Talking About Suicide

Because it's not a taboo

Reading about Lawrence Egbert

The Washington Post last weekend posted a profile of Lawrence Egbert, the former medical director of the Final Exit Network. The group guides, informs and accompanies people who kill themselves, sometimes being the ones holding their hands at the end. What makes Egbert even more unusual is this: “But unlike the group’s current leadership, Egbert is also willing, in extreme cases, he says, to serve as an ‘exit guide’ for patients who have suffered from depression for extended periods of time.”

The profile leaves a lot of questions unexplored, but it’s a useful look at real people who have considered suicide or have been with a loved one when he or she went through with it. Egbert recalls laughing with a man who got flustered with Egbert’s rapid-fire instructions: “Slow down! I’ve never done this before.” “Well, it is a once-in-a-lifetime experience!”

The story also, mentions that even Egbert, a doctor who used to review medical school applications for Johns Hopkins, his alma mater, couldn’t always arrange a foolproof suicide: “In the early days, Egbert says, he and other volunteers used a common supermarket ‘turkey bag,’ which had a tendency to fail on occasion. Once, he recalls, he was working with a woman who’d had two unsuccessful suicide attempts. The woman seemed to die but awoke a few minutes later. ‘You screwed up twice yourself — you call in the pros, and we couldn’t do it either!’ he told her. They patched a hole in the bag, and this time it worked.”

Unfortunately, the story doesn’t say how many times the assisted suicides failed, or whether any were called off because of it, or whether other means had to be used in desperation to complete the job. (For some reading about cases of botched assisted suicide, try Russel Ogden, who documented several of them in Canada for a thesis paper long ago and now leads the Farewell Foundation.)

These days the Final Exit Network uses helium and a plastic hood, but Egbert tells the reporter he doesn’t know exactly how much helium it takes. The “guides” let two tanks run down, just to be sure.

These can be startling details for readers who can’t even imagine someone wanting to die. Beyond that, it’s also startling because of the guesswork involved in suicide, even among people who are in some cases well-educated or well-trained and well-meaning.

Clearly, the Final Exit Network is still finding its way along. With the recent legal troubles, the story says the group has decided to stress family notification more so the suicide doesn’t come as a surprise. Whether that means the group will turn away people who don’t want to tell their families isn’t clear.

The group has also argued over helping people who have depression so severe that it hasn’t responded to treatment. Egbert won that argument when he was still the group’s medical director, but it seems the group thinks differently now that he’s gone.

Egbert may be the rare person who feels that depression can be a kind of terminal illness, but even he slips into the easy mistake of judging someone by their appearance and demeanor and wondering what in the world could be wrong. The story describes him taking the case of a depressed woman who wanted to kill herself: “The woman was a 65-year-old teacher who had suffered from extreme bouts of depression since she was a teenager and was prone to violent outbursts. Still, ‘I had very lively mixed feelings, just looking at her,’ Egbert says. ‘Very attractive, very intelligent. A woman who could walk for miles — pretty much do anything.'”

The reporter himself visits with another depressed woman who had contacted the Final Exit Network after deciding that shooting herself would be too messy. She still has the helium tanks, waiting: “She figures she might use them someday. It’s odd to hear her say this because she seems so utterly alive: funny, inquisitive, engaged in life. … She’s trying to lose weight. She looks healthy. How then could she be thinking about ending it all?”

There’s still plenty to discuss about the story, but I”ll end this post by wondering about those judgments. Are people like those women the ones suicide prevention groups were founded for? The surprises? The ones who seem to have potential, who seem full of life? Are we perhaps more comfortable understanding the suicides of people who look the part? If so, does that thinking inform the seemingly growing support and sympathy for assisted suicide for the terminally ill? “Look at that. It must be awful to live that way.” And what does that mean for people without terminal illness but with the wish to end their lives? Must they somehow show that they need the assistance?

These are just questions, and perhaps far-flung ones, but there are so many around this topic and the story about Egbert illustrates that well. As Margaret Battin wrote in her book “The Death Debate: Ethical Issues in Suicide,” “Our society has not evolved a measured, considered set of moral rules, laws and customs concerning suicide. This is cause for philosophic and practical alarm.”

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