According to Stutsman, “Maine and Hawaii are still very hopeful states.”12

Yet, like other speakers, Stutsman did not foresee immediate success. He said his goal for ten years from now is that Oregon won’t be known as the only state permitting assisted suicide, but as the first state to have done so.

"Barriers to Acceptance of Assisted Suicide"

Speakers and participants at the Oregon conference were candid about barriers that stand in the way of public support for assisted suicide. Among these are terminology, lack of support from major medical associations, and fear created by safeguards.

Terminology poses problems. Assisted-suicide activists know the power of words. They are keenly aware of the fact that all social engineering is preceded by verbal engineering. The names of most pro-assisted-suicide organizations are illustrative (e.g., Compassion in Dying, Death with Dignity National Association, Caring Friends, Oregon Death with Dignity, etc.). Indeed, at the January 2003 Hemlock Society conference, officials announced that the organization was planning a name change that would reflect a softer image and, therefore, be more appealing to the public. tc "Terminology poses problems. Assisted-suicide activists know the power of words. They are keenly aware of the fact that all social engineering is preceded by verbal engineering. The names of most pro-assisted-suicide organizations are illustrative (e.g., Compassion in Dying, Death with Dignity National Association, Caring Friends, Oregon Death with Dignity, etc.). Indeed, at the January 2003 Hemlock Society conference, officials announced that the organization was planning a name change that would reflect a softer image and, therefore, be more appealing to the public. "

In addition to changes in organizational names, the phrases “assisted suicide” and “physician-assisted suicide” (PAS) are being phased out. Since the word “suicide” conjures up negative public feelings, activists are seeking to delete it. Oregon Assistant Attorney General Stephen Bushong said he never refers to “assisted suicide”: “I use the term ‘physician aid-in-dying’ or ‘physician hastening death of a terminally ill person.’”

“Aid-in-dying” is currently the phrase of choice for many assisted suicide activists. But it is not new. Failed initiatives in Washington (1991)13 and California (1992)14 would have legalized “aid-in-dying,” defined to include both euthanasia and assisted suicide. Likewise, a model law to permit lethal injections or a fatal overdose for children as young as six was called an “aid-in-dying” act.15 Apparently, activists believe that the bad taste left from those failed ventures has faded sufficiently, and they’re banking on the fact that the resurrected label will convey a much-needed gentle image.

Lack of support from major medical associations. With the exception of Oregon, where the state medical association did not take a position during the 1994 campaign that legalized assisted suicide, the American Medical Association (AMA) and state medical associations oppose assisted suicide. Assisted-suicide activists want desperately to change this since physician support or, at least, neutrality would greatly increase their prospects of success. This is particularly true in state houses where legislators could use physician support as cover for a favorable vote on an assisted-suicide measure. “We’re not going to succeed where there is only a legislative route unless there is a large shift on the part of large medical associations,” said Garrow. “We must produce a major change of opinion within the medical profession.” tc "Lack of support from major medical associations. With the exception of Oregon, where the state medical association did not take a position during the 1994 campaign that legalized assisted suicide, the American Medical Association (AMA) and state medical associations oppose assisted suicide. Assisted-suicide activists want desperately to change this since physician support or, at least, neutrality would greatly increase their prospects of success. This is particularly true in state houses where legislators could use physician support as cover for a favorable vote on an assisted-suicide measure. We’re not going to succeed where there is only a legislative route unless there is a large shift on the part of large medical associations, said Garrow. We must produce a major change of opinion within the medical profession. "

Oregon presents a cautionary example. There, where the law has permitted assisted suicide for more than five years, physician attitudes have changed. According to Stutsman, the majority of Oregon medical students now favor physician-assisted suicide. As physicians who practiced in Oregon prior to legal assisted suicide retire, they will be replaced by those whose entire professional careers have taken place in an environment where assisted suicide is viewed as just one more medical treatment.

