APR 1995


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD


Assisted Suicide -- Gone Wrong

Originally published in Colorado's AIDS Newsletter, Resolute! , April 1995

Do not reproduce without the permission of the author

When Greg first asked Bill to help him die they had been together for twelve years, and it was the day after Christmas. Greg had been so weak that he couldn't lift a present. It was even too much for him to pull wrapping paper off of a box. He had such bad diarrhea that he needed a diaper change as much as seven times a day. Greg had lost so much weight his knees would knock together and cause sores. Because he had only wasting syndrome and no major opportunistic infections, they were told he could live several more months in this condition.

They first tried hospice care, but what was available at the time was offered nursing homes. The first place Bill looked at was so dirty he reported it to the Health Department. The second looked nice enough, but after Greg was left in his own excrement for three hours Bill took him home.

Greg had been asking for help for three months, but not specifically enough for Bill to respond. When Greg finally made it clear the day after Christmas, "I want you to help me die," Bill initially said he didn't think he could. Greg withdrew in anger until Bill relented. Then as Bill tells it, 'It was like he'd won die lottery, knowing he wasn't going to be suffering anymore."

This is becoming an increasingly common story that health professionals are hearing as PWA's opt for what is called rational suicide or self deliverance. Where just a few years ago mental health professionals felt an obligation to hospitalize someone under these circumstances to prevent such actions, the National Association of Social Workers came out with a policy statement in 1993 which was supportive of an individual's right to die. NASW stated: "If a social worker is unable to help with decisions about assisted suicide or other end-of-life choices, he or she has a professional obligation to refer patients and their families to competent professionals who are available to address end-of-life issues." There is a definite shift in our culture in its attitudes on the subject, and Oregon has passed a law (now challenged in court) condoning and regulating physician-assisted suicide.

In a study of physicians in San Francisco (1992), one in four said they would prescribe a lethal dose of medication for a PWA who requested it, and two in five would refer their patient to die Hemlock Society. In Amsterdam it is legal, and Prime Time Live recently documented in a very sympathetic manner a doctor helping a patient die. Sixty minutes and National Public Radio have aired similar accounts on the same subject. Clearly the mood of society is changing.

Unfortunately, Colorado's felony statutes specifically refer to assisted suicide as a form of manslaughter, along with recklessly causing the death of another, or killing someone in the heat of passion. Rep. Peggy Lamb recently introduced a bill in our state legislature to legalize physician-assisted suicide, but it died in committee There has been some talk of a petition drive to get the issue on the ballot, but I couldn't get her office to return phone calls for this piece.

Because of the legal restraints in this state, more unnecessary pain and violence is wrought upon the HIV/AIDS community. Without the help of a mental health professional the couple may lack support at the very time they need it most. I have had clients try and protect me, by not seeing me or not telling me what is going on until the deed has been done. In one instance, I didn't know until my client's lover came into my office and put his ashes on the coffee table between us.

Even worse, their actions may be ill considered and unnecessary. A member of one of my HIV groups considered a morphine overdose because he was afraid of death by choking -- which is the end he foresaw. The group's combined experience with dying was enough to reassure him that his dying process was not going to be with difficulty. He died peacefully a few weeks later.

And yet as Julian Rush, the Director of the Colorado AIDS Project, has said, "We can't guarantee PWA's a death that is pain free and with dignity." However, without the help of a physician the chance of a botched job is quite high. According to a study done at Simon Fraser University in Vancouver, close to half of the assisted suicides left permanent injuries or loved ones resorting to suffocation or slashing wrists. But if partners or family members don't assist, even more violence is a possibility; most typically the use of guns and hanging.

In the case of Greg and Bill, they used a lethal dose of pills. However, Greg's digestive tract wasn't absorbing properly, so although he was unconscious he didn't die. Bill recounts his story from this point:

"I think we probably started about one o'clock in the morning or so. So I just sat there, and I listened to music, and I don't think he ever really woke up after that. But I think when it got to be about 3 or 3:30 in the morning, I started freaking out thinking he was still alive. He was very much alive, and breathing just fine and so I tried to wake him up, and I guess I started panicking, and I guess I kind of said to him, you know, do you still want to do this? And I swear in my mind he said yes, mumbled the word yes. So I waited about another hour, and then I thought I have to do something soon, because once it becomes morning, and then his mother comes down and he's not gone, and it could be -- well, who knows what would happen. I was afraid that the amount of medication if it didn't kill him, would put him in a coma or would, you know, make him a vegetable, and then he would die naturally anyway, after how many days, but, I didn't want them to know. I didn't want anyone to know. Because I really thought I was getting away with murder. And I was terrified, and I remember at the beginning the blinds weren't closed, out to the backyard, and there really isn't any way anybody could see in because we had a big tree, and you know the garage was back there and stuff, and then I remember when finally did decide to use the plastic bag that was probably about 4, 4:30 in the morning, then I closed the blinds completely, but I kept looking around the whole time, because...

The first time I did the plastic bag, I put it on top of his head, and I made sure there were no air holes, and I laid on top of him over a pillow. I don't know how long -- it seemed like it was forever -- and I swear, I put my ear to his chest and I felt his nose and stuff and there was no movement. So I took the plastic bag and I hid it -- I don't even know where. Not that that would've done anything. And I went back in, and all of a sudden he goes like (gasps) and it's like he was just holding it in and stuff, and I thought he was gone, but he wasn't, and so he was taking this big deep breath, so at that point, I really freaked out, and I got two plastic bags, and I really made sure that they were tight, and I put a pillow, and I just lay on top of him.

It was really strange, but there was no going back at that point, you know. So it probably took more than five minutes. I really wanted to make sure the second time, because I wasn't going to do it again.

I'm sure he was drugged enough to where there probably wasn't any pain or any consciousness on his part. He was making a move, at the very end he made a movement and a sound of gasping for breath, because the whole plastic bag was really molded to his face because there was no air. His legs might have, you know, tensed up a little bit, moved up a little bit, his arms might have moved just a little bit, but no... no struggling. Definitely, no.

And then I still couldn't' tell because my heart was beating so fast, and I kept hearing something, and I thought, is that his heart or is that my heart? I had to call a friend with a stethoscope, and he confirmed Greg was gone because I really couldn't tell.

I picture that person laying on top of Greg with two plastic bags and a pillow, and it just doesn't seem like it was me."

Greg was unconscious, and he had said specifically with regard to suffocation, "Do whatever it takes. I just don't want to be here anymore.' Yet this is such a great sacrifice on Bill's part, one of the greatest acts of love one could do for another. Needless to say, it has left Bill with powerful grief, guilt and fear that could have been avoided with more support both psychological and medical at the time this was going on.

Susan Dunshee, President of the Compassion in Dying organization in Seattle sums it up best: "It is startling how many times assisted suicides fail, leaving both the victim and loved ones in terrible despair. Legalizing assisted suicide would help standardize the practice by allowing physicians to prescribe the right combination of drugs and to advise the patients properly."

A postscript: Bill now has AIDS himself and when asked if he would consider self deliverance he didn't hesitate to say, 'Yes, definitely if the quality of my life is severely compromised and I'm disabled to the point Greg was. But I wouldn't ask my present lover to help me.'


"AIDS Impact of the Right-to-Die Movement"

"Dignity Dead in Committee"

"Self-Deliverance as a Security Blanket"


Compassion & Choices (Formerly the Hemlock Society)

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Last messed with March 11th, 2010

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.