When the Hemlock Society finally unraveled in 2003, its more radical members formed the Final Exit Network.

"A group of us got together in Chicago," Egbert remembers. "We said, 'What about the people right now who are suffering horribly?'"

The remaining members of the Hemlock Society evolved into Compassion & Choices, which has some 15,000 members and focuses on hospice care and legalizing physician-assisted suicide. Two days after the Georgia arrests, it released a statement disavowing any connection to Final Exit.

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.

"There is a distinction between aid in dying and assisted suicide," says Compassion & Choices' president Barbara Coombs Lee in a phone conversation from her home in Portland, Oregon. "Assisted suicide is irrational, the result of mental illness. Aid in dying is not mental illness. It's a courageous and prayerful inner dialogue on the meaning of life."

Persis Oberreither, a member of Compassion & Choices in Florissant, says she would never use the helium method. "Visually, it conjures up an image to me of an executioner's hood with gas pumped in. There has got to be a better way. That method is so undignified, it defeats the purpose."

Kurt Perry was scheduled to die on February 26 at his home outside Chicago. The Georgia arrests disrupted his plans. He'd been talking with Dincin and Rosalie Guttman, his exit guides, for three years. "They listen to me and give me advice about how to go through my life," he told the Chicago Tribune, "until my decision is made and I've suffered enough."

Perry, who is 26, has Charcot-Marie-Tooth, a neurological disease that weakens the nerves that control muscles in the hands and feet. It is not considered fatal. Perry can still speak and walk with a cane, and experts say his condition probably won't get any worse.

How can Final Exit justify helping a young man with a non-fatal disease end his life?

"The right to die is a civil right," argues Dincin. "It's not a right of religion to determine, it's not a right of the government, it's not the right of your family and friends. Whose life is it, anyhow?"

"We get a very small number of nut cases who are attracted to our organization," admits network board member Jerry Metz. "Some are lonely, some want the attention and the drama. Some make us jump through hoops until we find out we've been had. Those are darned rare, fortunately.

"We're not interested in talking people into ending their lives," Metz continues. "We try to talk them out of it. Some members get tired and protest that this is what they really want to do."

If clients waver in their decision to die, the exit guides are instructed to walk away.

"There was one woman near New Orleans," Hoggard recalls. "She had told the first responder she was off-and-on about wanting to do this. Her condition had periodic pain, and when the pain was present, she wanted to exit. When it wasn't present, she'd call us and say she wasn't ready."

Hoggard and his partner made three separate trips to see the woman, at Final Exit's expense. Each time, she changed her mind. Finally, says Hoggard, "We told her, 'It's your decision, but we don't think headquarters would want us to come back.' She called us at 4 a.m. and asked us to come back. We went back, and she went through with it.

"I felt OK about it," he continues. "She had gone back and forth the whole time. She knew she could change her mind, but she was in so much misery. She knew what she was doing."

This is one of the contingencies covered at exit-guide training, which takes place three weekends a year, usually at a hotel in a conveniently located city. At training new guides study the group's history and exit procedures, listen to stories from experienced guides, practice handling the hood and helium tanks, and learn how to deal with police. ("We tell them to refuse to say anything until they have a lawyer," Metz says.)

Exit guides say they have few regrets about their work. When describing cases, they speak calmly and matter-of-factly, though some are reluctant to give out specific details.

"It's nicer to die at home with your family if it is your wish and their wish," says Baker. "It can be a very tender experience. One time, there were teenagers involved. We all sat around and held hands. The man's wife said a prayer as he was dying. It was very touching and satisfying."

Says Ann Mandelstamm: "It's not like we do this every week. The cases are spaced apart. The exit-guide part is the most sensational, but really we want to help people with getting older and avoid being caught without advance directives."

Mandelstamm notes that last year in Oregon, 89 people got prescriptions of lethal drugs under the Death with Dignity Act. But only 60 of them decided to use them.

"Most people want to know they have a way out if things get horrible," she says. "They just don't want to do it that week. It makes sense. They're entitled to a way out if they want it."

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