Cultivation of young physicians and medical students is on the agenda outside of Oregon as well. In response to a questioner who asked what could be done to get the American Medical Association to support assisted suicide, Dr. Timothy Quill suggested focusing on autonomy. (Quill is best known for his 1991 New England Journal of Medicine article in which he described assisting the death of a patient after referring her to the Hemlock Society.16 He was also the lead physician plaintiff in one of the failed assisted-suicide cases.17) “Younger doctors are schooled in patient autonomy,” he said. “It’s like, you want it, you get it.” So, if the issue is framed as one of patient control, medical students and young physicians can “be activated.”

Safeguards create fear. Fear of abuse tops the list of concerns that create barriers to assisted-suicide support. According to Stutsman, “With this issue, we lose women voters first because they’re afraid of abuse.” To allay those fears, drafters always include so-called safeguards18 in any assisted-suicide proposal. However, those very safeguards send a message that is problematic. Dr. Marcia Angell, the former editor-in-chief of the New England Journal of Medicine,19 told participants that support for physician-assisted suicide is “soft, very skittish” because people fear doctors. And, while the inclusion of safeguards in assisted-suicide bills has been necessary to dispel fears, the safeguards themselves actually feed those fears. “By adding safeguards, it gives the public the impression that PAS is a very scary thing,” she said.

"Assisting Suicide Isn’t Rocket Science"

While most participants at the Portland gathering were focused on ways to gain physician support and to establish strategies for victory outside Oregon’s boundaries, a few did not want to confine activities to calm, methodical and, possibly, slow progress.

Hemlock’s Faye Girsh20 took speakers to task for what she obviously viewed as unreasonable caution, and she suggested another model. “This isn’t rocket science. You don’t need four years of medical school” to assist someone’s death. “In our Caring Friends program, we’re using techniques that don’t require physician participation. . . . We’ve had four years of experience.” But Girsh’s pitch for Caring Friends—a Hemlock Society program that provides hands-on death assistance—was not well received.

Stutsman pointed out that, if the goal is legal reform, “involvement of physicians is all important. In order to get voter support, physicians are necessary.” Angell said she didn’t think doctors should be “let off the hook. . . . When they sign on to take care of a patient, they should take care of the patient all the way through,” including assisting suicide. Although Quill acknowledged that the “technical part” of ending a patient’s life isn’t difficult, he said a doctor is necessary to diagnose the patient and to decide whether assisted suicide is the right thing at the right time.

Girsh strongly disagreed. She insisted that people can be trained to make clinical assessments, and that well-trained volunteers can help people explore their options as well as help them end their lives with currently available non-medical methods.

Support for the full-speed-ahead approach described by Girsh in Portland was readily apparent three months later, at the 13th National Hemlock Biennial Conference, held at San Diego’s Bahia Resort Hotel on January 9-12. Most who attended the San Diego confab were the rank and file of assisted-suicide activism.

There is a division among activists over the means to reach their goal. But the “right-to-die” organizations are more closely aligned than they may seem on the surface. The origin and activities of two organizations—the Hemlock Society and Compassion in Dying—illustrate this phenomenon.

"Hemlock as Behind-the-Scenes MoneyCow"

Ever since its co-founding in 1980 by Derek and Ann Humphry, the Hemlock Society has been viewed as the “street-fighter” element of the euthanasia movement. Hemlock publicly led failed attempts to legalize “aid in dying” in California and Washington. It openly supported Jack Kevorkian. It published the suicide manual, Final Exit.

By comparison, Compassion in Dying (CID) has a staid public image. It drapes itself with the “respectable” aura of a professional organization that works within the system. Currently headed by Barbara Coombs Lee (a former managed-care company executive who was one of the chief petitioners21 for Oregon’s successful voter initiative), CID has spearheaded the court cases to have laws against assisted suicide declared unconstitutional. It is also known as the go-to group for information about and implementation of the Oregon law.

However, few people are aware that CID’s roots are in Hemlock-type in-your-face activities.

CID was founded after the 1991 defeat of Washington State’s aid-in-dying initiative. Its purpose was to offer suicide assistance for “deserving cases.”22 Ralph Mero, the organization’s first executive director, described it as an outgrowth of the Washington State Hemlock Society,23 which he also directed. It was the first U.S. group to admit publicly that it offered actual suicide assistance. As detailed by Mero himself, CID was involved in 24 prescription-overdose deaths during its first 13 months of operation24—a time when assisted suicide was not legally permitted, even in Oregon.

