Sunday, May 22, 2011

Baltimore doctor helps the ill commit suicide,0,4152934.story

Baltimore doctor helps the ill commit suicide

Dr. Lawrence Egbert has been dubbed "The New Doctor Death"

By Justin Fenton, The Baltimore Sun

5:58 PM EDT, May 21, 2011

From a cluttered Baltimore apartment office, Dr. Lawrence Egbert says he has helped direct the deaths of nearly 300 people across the country.

Some of his patients, as he calls them, are racked with cancer, paralyzed or staring down Alzheimer's. Others simply want to slip away on their own terms. Sometimes family members gather around the bedside to say goodbye; in other cases, their appointed "exit guides" lock the door behind them and make arrangements for someone to stumble across the body.

A decade after Jack Kevorkian went to prison for helping a man with Lou Gehrig's disease commit suicide, Egbert, 83, has been dubbed "The New Doctor Death" by Newsweek after being criminally charged in two states for his role as medical director for the Final Exit Network. An Arizona jury acquitted him last month following a three-week trial in the death of a Phoenix woman. He has also been charged in Georgia.

The cases have revived the debate over assisted suicide and placed Egbert, a retired anesthesiologist, at the forefront of the debate over Americans' right to take their own lives. The Final Exit Network is the only known group performing such work, and members say their assistance is compassionate and progressive. Prosecutors call them "killers." Even other right-to-die advocates, including Kevorkian himself, disagree with their methods.

Amid the controversy, Egbert has been dismissed from his role teaching classes at the Johns Hopkins University and has had a falling-out with his church. After snapping his pelvis in a bicycle accident, he even contemplated taking his own life. But should he prevail in his pending case in Georgia, Egbert said, he'll resume his work with the Final Exit Network.

"I never thought of myself as having done anything that I should feel guilty of," said the Hampden resident. "I don't feel any conflict about helping someone stop suffering."

'Hasten death'

Jana Van Voorhis was descending into madness, relatives say. Born into a wealthy family, she had a bubbly personality. But she'd also battled mental illness since her teens and was increasingly complaining of aches and pains. Following the death of her mother, she began telling doctors that bugs were eating her kidneys and feet, and feared exposure to radiation and rat poisoning.

On April 12, 2007, she contacted the Final Exit Network and faxed paperwork to Egbert, who dispatched two regional exit guides to travel to Van Voorhis' Phoenix, Ariz., home, where she reaffirmed her desire to "hasten her death."

Final Exit's preferred method involves piping helium into an oxygen-eliminating hood placed over the individual's head. Largely for legal reasons, however, network members do not provide the materials and are hands-off in the actual suicide.

Instead, Van Voorhis' guides arranged pillows. They advised her to activate a minimal amount of helium from a tank, purchased at a party store, so the hood would not fly off. About eight minutes after Van Voorhis eased on the tank, she fell asleep. She began breathing irregularly.

Four minutes later, she was dead.

Her guides then moved some of the pillows, so her death would appear natural, and removed the helium tanks and the hood, and placed them in separate trash bins in an industrial park.

Unlike many cases, Van Voorhis' family had not been advised of her plans, and several days passed before her brother-in-law found her dead. Something didn't seem right.

"She was 58 years old, and she was in relatively good health," Jared Thomas, 66, who found the body, told The Sun. "It was unusual to see someone that age dead in bed, especially when it was made to look so clean and sanitary, like she had died in her sleep."

Final Exit Network

Though always active in social advocacy, Egbert's interest in the right-to-die movement came late in life. Born in Chevy Chase, Egbert went to high school in the District of Columbia and attended the Johns Hopkins University and the University of Maryland Medical School.

During a stay in Texas in 1982, he read a newspaper article about a man who had been executed by the state through lethal injection. The article listed the cocktail of drugs used by the state, and Egbert recognized them as the very same drugs — in similar doses — that he was administering to patients.

He says the key moment came in the mid-1980s when the pastor of the Unitarian Universalist Church in Dallas asked if he would euthanize a parishioner with cancer. After researching the issue, he agreed, and though the woman's daughter talked her out of it, he became a believer in the benefits and rights to assisted suicide.

Egbert joined the Hemlock Society, which helped pass the nation's first law permitting physician-assisted suicide in Oregon. In 2000, he was present for the first time at a suicide, when a Philadelphia man suffering from cancer took his own life. In 2004, an ideological rift caused the Hemlock Society to merge with a more moderate group called Compassion and Choices and focus on legislative advocacy. Egbert was among those who formed a nonprofit called the Final Exit Network, and he became medical adviser.

The network's "patients" call a hot line, and their information is passed on to a regional coordinator who asks them questions and evaluates their condition and whether they have exhausted their options.

"We basically start with the idea that if a person wants to commit suicide, that is a reasonable statement, given their psychological state now," he said. "Whether you can do something about that, or should, is a whole other debate."

