After death of Jack Kevorkian, Lawrence Egbert is the new public face of American assisted suicide

After the death of Jack Kevorkian, Lawrence Egbert is the new public face of American assisted suicide
By Manuel Roig-Franzia, - Washington Post
January 19, 2012

Dust speckles shelves up on the third story. Wood floors creak. Walls and cabinets in the cramped office, tucked into a red-brick Baltimore rowhouse, channel a generation’s worth of sloganeering.

“We shall overcome Reagan”

“Nuclear Free Zone”

“Don’t buy war toys”

Lawrence Egbert comes here almost every weekday, taking calls on an old white push-button phone with a handset darkened by years of smudged newsprint and perspiration. He climbs the stairs, slower now since a bicycle accident two years ago cracked his pelvis, but steady and resolute.

Amid the kaleidoscope of distractions, a lumpy white garbage bag slumps on the floor against a metal bookshelf. Egbert doesn’t object when I ask to peek inside.

I pull the yellow drawstrings, and the bag sags open. A muddle of plastic lies before me. Long plastic tubes twine around each other, refusing to let go, like stubborn tendrils of ivy clasping tree branches.

Egbert, a slightly built, genial and energetic retired anesthesiologist with a snowy goatee, turns to his computer, his back to me, content to answer an e-mail while I sort through the pile. Once I finish untangling, I hold in my hands a curious plastic sack, about 21 inches long and 18 inches wide. A bunched white elastic strip, reminiscent of a garter, circles the mouth at the open end. A thick plastic tube runs into the sack, stretching 37 inches before branching into a T-shape with 12-inch arms extending from each side of the joint.

Egbert calls it an “exit hood.” It’s a contraption that can end a life in minutes. The 84-year-old doctor, who formerly served as a campus Unitarian Universalist minister and has taught as an assistant visiting professor at Johns Hopkins University, offers to explain how it works. The tube connects to two helium tanks, he says. He lifts the hood over his head and lowers the open end, letting go as the garter clamps to his forehead. Then, he says, you release the valves on the tanks, streaming helium into the hood.

“You fill it up until it feels like a New York chef’s hat,” he says, stretching the hood to demonstrate.

Then, he says, you pull the hood down. And he does just that, easing it past his eyes, his nose, his chin, and cinching it even tighter at his neck with a sweatband. His face goes hazy behind the plastic, a blurry image of a man whose life and work are prone to distortions and intrigue. His breath fogs the plastic, but he holds the hood there for a moment, saying something that I can’t quite make out.

Might he need saving?

Another breath. More fog. Even though there’s no helium coursing into the hood, I’m anxious. Should I pull it away?

Another breath, and, finally, he lifts the hood. He inhales deeply and smiles.

“That’s how it’s done,” he says matter-of-factly.

In those final seconds before his patients lose consciousness and die, the words they utter sound like Donald Duck, he says, imitating the high-pitched, nasally squeak familiar to any child who has sucked a gulp from a helium balloon.

So, this is how a human being can leave this Earth?

Sounding like Donald Duck?

Egbert estimates he has been present for 100 suicides in the past 15 years, a figure that puts him in the same league with the famed assisted-suicide maverick Jack Kevorkian, who claimed to have helped more than 130 people die. Egbert calls Kevorkian a “radical” because the latter took an active role in some suicides, building a machine to administer lethal doses and sometimes injecting patients himself. Egbert sees his work as a calling, a vocation aimed at ending suffering. But he says he provides only guidance and support.

Egbert says he approved applications for about 300 suicides, most as medical director of the Final Exit Network, a loosely knit group that claims 3,000 dues-paying members. Even within his own organization, Egbert is controversial. The vast majority of the network’s members suffer from painful physical ailments such as late-stage cancer, he says. But unlike the group’s current leadership, Egbert is also willing, in extreme cases, he says, to serve as an “exit guide” for patients who have suffered from depression for extended periods of time.

At the same time that Egbert was guiding the people he refers to as his patients, Kevorkian was the embodiment of the national debate over assisted suicide, a figure of simultaneous international renown and scorn. But with Kevorkian gone — he died in June — two indictments of Egbert, one in Arizona and another in Georgia, have transformed him into the public face of American assisted suicide, a practice as tangled in controversy as the contents of the bag I had just opened. It has been more than 17 years since Oregon voters passed a ballot initiative approving the nation’s first assisted-suicide law for terminally ill patients. Only one other state — Washington — has legalized the procedure, and the American Medical Association remains firmly opposed. (Montana’s Supreme Court issued a ruling in 2009 that essentially sanctioned assisted suicide, but the legislature hasn’t formally passed a law, leaving the state in a legal limbo.)