Efforts to downplay links between CID and Hemlock were described at the San Diego conference by Dr. Peter Goodwin, CID’s current medical director. Summarizing the 1994 Oregon campaign, Goodwin said, “Hemlock was our money cow.” Without Hemlock’s financial resources, “we would have been dead in the water.” However, the campaign publicly and intentionally distanced itself from Hemlock. The campaign concentrated on pain and suffering, while it emphasized the measure’s safeguards.

Key also in the Oregon success was the neutral stance taken by the Oregon Medical Association (OMA). Goodwin, who had been a professor of medicine at the Oregon Health Sciences University—Oregon’s only medical school—for many years, and had taught close to half of Oregon physicians at one time or another, was almost single-handedly responsible for the OMA’s position of neutrality. He explained that, early in the ’94 campaign, the OMA considered two resolutions. One would have reaffirmed the OMA’s support for the American Medical Association’s position opposing assisted suicide in general. The other would have put the OMA in specific, direct opposition to the Oregon proposal.

At the meeting where the resolutions were considered, Goodwin and the OMA’s incoming president successfully argued that no action should be taken on either resolution since it would be best to “let the people of Oregon tell us what they want.” The strategy was successful. Assisted-suicide advocates did not need the OMA to endorse their position. They did need, and they did achieve, a hands-off stance. According to Goodwin, that neutrality allayed the fears of the general population since it sent a message that, “if the OMA could tolerate this, the claim of the opposition that this was hugely dangerous lost some of its power.”

Three years later, voters were asked to decide whether to repeal the law. The OMA did express opposition to assisted suicide at that time. (According to Goodwin that was only because opponents “stacked the House of Delegates” and only permitted him to speak once). Goodwin said the OMA’s 1997 position had little effect, and merely served to confuse voters. The law was not repealed.

When Oregon’s law went into effect in 1997, three years after its passage, Goodwin assumed the role of CID’s medical director, and CID has been active in facilitating most of the reported assisted suicide cases in the state. (If a patient’s own physician opposes assisted suicide or believes the patient does not fit the Oregon law’s criteria, CID will arrange the death.) According to Goodwin, about 75 percent of those who die using Oregon’s assisted- suicide law do so with CID’s assistance.

He said he has been present at a number of assisted suicides—which he called “aid in dying”—and described this as “an incredible privilege.” “I’ve delivered many, many babies,” he said, “but this is the deepest privilege—to share this sort of intimacy with patients and with their families. And I wish more physicians would appreciate that, because it might involve more of them in this process.”

Goodwin explained that almost all who choose to die using the Oregon law do so for reasons of autonomy. The deaths result from large doses of liquid Nembutal “obtained from certain selected pharmacists around the state,” and all have been peaceful and complication free.

Even with the rosy picture he painted, Goodwin acknowledged that the future is still “very, very uncertain and very, very cloudy in Oregon.” This is due, in part, to the discomfort that many older physicians still feel about participating in assisted suicide. He also attributed the uncertainty to the court case pending over Attorney General Ashcroft’s directive that would prohibit physicians from using their federal licenses to prescribe federally-controlled substances for assisted suicide.25

In light of those concerns he urged attendees to prevent conservatives from rolling back the clock. “We cannot afford to continue to be sort of passive and namby-pamby about this,” he said. “We have got to fight.”

Hemlock’s “Crown Jewel”

As she made abundantly clear at the Portland conference, Faye Girsh is not passive when it comes to pushing assisted suicide, and she found a receptive audience in San Francisco. She explained the origin and rationale for the Caring Friends program, described in the conference program as Hemlock’s “Crown Jewel.”

Girsh paid tribute to Ralph Mero as the person who started CID “after the defeat of our first initiative in Washington State” and described Caring Friends as an extension of Mero’s work. Indeed, it does follow the spirit of CID’s founding. That group had been formed to circumvent laws against assisted suicide. Now, with CID implementing the Oregon law, Hemlock’s Caring Friends has picked up the baton to assist in deaths outside of any legal boundaries.

