At the time of the Georgia arrests, two exit guides were under investigation in Arizona for their roles in the 2006 suicide of a 58-year-old Phoenix woman named Jana Van Voorhis. (See "Death Wish," Phoenix New Times, August 23, 2007.) Van Voorhis did not inform her family of her plans. After her death her sister and brother-in-law claimed Van Voorhis did not have cancer, as she told Final Exit, but was, in fact, mentally ill.

Dincin concedes he's unfamiliar with the specifics of the Van Voorhis case but maintains that Final Exit did nothing wrong.

"Just because someone has a history [of mental illness] doesn't mean it's available all the time," he says. "There were a host of other difficulties. There were complaints by this woman's sister that she had been disinherited by $700,000. The sister was mad. We don't do anything to anybody they don't want done to them."

James Hoggard, an exit guide and former Baptist minister, with his companion, Julia Peggs.
Jennifer Silverberg
James Hoggard, an exit guide and former Baptist minister, with his companion, Julia Peggs.

After the Van Voorhis affair, though, Final Exit began scrutinizing its clients much more carefully.

The Maricopa County attorney has yet to decide whether to press manslaughter charges against the two exit guides. The case of the so-called "Georgia Four" is also in legal limbo. No trial date has been set.

"We'll see what happens," says Mandelstamm. "This could shut us down. Or, if it comes out in the legitimate press, it could get people talking. When I was young, no one ever mentioned cancer out loud. It was, 'She has'" — Mandelstamm's voice drops to a whisper — "'cancer.' There's a secret phase and a scary phase, and then it's out in the open."

James Hoggard has noticed that sometimes his clients' bodies will jerk and appear to gasp for breath as they die. But he doesn't believe they feel any pain once they pass out.

"We used to kill chickens on the farm by wringing their heads off," he says. "We'd pick the chicken up and swing it around till the body fell off. The body tries to get up and run. Sometimes it takes two or three steps, but it's not controlled by the brain. It's the body reacting."

Since its inception, Final Exit has preferred helium as its killing agent. Says Dincin: "It's quick, painless, certain, comfortable and humane."

In the 1992 edition of his best-selling Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, Derek Humphry recommended prescription drugs — specifically barbiturates, preferably Nembutal — ground up in Jell-O or swallowed with a stiff drink. He also suggested that patients tie plastic bags over their heads, just in case the pills didn't do the trick.

Deadly cocktails of this sort, though, often made patients dependent on their doctors and pharmacists. Humphry decided to bypass the medical profession altogether and, in the 2002 edition of Final Exit, unveiled a new method of painless suicide: inert gases, especially helium, which is easy to obtain.

"You can buy it at Toys 'R' Us!" Dincin proclaimed, to surprised laughter from the St. Louis group back in February.

Normally, you breathe in oxygen and exhale carbon dioxide. Most methods of asphyxiation prevent you from exhaling, so the carbon dioxide accumulates in the body and makes you gasp for air. Helium, however, flushes all the oxygen from the blood, and organs start to die off, one by one, starting with the brain.

Hoggard's companion, Julia Peggs, 64, attempted suicide eight months ago. Final Exit, she says, would not have approved her case. She'd recently had her colon removed and was in despair over the demise of an abusive relationship and unresolved grief over the suicide of her twin sister 30 years earlier.

After the colectomy, Peggs tried to slice herself open. "I was hoping to die in the ambulance because there had been a lot of blood. I felt myself going up and away. It felt wonderful. All the troubles of the world fell away. I thought I would see my sister. I was disappointed when the EMT started slapping my face around and giving me oxygen."

Scientists say that when the body senses impending death, it produces large quantities of soothing hormones, endorphins, to make final moments more pleasant.

Exit guides have also observed this sort of tranquility. Jerry Metz recalls one case where the client's wife sat at his feet with her eyes closed as he pulled the hood down over his head.

"She wanted to be with him, but not," Metz recalls. "She didn't see the 'V for Victory' sign he flashed with a big grin."

Lawrence Egbert joined the Hemlock Society fifteen years ago, after his minister asked him to help a fellow parishioner end his life. In the end, though, the patient didn't go through with it.

"His daughter didn't want it," Egbert remembers. "She thought it was bad, wrong. So he had two more months of Hell on this earth. He was doing what his daughter wanted. Was that better? I don't know. It's hard to argue."

Baker and Mandelstamm joined after witnessing the prolonged, painful deaths of close relatives.

They, like many of Final Exit's eventual members, wanted to be part of what Dincin calls a "direct service organization," more concerned with relieving suffering than trying to change the assisted-suicide laws. Unlike Dr. Kevorkian, who actually pushed the button to deliver fatal drug doses to his patients, the Hemlock Society's volunteers, called Caring Friends, did not play an active role.

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