Egbert has been acquitted in Arizona, but the Georgia case looms, trudging slowly through the court system toward a possible trial that could further shape national opinion about assisted suicide. Egbert lacks Kevorkian’s public relations flair — he’s not one to dress in costumes — and he lacks Kevorkian’s certitude. I expect to find an absolutist, a proselytizer for a cause, when I first drive to Baltimore to meet Lawrence Egbert. Instead, I encounter a man whose zeal is tempered by self-doubt.

“Once I am a true believer, that’s the time I should quit,” he says one afternoon. “I never get used to it. I’m not used to it now.”

Egbert has worked with patients who used barbiturates or morphine to speed their deaths, but he says those treatments can be hard to acquire in the quantities necessary to end life. Helium, on the other hand, is easy to get. Final Exit’s patients are instructed that they can buy helium tanks at party stores, Egbert tells me. Remnants of his clients’ visits to party stores lie beneath the hoods, at the bottom of Egbert’s garbage bag. Here is a pack of balloons. Pink, blue, yellow, green.

For the hoods, Egbert’s organization has recommended two suppliers: One sells a $60 hood with a “very adjustable ‘sweatband’ neck, considered superior to bags with Velcro necks,” according to a script used by volunteer phone operators, known as “first responders.” The other option is called an “Orchid Bag” and has an elastic neck.

Egbert tells me that years ago he asked someone who was about to “exit” if he could reuse the hood to save future patients the cost of buying a new one. The patient was delighted with the idea, Egbert says. He started asking everyone.

The hood in my bare hands feels slightly slick. So, this one, the one I’m holding, has been used to end someone’s life? I ask. Egbert tells me it has surely been used at least once, and maybe several times, and the same could be said for most of the other 17 hoods in the garbage bag.

“Do you wash them?” I ask.

Egbert laughs.

“Nobody’s ever asked me that,” he says.

He considers this for a moment.

“If a person is going to die, what do they care?” he says. “They’re not going to get infected.”

He says patients lose consciousness within 30 to 60 seconds of pulling the hoods over their faces and are usually dead within five to 10 minutes. “They turn blue or bluish — we can say gray,” Egbert says. “After they’re unconscious, their muscles start twitching. That’s very upsetting to relatives. Some think they’re trying to wrench the bag off.”

I ask Egbert how much helium it takes to kill a person. “I don’t know,” he says. He recommends buying 50-liter tanks. “I know we have two tanks, and we run them to zero. Until they stop hissing. ... It’s better to have too much than too little.”

I find myself staring at one of the hoods, turning it over and over, trying to comprehend how someone could spend the final moments of life with this thing over his head. I tell Egbert that the hoods make me feel uncomfortable.

He responds in a reed-thin voice, with the manner of a country doctor: “I hope so.”

***

The newspaper story told of a death penalty case in Texas, but Egbert couldn’t stop thinking about the people who were consulting with the executioners. They were doctors. Doctors like him.

For a man in his ninth decade of life, Egbert has a remarkable memory. The exact date of the execution is etched: Dec. 7, and the year, he says, was in the early 1980s.

Later, I look it up. Indeed, on Dec. 7, 1982, Texas executed a man named Charles Brooks Jr., who had been convicted of murdering a mechanic. It was the first execution in the nation by lethal injection.

At the time, Egbert says, he was working as an anesthesiologist at Parkland Memorial Hospital in Dallas, the same facility where President John F. Kennedy was taken on the day of his assassination. Egbert guided surgery patients from consciousness to unconsciousness and back again. “Anybody can put ’em down,” Egbert tells me. “It’s the skillful ones who can wake ’em up.”

The death penalty left off that final stage — the reviving. “Why are doctors doing this crap?” he thought.

Later, a Unitarian minister asked whether Egbert would assist in the suicide of a terminally ill member of his congregation. Egbert’s thoughts flipped back to the death penalty. Would he be like those doctors? Eventually, he concluded that assisting the ailing woman in committing suicide was a “humane” way to end suffering.

The woman’s daughter ended up talking her out of it. But Egbert was sufficiently intrigued to join the Hemlock Society, an organization founded by journalist and author Derek Humphry, who would later write a huge bestseller, a suicide how-to guide called “Final Exit.” (The Hemlock name would later be abandoned; some former members became part of a right-to-die advocacy organization called Compassion & Choices, while others, including Egbert, helped create the Final Exit Network in 2004 because they wanted to actively work with people who were contemplating suicide.)

Egbert’s first suicide case involved a successful businessman in suburban Philadelphia, he says, though he doesn’t remember the exact date. Egbert rattled off instructions so quickly, he recalls, that the man told him, “Slow down! I’ve never done this before.”