A catalyst for Caring Friends, as it is currently organized, came when other states failed to follow Oregon’s lead and after attempts to gain court approval for assisted suicide failed. Not willing to accept the outcome of those losses, Girsh and others became angry and frustrated. “Well, damn it, we had to do something,” she explained. “Gosh, you know, you go through all the channels and they don’t help you” so you have to take things into your own hands.

She said she asked herself, “Why do we have to wait for Justice Rehnquist or this person or that person or the Pope to decide how we’re going to die?”

An Arizona woman, who later killed herself, provided $40,000 in seed money to begin training volunteers to facilitate deaths through Caring Friends. The program now has 104 trained volunteers in various states and is conducting additional sessions to increase that number.26 To emphasize why more Caring Friends are needed, Girsh referred to the New Year’s Eve suicides of Morris and Estelle Spivack. The elderly Floridians, who had been married for forty-two years, leaped to their deaths from their seventeenth- floor condominium window. (Although increasingly feeble, neither was terminally ill.) “The two left a note with clear burial instructions and the names of relatives and their lawyers,” she said. “Do we need to expand the Caring Friends program? Yes.” Ostensibly, with Caring Friends’ assistance, the deaths would still have taken place but would have been less messy.

(Hemlock’s willingness to look favorably on double suicides is not new. In a Final Exit chapter titled, “Going Together,” Derek Humphry wrote: “Some couples choose to die together, regardless of whether both are in poor health, or only one. . . . That the couple would wish to die together is a tribute to the strength of a loving relationship.”27)

Caring Friends’ Procedures tc "Caring Friends’ Procedures "

Caring Friends is coordinated out of Hemlock’s Denver headquarters by Lois Shafer,28 the community services director for the Hemlock Foundation. Schafer outlined the volunteer training program and the procedure for obtaining the group’s services.

She said Hemlock pays for half of the airfare and hotel costs for trainees. Those selected for training are expected to be good listeners, since volunteers become close to those whom they assist. She explained that, even if the person who will be using the program may have a loving family around, “they don’t want to drag everybody down” and “they don’t want to be a pall on the household.”

According to Shafer, the process for hastening a death begins when a person contacts the Denver office. To receive Caring Friends’ services, a person must be a Hemlock member.29 However, Hemlock board member Arthur Metcalfe assured participants that this requirement does not present a problem since people can—and often do—join Hemlock and request the services of Caring Friends on the same day. After the assisted-suicide candidate submits medical records and a written personal statement, the “senior committee” looks at them “and decides if we can risk this one.”

Once the go-ahead is given, the Denver office calls a volunteer in the field to give information about the person and asks if the volunteer would be willing to fly to the person needing services. If so, background information and records are sent to the volunteer, who then phones the person and arranges a personal visit. (Not all Caring Friends’ assisted suicides involve personal visits. How-to instructions, plastic “exit bags,” and information about procuring substances are all available by mail.)

“If they get to the point where they say, ‘Okay, I want to set a date now,’ then we contact one of our senior Caring Friends. These are people who have more experience being at the bedside of folks who have self-delivered,” Shafer said.

She claimed that the program puts a lot of effort into working with the family. “Families are so grateful when they call us after the fact,” she said. Shafer neglected to mention that some families are horrified by Caring Friends’ involvement in a loved one’s death. (See: “A Widow’s Story,” below, p. 43.) It is something that could eventually cause problems for the Hemlock Society.

Michael Evans, an attorney who provides legal advice for the organization, compared the role of the senior volunteer to that of “an auditor who comes in and reviews the situation in a kind of socio-psycho-medical way.” Protecting the organization is important. “Despite the fact that we talk about speedy and peaceful dying,” he said, “that is not our goal. The goal is to have a good decision and a good decisional process.” He pointed out that that process will be extremely important in any legal proceedings. And after predicting that there would be litigation, he made a pitch to participants to contribute to a legal defense fund so funds will be available when needed.

The process for obtaining medical records for the senior committee to review is somewhat dicey. Dr. Richard MacDonald, Hemlock’s medical director,30 said, “We don’t suggest you go to your physician and say ‘I want you to send my medical records to the Hemlock Society.’”

