is death announced its approach in December 1994, when Earley reached for a book on a high shelf. At first telling, it was just a book. Later, he told a reporter that he had been reaching for The Mariner's Dictionary, which was indeed still atop his bookcase when he died. And later still, he told a third reporter that he had been looking up the word bowsprit.
      Was he embellishing as he went along? No matter. The core truth remained the same: as Earley reached for whatever book, for whatever reason, he discovered that he could not lift his right heel to stand on tiptoe. That was the first signal that his nervous system was under attack. Later, he would find himself inexplicably tripping and falling. He would need a cane, then a walker, then a wheelchair.
      It took several months, an array of neurological tests and a visit to a specialist before Earley arrived at the day, late in the summer of 1995, when his doctor at the Veterans Administration Medical Center, in Providence, offered this advice: Go home and look up amyotrophic lateral sclerosis.
      Earley later ridiculed his doctor's unorthodox way of breaking the news of a fatal illness, but he did as suggested. He logged on to a computer at a hospital library and plunged into medical texts and journals, absorbing all he could on the rare but frightful affliction called Lou Gehrig's disease.
      Soon he understood every detail of what would happen to him: one by one, the nerves that control movement would die off, until he became totally paralyzed. But Earley chose to regard this with wonderment, rather than horror.
      "He would be reading about it, recalled a friend, and say, 'Oh, wow -- look at this! In time I'm going to have difficulty swallowing and breathing!' I have concluded that he sees it as an experience -- something new to do."
      If that experience included grief or anger, or regret that his life would be cut short in middle age, Earley didn't express such feelings.
      Newly divorced, childless, estranged from his only sibling, his parents long dead, Earley had only two people to whom to break the news: his best friend of 25 years and his girlfriend.
      He would say: "'I'm just another slug that got hit."
      He would say: "The things in your control you get angry about. This is not in my control. I cannot be angry."
      He would say: "I've had a good long run at it. I've had some very good-quality experiences. I'm full."
      Earley also told them that while he could accept death, he could not tolerate the final stages of his illness -- the indignity of total helplessness, the drooling and gasping for air, the slow death by drowning as fluids filled his lungs.
      He saw only one way to avoid that suffering: suicide.
      Earley went to AAA and got a TripTik to the town in Michigan where Dr. Jack Kevorkian lives. He asked his best friend, Steven Ames, to drive him there, and after the deed was done to toss his body in the back of his pickup truck and drive it home.
      Ames remembers replying: "I can't do that! For a bright guy, Nöel, you are sometimes very stupid."

n Dec. 2, 1996, some 15 months after his diagnosis, Nöel Earley looked up from his motorized recliner at the mob of people crowding his small, cluttered apartment. Tiny microphones were clipped to his collar, and several cameras focused on his face, now angular -- gaunt.
      No fewer than 11 news organizations had turned out for this press conference. But Earley seemed perfectly at ease, despite a two-day stubble on his cheeks and his obvious debility: one thin arm was the only limb he could use, and the fingers on that hand curled with paralysis.
      Earley knew most of these reporters. And he could command their attention this December morning thanks to months of growing fame.
      It had started in February, when he called The Journal-Bulletin, offering to tell of his plight in order to promote a bill introduced by state Sen. John M. Roney that would have legalized and regulated physician-assisted suicide in Rhode Island.
      In May, he persuaded the Rhode Island Medical Society to break with the American Medical Association's longstanding opposition to physician-assisted suicide; the society voted to take a neutral stance. Later that month, he testified before a state legislative committee, urging approval of Roney's bill; instead, the General Assembly overwhelmingly passed a law making assisted suicide a felony.
      In June, Peter Klein, an independent videographer working for ABC-TV's Nightline, started making a documentary on Earley.
      In September, Earley stirred a flurry of publicity by announcing that he had made a date with death: Dec. 4.
      In November, Channel 6's Marilyn Schairer broadcast a five-part series on Earley, and an Associated Press story on him ran in newspapers around the world.
      Earley welcomed all the publicity, and he welcomed the streams of visitors it brought to his door -- friends rediscovering him after years of separation, strangers of every ilk.
      A charismatic-Catholic healer tried to save Earley's life with prayer. An acupuncturist examined him and suggested that he alter the balance of his yin and yang. A woman in the throes of depression came to discuss suicide; he tried to talk her out of it. A missionary nun, awaiting her next assignment, made Earley her mission, visiting several times in hopes of dissuading him from suicide.
      The publicity brought in piles of mail -- much of it addressed simply to "Noel Earley, Lincoln, R.I." -- often containing rosaries, prayer cards, quotations from the Bible and entreaties to accept the Lord and the suffering that life inflicts. "Dear Mr. Earley, I'm writing to let you know that we are praying for you here at the Fellowship Baptist Church in Rome, Ga. . . ."
      But also: "Dear Mr. Earley, You are acting for tens of thousands of people, giving a voice to us. I have full-blown AIDS and I have already made the decision that you have made. . . ."
      The publicity fed itself, bringing in yet more reporters, more TV cameras -- from Britain, from Germany, from Brazil, from Croatia even. By late fall Earley was rarely alone, and that caused endless tensions with his friends, particularly his girlfriend -- who hated the media and spoke to The Journal-Bulletin only on the condition of anonymity, and only because Earley wanted her to.
      Earley's best friend, Steven Ames, remarked with exasperation that Earley was "reveling in all the attention," but Earley insisted that he had no love for the limelight, that the interviews he gave -- which he said were getting boring -- were all for his cause.
      Another friend, Reid Mendenhall, saw it this way: "He's not allowing his death to be wasted. He's using his death as an instrument to push people and make them think about something difficult."
      Whatever the reason, Earley got so caught up in the frenzy that he seemed to forsake all privacy. He talked to anyone from anywhere; he allowed interviews to drag on for hours, until he was sick with exhaustion. Photographers climbed around his motionless body rigging up bizarre lighting equipment. They shot him through the living-room window; they shot him being bathed; they shot him being carried bare-legged into bed.
      His friends wondered how someone so concerned with dignity in death could allow, even encourage, this circus. Earley replied that he wanted the world to see exactly how bad it was -- how necessary the suicide.
      But on this Dec. 2 the world saw Earley, a pink blanket draped over the stick-like shapes of his legs, announce that he was not yet ready for that end. Four television stations, three radio stations, the Associated Press, two newspapers and the Nightline videographer recorded him saying:
      "I'm announcing today that I am not going to commit suicide on December fourth, since I can still speak. I am going to wait till my voice runs out, in which case it will take about three days till I start gasping for breath.
      "I'm going to have a professional assist me, but not directly. I'm getting the means to end my life from a professional."
      No, he told the reporters, he had not had second thoughts about suicide. It was just that his voice had lasted longer than he'd expected. He wanted to keep up the fight as long as he could, stopping only before he lost the ability to plunge a lethal dose of drugs into his thigh.
      "The message is more important than I am," Earley told the reporters. "I'm just an ordinary person dealing with extraordinary circumstances.
      "We don't let animals suffer. Why should we let humans suffer? It's unconscionable. . . . Give us the right to end a disease process that assaults our independence and our dignity."