“Well, it is a once-in-a-lifetime experience!” Egbert responded. They laughed so hard, Egbert says, that they alarmed the man’s wife, who came running downstairs.

In the early days, Egbert says, he and other volunteers used a common supermarket “turkey bag,” which had a tendency to fail on occasion. Once, he recalls, he was working with a woman who’d had two unsuccessful suicide attempts. The woman seemed to die but awoke a few minutes later. “You screwed up twice yourself — you call in the pros, and we couldn’t do it either!” he told her. They patched a hole in the bag, and this time it worked.

Another time, he advised a patient who was using large quantities of morphine to down the pills with vodka. “I prefer chardonnay,” she told him. He got her a glass.

As Egbert burrowed deeper into this world, he often thought of his father, Lawrence Egbert Sr. Good-paying government jobs had allowed his father to provide a comfortable home in Chevy Chase, where Egbert grew up among the region’s privileged classes. But his father’s sunny demeanor was changed by his experiences on the military prosecution team at the Nuremberg trials of Nazi war criminals.

The senior Egbert, an Army lieutenant colonel who later was an editor of the official trial record, would sit in the back yard staring blankly after returning from Europe. He was haunted by the testimony and his inspections of death camps.

The father’s experiences prompted the son’s curiosity. The younger Egbert fixated on the appalling actions of Nazi doctors, especially the experiments they had conducted, such as immersing inmates in ice water or injecting them with poisons.

“Most of them thought it was justified,” Egbert says one afternoon. “Some of them were delighted by it.”

As he did with the death penalty doctors in Texas, Egbert weighed the choices that Nazi doctors made — choices that eventually led to unspeakable evils — against the choices he made.

“It makes me suspicious of everything I do — that I might be doing something evil,” he says. “I think about it a lot.”

He thinks of doctors consulting for executions, for instance, and imagines “a slippery slope.” He also wonders whether his own work could nudge society toward something awful.

“I could be part of a slippery slope,” he says, “to us becoming like Nazis — the Final Exit Network, and me as an individual.”

***

Steven Kahn seemed like a perpetual-motion machine. He took up Rollerblading in his late 40s, recalls his wife, Merrily Kaplan. He swam and rode bikes.

Then he started falling down. “A lot of people thought he was drunk,” Kaplan recalls. “He was slurring his words.” Eating became an exercise in choking and spitting.

What people didn’t know was that Kahn, at 50, had received a diagnosis of amyotrophic lateral sclerosis, the degenerative disease that felled baseball legend Lou Gehrig.

As Kahn’s illness progressed and one treatment after another failed, he began to meticulously consider his options, Kaplan says. Doctors and hospice volunteers wanted to talk about managing his pain; he wanted to talk about ending it quickly.

Kahn, who had been an architect in New Haven, Conn., thought he could shoot himself or hang himself, Kaplan says. But then he realized he wouldn’t have the strength to pull the trigger or knot the rope. He thought about crashing his car over a cliff, but he couldn’t be sure he’d die, Kaplan says. For a time, they warmed to the idea of sleeping pills. Friends would call and say, “I saved three pills for you!” But they could never accumulate enough.

They found the Hemlock Society while doing research on the Internet, and that led them to Lawrence Egbert, whom Kaplan took to calling “The Man With the Hood.” She was simultaneously comforted by him and ill at ease. “Do I make him tea?” Kaplan recalls telling a friend before his visit to her home on the Quinnipiac River. “What’s the protocol? It was just bizarre.”

Kahn wanted to die in a back room, where he had installed glass walls overlooking the river. They set a date with Egbert in March 2003. On the day of her husband’s death, Kaplan served his favorite carrot cake. He couldn’t eat it — he was being fed through a stomach tube. But he placed a bit to his lips so he could taste it.

Egbert arrived with a clergyman, and Kaplan stationed friends at the front and back doors to block visitors. Someone pulled the shades open, so Kahn could see the river one last time, Kaplan recalls.

Kahn “mostly” placed the hood on his head himself, she says. She doesn’t remember who helped. She thinks he was able to turn the helium valves himself. As it began to flow, “he just kind of drifted,” she says. “I remember feeling very proud. His eyelids kind of fluttered. He got kind of still.”

There was one more thing she needed to do: “Cancel the chocolate pudding.” A friend was going to bring some over that night for Kahn. He wouldn’t need it now.

Kaplan, in effect, was the grieving but satisfied family member. Yet it wouldn’t be long before Egbert began accumulating family members who felt aggrieved.