He told the audience that attendance at a hastened death is a great privilege. When the time for the death has arrived, the volunteer who did the preliminary work, a senior volunteer and, often, MacDonald go to what he called “the scene of the chosen death.” “It’s not a medical procedure,” he admitted, but said his presence has “to ensure that people were comfortable, that their loved ones and the volunteers would understand how death occurs.”

He said, “I’ve been at more dying events in the last four years than in fifty years of practice.” He wouldn’t give exact numbers, but he did say that he has been present at over 85 of the more than120 Caring Friends’ deaths that have taken place in a four year period. “I’m sort of a midwife to ensure that we depart safely and surely and as peacefully as possible,” he said. “I want to tell you what a privilege it is to attend a hastened death.”

Those who use the services of Caring Friends have done so because they don’t want their loved ones to see them die badly, he said. “This is a control issue.”

Exit Bags and Gas

And what, exactly, is used to accomplish deaths assisted by Caring Friends? None other than the plastic bag—a method that euthanasia activists have suggested for many years.31

MacDonald explained that, when Caring Friends first began, it used barbiturates, but it has been increasingly difficult for people to obtain them. As a result, “We have had to shift to techniques using plastic bags and helium. That, remarkably, has become an acceptable method of hastening death.” His initial abhorrence of plastic bags has disappeared. “In seeing the technique used,” he said, “we have seen it to be the principal technique used in Caring Friends.”

Over the years, customized “Exit Bags” have been designed for this purpose. An advertisement in Hemlock’s newsletter promoted the Exit Bag as a necessity: “Data from the Netherlands reveal that in 20% of self-deliverances involving lethal dosages of medications, individuals do not die quickly but linger in a coma for up to four days! This is why how-to guides such as ‘Final Exit’ and ‘Departing Drugs’ also recommend the use of plastic bags for self-deliverance.”32

An information sheet that accompanies shipment of the Exit Bag describes its features: “Optional neck band for ‘turtleneck’ fit; Adjustable velcro strip for snug but comfortable fit with sewn-in elastic and flannelette collar; Extra large size to minimize discomforts of overheating and breathing difficulties.” Praising the merits of the bag, it states: “The customized EXIT BAG takes the guesswork out of the use of plastic bags. Instead of using bags that are too small, faulty in some way, fastened too tightly with elastic or tape, the customized EXIT BAG allows you to make personal adjustments for safety and comfort.”33

New models of the Exit Bag have been introduced in the last few years; in particular, a model designed for use with helium gas. Like the original bag, the new bag—described as a “fast, safe and efficient method”—has been advertised in Hemlock publications.34 In addition, Hemlock newsletter articles have promoted the helium/plastic bag method.

One such article describes it as a “gentle, quick and certain death.”35 The gas “disperses easily and is difficult to trace in a corpse.”36 Readers are assured that “a little twitching in the arms and legs” doesn’t last long and should be expected. Among the practical tips given is that one should say goodbye before the bag is pulled over the head since, once the flow of gas begins, the helium makes the voice sound like Donald Duck. A final pitch is made for using Hemlock’s program: “Although there have been reported good deaths with just family present, we strongly recommend contacting the Caring Friends program to provide the expertise needed.”37

The same advice has been repeated in other articles. In one, Girsh pitched a new Hemlock publication that has illustrated directions for the use of helium.38 But, once again, she suggested that it would be a good idea to have someone from Caring Friends present. “Even if we published Helium for Dummies, we still think that having someone with expertise present” is needed. “Ending your life can be complex, you only do it once, and failure could be disastrous.”39

Hemlock also markets a video about Caring Friends. It is intended to gain further recognition for “the country’s only nationwide program providing free, in-home counseling to hopelessly ill people” who want to evaluate their options.40

At the San Diego conference, MacDonald was asked if plastic bags could cause an image problem for the assisted-suicide movement. He acknowledged that they could, but said that “the vast majority of people accept the bag and inert gas.” “It is a very speedy process,” he said, “and it has never failed in our program.”