During his tenure as medical advisor, Egbert said patient information was sent to him, and he determined whether the group would assist. "For at least 95 percent, we say OK," he said.

Final Exit Network counts thousands of supporters and has volunteers throughout the country who act as counselors, called exit guides, to help clients through the process. While some people decide against following through, others keep in touch with the guides on a stand-by basis.

Egbert said he has been personally present for nearly 100 deaths, including a handful in Baltimore.

He recalls the death of one man who had prostate cancer that had invaded his spine, and 13 relatives and their families visited to say goodbye. He tears up recounting how the wife and children of a North Carolina man with Lou Gehrig's disease placed their hands on him as he took his last breaths. Many patients want Beethoven playing in the background.

"To be part of the process that makes that possible to do — with considerable dignity — that's beautiful," he said.

Guides are strictly prohibited from doing anything more than counseling the patients. It was Kevorkian's personal administering of a lethal injection that led to his conviction, and Final Exit believes its work is protected First Amendment speech.

Compassion and Choices said it does not "use or recommend" the FEN's methods. "A terminally ill person's ability to ask their doctor for aid in dying should be part of medical practice, and that's what we're working towards," said spokesman Steve Hopcraft. "Without good legal options for end-of-life care, you open for the door for people like Kevorkian, and other individuals, to fill that gap in ways that may not be ideal."

Jerry Dincin, president of the Final Exit Network, said the helium method is "the kindest, quickest" way to die. "This is just another civil right that we have to fight for."

In the courts

Police investigated Van Voorhis' death for nearly two years, and in 2009 a grand jury indicted the two guides — Frank Langsner, 86, and Wye Hale-Rowe, 83. Egbert, who had never set foot in Arizona, and Roberta Massey of New Jersey were also charged.

At trial, prosecutors repeatedly referred to the case as a "killing" and described the group as "people who enter a home, help kill people, and cover it up," according to an account of the proceedings.

Hale-Rowe and Massey pleaded guilty, and Langsner's case ended with a mistrial. Egbert, however, was cleared of all charges.

Van Voorhis' family pushed authorities to take the case, and they believe Egbert caught breaks from the system. Testimony about Van Voorhis' mental state was not allowed at trial, nor was testimony from a member of the network who was present for the death, her brother-in-law said.

"The jury's out on [assisted suicide]. But I think that universally it would be accepted that you don't do this with mentally ill individuals," said Thomas, Van Voorhis' brother-in-law.

Egbert argues that it wasn't his role to determine whether Van Voorhis had a rational request.

"We're saying it's rational given the givens she's suffering with," he said. "Nobody even got close to saying she wasn't suffering. We assume a person is doing something that makes sense to them."

A similar situation is alleged in Georgia, where a client's wife came across helium receipts and an entry on his calendar that mentioned someone she didn't know. Georgia authorities then set up a sting operation and raided the homes and offices of network members across the country.

The only difference between the cases where Egbert has been charged, and the dozens of others he has been involved with, appears to be the involvement and acceptance of family; when relatives respected the person's wishes and helped keep the true circumstances of the death quiet.

The Georgia case is being held up as the defense challenges whether the state's assisted-suicide law violates the First Amendment.

Sticking it out

Despite criminal charges and convictions of some of its members, the Final Exit Network continues its work.

Advocates say progress is being made in the effort to legalize assisted suicide. In 2009, Washington state became the second in the nation to legalize physician-assisted suicide, and courts in Montana have upheld the practice.

In Maryland, assisting with a suicide remains a felony punishable by up to a year in prison or a $10,000 fine.

Egbert said that he's received wide support since his arrest but that there has been a backlash locally. At Hopkins, he had been an assistant professor in the anesthesiology department, taught an ethics course, conducted interviews on prospective pre-med students, and was a Unitarian minister at the school's chapel. Following publicity of the criminal charges, Egbert retains only his title as a professor and is not teaching classes.

Through a spokesman, Johns Hopkins declined to comment on Egbert's dismissal.

Egbert, who rides a bicycle, fell and broke his pelvis in late 2009, causing terrible pain. It took a month before he could climb the steep, three-story staircase to his office. He said he decided he was ready.

"My wife got terribly upset when I said, 'I don't want to do this anymore, let's get a tank of helium and get this over with,'" he recalls.

So he stuck it out. These days, he appears to be in fine shape and climbs the stairs to his office with no apparent restrictions. Did the experience give him pause, that perhaps he'd helped hasten the death of others who could've gone on to live healthy, productive lives? Egbert says no.

"The answer is, it goes back to respecting the person at the time," he says.

Copyright © 2011, The Baltimore Sun

Donations can be sent to the Baltimore Nonviolence Center, 325 E. 25th St., Baltimore, MD 21218.  Ph: 410-366-1637; Email: mobuszewski [at]


"The master class has always declared the wars; the subject class has always fought the battles. The master class has had all to gain and nothing to lose, while the subject class has had nothing to gain and everything to lose--especially their lives." Eugene Victor Debs


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