Final Exit: Compassion or Assisted Suicide?

The crackdown on Final Exit Network, a group based in Marietta, Ga., that is accused of assisted suicide, has revived the right-to-die debate that was fueled in the 1990s by Jack Kevorkian, the Michigan doctor who assisted in the deaths of 130 terminally ill people. But Final Exit claims that its volunteers do not perform assisted suicides à la Kevorkian, who was convicted of second-degree murder and went to prison for giving a lethal injection to a man suffering from Lou Gehrig's disease. Rather, the group argues that it merely provides a "compassionate presence" for terminally ill people, giving them information about suicide if they request it. If an individual decides to proceed after reading that information — which includes a passage on committing suicide by helium inhalation — a member of the network will be present, but only to hold that would-be suicidal person's hand as he or she proceeds with ending life.

Law enforcement believes otherwise, and has charged the group with assisted suicide, evidence-tampering and racketeering. Authorities say the group broke the law by assisting with at least 130 suicides across the country and disposing of the helium tank and "exit hood" used to ensure a person inhales only that gas instead of oxygen. The authorities have also frozen the group's assets, effectively putting it out of commission. Four of the group's members — including its medical director, Dr. Lawrence Egbert, who lives in Baltimore — were charged last week in the death of a Georgia man in June. (Read "The Cults That Went Wacko.")

Amid the controversy, Kevorkian (who was released from prison in 2007 for good behavior after serving eight years of a 10-to-25-year sentence) has weighed in. Never publicity shy, Kevorkian says that while he believes the group was the victim of a witch hunt, he feels its members shouldn't be performing assisted suicides without a doctor present.

But the infamous doctor was soon overshadowed by a national back-and-forth over whether terminally ill people should be allowed to die with dignity or whether they would benefit from having more resources, like home-care aides, at their disposal. The debate is an emotional one, says Paul Wolpe, director of the Atlanta-based Emory Center for Ethics, mainly because Americans are still uneasy with the idea of assisted suicide. Yet Jerry Dincin, Final Exit's vice president, believes the sentiment could be changing and that the right to die could become "the human right of the 21st century."

"You could liken it to women's suffrage in 1910," says Dincin, of Highland Park, Ill. "Women had to fight for that and be arrested for that, but now they have that right, and I don't mind fighting for this right in the same way. When a terminally ill person's quality of life is so miserable that they think life is not worth living, I think it is their right to decide whether they want to take their own life."

Although assisted suicide is illegal in most states, voters in Washington State and Montana voted late last year to legalize physician-assisted suicide. Oregon has had a physician-assisted suicide law since 1994, and New Hampshire, Massachusetts and New Mexico are considering whether to pass similar laws. In Georgia, however, assisted suicide is a felony, and members of Final Exit could face up to five years in prison if convicted of that charge. They also face three years for evidence-tampering and 20 years for racketeering.

While Dincin says members of his group are "compassionate, caring, loving angels of mercy," others believe they are murderers. "In this case, I would trust what law enforcement says, not the self-serving statement of someone who would like to avoid murder charges," says Stephen Drake of Not Dead Yet, an advocacy group based in Rochester, N.Y., that opposes assisted suicide.

Convicting Final Exit could be difficult. Prosecutors will have to prove just how involved the group was beyond providing information about suicide and holding a dying person's hand. "If the equipment was purchased by the dying person and the only thing the group did was provide a manual on how to do it, that seems very minimal and like it might fall outside the scope of [the law]," says Ani Satz, a law professor at Emory University.

Even so, escaping liability with its "compassionate presence" argument is a tricky maneuver. "The idea that they don't push a switch or administer a shot doesn't protect them from liability," says Russell Korobkin, a law professor at UCLA. "But I think it will be problematic to prosecute them for providing information, which is entitled to First Amendment protections. It seems that [Final Exit] is being very careful to stay on the right side of the line on this."

Medical advances may also play into legal arguments. Wolpe says progress has allowed the terminally ill to live longer, but it has transformed dying from something that occurs relatively quickly and painlessly to something more drawn out and potentially agonizing. "So," he says, "some people have decided that if we are going to intervene in the natural act of dying and allow people to live even though disease is rampant in their body, we can't make someone's decision to die the one exception to our meddling." And if assisted suicide remains illegal, Satz says it could force more "people to turn to nonphysicians to help them end their lives."

Ultimately, Wolpe believes the group will be acquitted of the charges. "If the defense is clever about this and focuses on the suffering of the people they helped and shows that they didn't technically violate the law, then I think the jury will be forgiving," Wolpe says.

Dincin of Final Exit couldn't agree more, but the issue for him isn't about getting away with murder. "We realize the risk we take when we're willing to walk that fine line between what a jurisdiction might call assisted suicide and what we might call compassionate presence," he says. "But whose life is it anyway? I know that my life is mine. It doesn't belong to the Georgia Bureau of Investigation or any religious entity or any person. It belongs to me, and I have the right in extreme circumstances to take it."

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