he media's appetite for Nöel Earley sprang not merely from the power of his personality and his unusual willingness to share the story of his dying. Earley appeared on the scene at a pivotal moment in the nation's consciousness. The timing, indeed, seems uncanny.
      On March 7, 1996, four days after the first story about Earley hit the streets, a federal appeals court in San Francisco overturned a Washington-state law prohibiting assisted suicide.
      The next month, a federal appeals court in New York -- applying different reasoning to reach the same conclusion -- struck down two other state bans on assisted suicide.
      Less than a week after Earley made headlines in Rhode Island with his announcement that he would kill himself on Dec. 4, the U.S. Supreme Court agreed to review those appellate rulings, to decide whether assisted suicide is a right protected by the Constitution. That night, Oct. 1, Earley appeared on NBC Nightly News.
      And throughout the year, Jack Kevorkian -- the retired pathologist who had made a crusade out of helping sick people commit suicide -- was in the news. He was acquitted for the third time in May, and arrested yet again in November; but the charges were dropped five days before Earley died.

fter three decades of evolution in the public's view of death, dying and patients' rights, the question of assisted suicide has reached the top of our social agenda.
      The Karen Ann Quinlan ruling, in 1976, and the Nancy Cruzan case, in 1990, established patients' right to refuse life-sustaining treatment. And over this time, a consensus has developed in the medical profession, among ethicists and even among Roman Catholic theologians that there is no difference between refusing life support and removing it once initiated, and that patients do have the right to reject treatment -- including feeding and hydration.
      As attention has focused more and more on improving the care of the dying, particularly relieving their pain, doctors, ethicists and policymakers now accept the "double effect": doctors may increase pain medication in dying patients, even if the drugs hasten death, provided the intention is not to kill the person but to relieve pain.
      Even so, as a stunning research project revealed in 1995, doctors continue to ignore patients' wishes -- to persist in hopeless cases with treatment after treatment, and to allow pain to go unrelieved.
      For good reason, people fear losing control over the way they die.
      And so there comes a call to go a step further -- to do more than put aside the feeding tubes and respirators that keep death at bay: to actively usher in death with prescriptions for lethal drugs.
      To some, such assisted suicide is merely the next logical move in the right-to-die progression.
      To others, it means stepping off a moral precipice. Nöel Earley represents the kind of compelling case that cautious people say makes a poor basis for public policy. Here was a man with a rare illness and an idiosyncratic attitude toward life and death. Even if you agreed with Earley that assisted suicide was the best thing for him, does it follow that it's good for society? Does helping a handful of people like Earley create a risk for legions of others, who may be vulnerable to a needless death?
      Would legalization of assisted suicide make it too easy to get rid of patients, rather than to do the extra work needed to relieve their suffering? Would the right to die become a duty to die -- especially when living requires costly medical treatment?
      Does the focus on assisted suicide distract from a bigger problem: the need to improve care of the dying?
      But then, shouldn't patients have the right to control the way they die?
      Don't doctors have an obligation to end their patients' suffering? And aren't there clearly cases when all the tools of medicine are powerless against disease, against suffering?
      What can we say to people whose lives are rendered intolerable by untreatable illness, people for whom death would provide the only relief?
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