hen she met him, he was tall and burly. He had broad shoulders and massive arms; his wrists were so muscular he couldn't fasten his cuffs. He amazed her, though, with his mind. Once, in response to a question, he whipped off a diagram of the human nervous system. He pursued her for a year and a half, often dropping off handwritten love poems and dashing away.
      "He kind of grew on me," she says. "He's a wonderful human being. He's unusual because he's so other-oriented -- he's not at all concerned with his own needs. I've seen him with his last buck buying someone a cup of coffee, instead of buying himself a loaf of bread.
      "He's so comfortable with himself. Within himself, all his needs are met."
      At first, she couldn't believe he was sick. He was so cavalier about his illness. His odd sense of humor, his enthusiasm for life, didn't change with the news of a fatal disease. All that changed was his acquisition of a cane. Once she grabbed it away from him, laughing. "You don't need this!" He fell.
      When he came to see her, his feet growing floppy from paralysis, she would hear the thump, thump, thump of his approach. His legs got thinner and thinner. Sometimes she would plead with him: "Nöel, make it stop!"
      Privately she thought, Maybe he'll change his mind about suicide; maybe they'll discover a treatment. She was always urging him to consider his alternatives. When he could no longer swallow liquids, she pushed him to get a feeding tube inserted in his stomach.
      He hated the idea of deforming his body that way, but eventually he relented. After the stomach surgery, he was in pain and despondent for some time. "Until then," she says, "he saw it as an interesting process. When he got the feeding tube it was a blow to his self-esteem -- it blew him away. When he saw the quality of his life improved, he got over that."
      But the illness marched on, bringing a new loss with each day. His shoulder bones began to protrude. His voice grew hoarse and weak. She leaned close to hear him speak. She could see those tiny twitches, the death throes of nerve cells, wriggling in his arms, his chest, his neck. Make it stop!
      The day in mid-December when he choked on his food and decided he could no longer swallow solids, she swore she'd never cook again. So he bought her a giant food processor to restore her interest.
      "Don't spend all your money," she protested. "You need it! You're going to live! You'll get ventilated and live another ten years."
      She pushed for the ventilator too, a machine to breathe for him when he could no longer breathe on his own. But that just angered him. "You want me to suffer!" he'd say. All she wanted was for him to live.
      His other friends supported his wish to choose suicide. But the person closest to Nöel Earley in the last years of his life did not want him to kill himself, and did not even agree with his campaign to legalize physician-assisted suicide.
      "I'm very uncomfortable with it," she said. "I don't see how they can write a law that would protect people from being coerced into it.
      "An elderly woman with a lot of money -- her children could make her feel guilty. How do you tell who wants to die, and who is being coerced?"
      In the eyes of many ethicists, that, indeed, is the question.

he vast majority of people who would be affected by the legalization of assisted suicide would not be middle-aged men like Nöel Earley. They would be elderly people, mostly women, many in hospitals or nursing homes, many with no one looking after their interests. What is the risk that, if the option of assisted suicide were readily available, people who didn't truly want to die would feel obliged to use it? Is it worth it to society to take that risk for the benefit of the few people who would freely choose suicide?
      This issue is particularly important in a society that has no national health-care system. Some who find assisted suicide morally acceptable believe it should not be allowed in the United States until inequities in health care are corrected. Otherwise, they say, poor people will face greater pressure than others to die, or managed-care companies will promote assisted suicide as a cheaper alternative to prolonged caregiving.
      The pressure a sick old person faces may not always be as obvious as relatives who wish Grandma wouldn't spend down their inheritance by lingering in a nursing home.
      Hendin, the psychiatrist who opposes assisted suicide, says that people who ask for suicide are often subtly influenced by the attitudes of those around them -- including members of the family who can't bear the dying process, and doctors who need to assert control over illness.
      "Requests for assisted suicide usually reflect the same ambivalence that is seen in other suicides," Hendin writes. "The outcome in such cases is often determined by whether family or physicians choose to hear the wish to continue living or only to support the wish to die."
      Those who support assisted suicide, however, point to numerous surveys showing that it's occurring anyway -- in secret and unregulated.
      "Would it be worse or better to bring the practice out into the open and regulate it?" says Dan W. Brock, a Brown University bioethicist. "No practice is going to be free of all abuse."
      Furthermore, Brock says, the same pressures that Hendin and others fear would lead to the abuse of assisted suicide come into play in decisions concerning the removal of life support, which is an accepted practice: there's no evidence, says Brock, that the power to remove life support is being abused -- that doctors are rushing to turn off respirators so that children can get their parents' money. So why would it be different with assisted suicide? After all, he says, we remain a society that denies and defies death, and doctors continue to battle death at every turn.
      Supporters of assisted suicide also say that legalization would come with strict guidelines, reducing the likelihood of abuse.
      For example, the law that was proposed in Rhode Island -- based on model legislation co-written by Brock -- would have required, among other things: that the patient first be offered hospice care and other comfort care; that the patient's conversations with the physician be witnessed and videotaped; and that a consulting mental-health professional affirm that the patient's judgment is not clouded by depression or any other disorder.
      But Hendin points to the experience of the Netherlands to argue that once we step onto the "slippery slope" of allowing assisted death, any guidelines will inevitably be breached. In the Netherlands, assisted suicide and euthanasia -- mercy killing -- are technically illegal, but exceptions to the law are allowed if doctors meet certain guidelines.
      Hendin says that those guidelines have been repeatedly ignored and revised, to the point where doctors sometimes decide that patients are better off dead without consulting them, and euthanasia has been performed on people who are not physically ill but simply unhappy.
      Hendin's critics dispute his interpretation of the data from the Netherlands; they also say that he puts too much emphasis on a few cases of abuse, and point out that Dutch society is very different from ours.
      The fact is, no one knows what would happen if assisted suicide were legalized in the United States.

onday, December 9

      Are you afraid of dying?
      "Not a bit."
      When did you lose the fear of death?
      "Incrementally, over time. Not just the war, where I saw a lot of death. Not just the experiences with friends of the family, or in the hospital. I began to realize that death was not so terrible in certain circumstances -- it was a welcome relief for so many people.
      "I now have a bedsore. There's nothing I can do about it.
      "My death will be a good death. It will be a relief to know that I'm not interrupting the lives of so many people. When I'm dead, people will stop worrying about me. People will stop separating from their families to come help me."
      If you had better alternatives for care, would you want to live longer?
      "I don't think so. This is not a quality experience."
      Why is the loss of your voice the cutoff point for you?
      "Because if I lose my voice, that's the last bit of quality I have. Last night I had an accident with feces. There was no dignity . . .
      "I can't enjoy food. I can't engage in sex. I can't dance. It's hard for me to converse. There's no intimacy except for those things that strip away my dignity."
      If someone could guarantee that you would be made comfortable at the moment of death, would you let death come naturally?
      Earley mouths, "No," but no sound comes out. He pauses, then tries again. "I'm really losing my voice. It's time . . . .
      "It will be a relief."
      A few hours later:
      "Wouldn't it be great if I were just coming down with something, and that's why my voice is going?"
      Whatever gave you that idea?
      "Wishful thinking."
[back to top]