Nonetheless, he’s not satisfied with the status quo. MacDonald himself plans to die by lethal injection, and said he can do that because he’s a doctor. He believes it is unfair that this option is not available to everyone since it treats non-physicians as “second class citizens.”


As indicated by speakers and participants at the Portland and San Diego conferences, there are definitely differences about strategy within the assisted-suicide movement. However, this tension—between those who advocate patience and those who promote plastic bags—should not be mistaken for differences about the goal.

Activists are committed to eventual achievement of death-on-demand.

Past losses will not stop them from pursuing every avenue to achieve that goal. Some will concentrate on legal challenges, some on legislative activity, some on future voter initiatives and others on activities that ignore the law. Furthermore, in spite of their surface disagreement, it is unlikely that the turmoil will weaken their resolve and their cooperation with each other.

For example, while participants at the Hemlock Society’s San Diego conference seemed to overwhelmingly eschew traditional attempts to bring about legal change—preferring the Caring Friends approach—Hemlock is bankrolling a legislative proposal in Vermont. The role being played by Hemlock is similar to the one it fulfilled in Oregon during that state’s initiative campaign (i.e., the behind-the-scenes “money cow”).

After the Portland and San Diego conferences, the Vermont measure41 was introduced, as were proposals in the Hawaii42 and Arizona43 legislatures. The Ninth Circuit Court of Appeals scheduled oral arguments in Oregon v. Ashcroft. No matter what the outcome of the case, it is almost certain to be appealed to the U.S. Supreme Court. Exploratory plans and preparation for introduction of ballot initiatives are underway in several states. And Caring Friends has stepped up its activities.

Assisted-suicide activists want a win now, more than ever. They know that, if they are perceived as winning anywhere, by any means, they have a far greater opportunity to retain financial support and to obtain public support.

It is thus imperative for all those who seek to protect vulnerable people from the threats of euthanasia and assisted suicide to remain informed, vigilant, dedicated, and active.

A Widow’s Story

When Sue went to bed one night, she thought she and her husband Bill would be taking a much anticipated trip to Mexico in the near future.

But, the next morning, Sue’s life and plans were shattered.

She woke up and found that her husband wasn’t beside her. At first, she wasn’t alarmed. It wasn’t unusual for Bill to get up before she did. Sue went into the kitchen, expecting to see him. But he wasn’t there. She called out to him. He didn’t answer. Then she went into their home office.

She was met with a scene she will never forget.

Bill was in his chair—dead. There was a plastic bag over his head. Attached to it was tubing running to a canister of helium gas. Next to Bill’s chair, Sue found all kinds of materials from Hemlock’s Caring Friends. There was a video tape. There were explicit “how to” instructions that even described how a person should “practice” before the actual “death event.”

Later, searching for answers, Sue called Hemlock’s Denver office and talked to Lois Shafer who heads Caring Friends. Sue said there were no apologies from Shafer. Instead, Shafer told her that Caring Friends always reviews medical records to make sure the program is appropriate for those who are seeking services.

Sue was shocked. Here was a stranger who had decided Bill should get help to commit suicide.

As for any review of Bill’s medical records, it’s not clear how or whether that was done. Bill’s doctor was as shocked as Sue when Bill died. Neither of them had any idea that Bill was considering suicide. Although 46-year-old Bill had been diagnosed with multiple sclerosis several years earlier, the only sign of his condition was his use of a cane. He still drove his car.

Sue doesn’t know how Bill first learned about Hemlock, nor does she know how long he was in contact with the group before his death. But she does know that Caring Friends was aggressive in contacting him. She told me she found unerased messages on their answering machine, indicating that Caring Friends had called Bill again and again and again.

The days and months since Bill’s death have been difficult for Sue. She gets through one day at a time.

The International Task Force on Euthanasia and Assisted Suicide receives many calls from people with similar tragic stories, but does not publicly discuss them unless a person volunteers to make the facts known to others. Sue (not her real name) asked that her story be told. She wants to warn others about Hemlock’s Caring Friends. “If it saves just one life,” she told me, sharing her story will be worthwhile.—Rita Marker

Last Updated on Tuesday, 08 September 2009 11:12