Do-It-Yourself Death Lessons

By WILLIAM A. HENRY III

Most how-to books instruct readers in ways to refinish furniture, profit from a recession, communicate with one's in-laws or cook some exotic ethnic casserole. But one of the hottest tomes of the moment -- it has sold out its first printing of 41,000 copies and will top next week's best-seller list of how-to and advice volumes in the New York Times -- explains, step by step, how to end a human life.

The book, Final Exit, is a manual for committing suicide or helping someone else to do so. It includes charts of lethal dosages for 18 prescription drugs, primarily pain killers and sleeping tablets; it debates and debunks the merits of cyanide; it offers abundant practical advice about asphyxiation by plastic bag or auto exhaust. Seemingly every detail is addressed: mixing pills with yogurt or pudding so that the patient does not vomit or pass out before ingesting a lethal amount; not turning off the telephone or message machine, because "any changes will only alert callers to something unusual happening"; having family members avoid any direct physical assistance, so they cannot be prosecuted; and, if concealment of the cause of death is sought, telling heirs to object to an autopsy.

Even more jarring to critics, the book exhorts doctors and nurses actively to abet the "self-deliverance" of the terminally ill. Author Derek Humphry contends that such assistance is common but tacit. "Part of good medicine is to help you out of this life as well as help you in," he argues. "When cure is no longer possible and the patient seeks relief through euthanasia, the help of physicians is most appropriate."

Humphry proudly asserts that he has assisted three family members in ending their lives when they faced intolerable pain or debilitation: a brother whose life-support machinery was disconnected and a wife and father-in-law who took sleeping pills. A former journalist with the London Sunday Times and Los Angeles Times, he now makes his living promoting the right to die. He is the author of three previous books on the subject and founder and executive director of the Hemlock Society, a group based in Oregon that claims 38,000 dues-paying members. Its motto: "Death with Dignity."

One committed member, publisher Steven Schragis of Carol Publishing Group, a small New Jersey house that is distributing the book, urged Humphry to move beyond philosophical arguments to practical guidance. Schragis says, "At some point you have to make a decision: Should people be able to have this information? This is our way of making a statement that they should." Alan Meisel, professor of law and director of the Center for Medical Ethics at the University of Pittsburgh, sees the publication as a significant change. "People are very worried that their dying is going to be prolonged and painful," he says. "With this book, it's clear we have entered a new phase of the right to die."

The book was published in April but at first languished unnoticed. Then, after a Wall Street Journal feature and stories on ABC's Good Morning America and CNN, sales skyrocketed. Says Humphry: "People want to take control of their dying. My book is a sort of insurance, a comforter there on the bookshelf that they could make their escape from this world if they were suffering unbearably." According to bookstores, many customers who seek the book are elderly; some others appear to be health-care professionals or AIDS patients. To date, apparently no one has been publicly identified as having relied on the manual to complete a suicide.

Given how controversial the topic is, Final Exit has generated surprisingly little heat. No prosecutor has attempted to suppress it. The National Right to Life Committee criticizes it in interviews but is not actively campaigning against it. A few booksellers decline to carry it, generally on moral and religious grounds. Says Ruth Holkeboer, owner of the Bookworm in Grand Rapids: "My father was a doctor, and my brother is a doctor. I was raised in the atmosphere of caring for life and saving life. My sales staff felt the same way. They said they could not put such a book in a customer's hands when they didn't know how it would be used." Some physicians are offended. Lonnie Bristow, a trustee of the American Medical Association who practices internal medicine in San Pablo, Calif., says, "For doctors to on one hand be of help and on the other be harboring ideas of dispatching their patients would destroy the therapeutic relationship of trust."

Some critics have contended that the book might encourage suicide among the unstable. But the text is full of cautionary statements about the value of counseling. Humphry distinguishes between "rational" suicide, undertaken by the irreversibly handicapped or the terminally ill, and "emotional" suicide by those who are depressed, of which he disapproves. He says, "My book pleads with the depressed to go to a psychiatrist. But it's addressed to the 6,000 people who die every day, not the handful who commit suicide." Others have been concerned that the book's data on lethal doses might make suicide -- or murder -- easier. Yet the U.S. is a society in which guns can be obtained with less paperwork than automobiles, and almost every kitchen contains some lethal cleanser.

Humphry argues that he will not make suicide easier -- just more reliable, less painful, less messy and above all less solitary. He urges those who choose suicide to gather family and friends around them for solace as they slip away. That gesture might require the biggest social and cultural change of all. Many people who could accept the idea of ending a loved one's pain would find it impossible to watch, and be complicit in, the actual suicide. For the one who dies, there may be a final exit. But those who live on might have to dwell with ceaseless doubt, guilt or scorn. Even if a suicide is rational, mankind remains emotional.

With reporting by Daniel S. Levy and Leslie Whitaker/New York