***

On Feb. 25, 2009, law enforcement agents climbed the stairs of Egbert’s Baltimore office and placed him under arrest as part of a probe by the Georgia Bureau of Investigation, or GBI, into the death of a 58-year-old man from Cumming, Ga., named John Celmer. The officers seized Egbert’s computer and took files from a cabinet, he says. Curiously, the garbage bag full of exit hoods was left untouched.

The arrests paralyzed the Final Exit Network. Exit guides, fearful of prosecution, began canceling suicides. A 60-year-old New Jersey woman who had joined the network in the latter stages of an incurable brain disease was furious about the halt of operations and committed suicide on her own using helium tanks and a hood, according to a report in the Philadelphia Inquirer.

Bank accounts containing more than $300,000 were seized by the GBI. The network’s attorney, Robert Rivas, accuses state authorities of trying to bankrupt the network. But investigators bungled the seizure, failing to file a complaint required under racketeering laws, and a judge ordered the money returned.Forsyth County District Attorney Penny Penn and a GBI spokesman declined to comment.

Three months after the arrests in the Georgia case, Egbert, who was free on bond, was indicted along with three others in an Arizona case, this one involving the 2007 suicide of a 58-year-old woman from Phoenix named Jana Van Voorhis. Her sister did not know about her plans and had complained to authorities. Egbert was not present for either the suicide in Georgia or the one in Arizona. But he’s the common thread in the cases. Indeed, he’s the common thread in the entire Final Exit Network, as he was responsible for signing off on all suicides for the group.

To be “guided” by the network, people who want to commit suicide are asked to apply for membership and pay annual dues of $50, which goes toward operating expenses such as travel. After a person joins, a “medical committee” decides whether the applicant is eligible, starting a process of consultations that can last years. The committee was supposed to have three members, but in reality Egbert was making most of the decisions on his own.

The Arizona case took two years. Two of Egbert’s colleagues pleaded guilty to facilitating manslaughter and agreed to testify, but Egbert dug in. In April 2011, after a two-and-a-half-week trial, the jury acquitted Egbert of conspiracy to commit manslaughter.

The Georgia case, which centers on Celmer’s death in June 2008, is moving more slowly. Celmer had discovered a lesion in his mouth in 2006 that was eventually diagnosed as cancer, his wife, Sue Celmer, said in an interview. The Celmers had lived separately for 10 years. But they occupied townhouses in the same development, and he remained on her health insurance policy, she said.

Chemotherapy swelled John Celmer’s face, and his skin was forever hot, she said. His gum tissue deteriorated, exposing sharp bones that sliced his tongue; a hole the size of a quarter formed under his chin.

In late May 2008, doctors rebuilt his jaw with bone from his calf. They shaved skin grafts from his chest and thigh, exposing raw, irritated flesh, she said. “He was a mess,” she said. “He was furious.”

Unbeknownst to his wife, John Celmer had already contacted the Final Exit Network by the time he underwent the surgery. Sue Celmer believes her husband didn’t tell her what he was considering because he knew she would disapprove on religious grounds. According to legal documents, he had bought an exit hood from a small company in California called GLADD, which stands for Good Life and Dignified Death. He had also bought helium tanks at a party store in Cumming, Ga.

At various times, Sue Celmer said, he was taking Chantix to try to quit smoking, and taking oxycodone or applying morphine patches to manage his constant pain. “Anybody who takes that many drugs is in no position to make decisions about their lives,” she said. “He was like a drowning man, and they saw it as a grand opportunity to promote their agenda and drown him.”

On June 19, 2008, Sue Celmer walked into her husband’s home, as she often did, and found him lying in bed dead. The scene seemed staged, she thought.

She sifted through her husband’s things and found literature from the Final Exit Network. She prayed, then she called the coroner. A postmortem examination showed that John Celmer was cancer-free at the time of his death, according to authorities.

The GBI took up the case and arranged a sting operation, contacting the Final Exit Network and assigning an agent to pose as someone who wanted to commit suicide during a meeting with two of the group’s volunteers, Nicholas Sheridan and Claire Blehr. The volunteers allegedly showed the agent how they would hold down his hands so that he couldn’t remove the hood while he was breathing in the helium, according to the GBI. The allegation, which the volunteers have denied, contradicts the Final Exit Network’s claim that its volunteers do not actually “assist” in suicides, but merely provide information, guidance and companionship. Shortly after the sting, Egbert, Sheridan, Blehr and Ted Goodwin (the group’s president at the time) were all arrested on charges of assisting in a suicide, tampering with evidence and racketeering.

Since then, though, Sue Celmer suspects the Final Exit Network of playing a delay game and wonders why the prosecutors don’t push ahead. She has already arrived at her verdict. “I call it murder,” she said. “Hitler thought he was justified in killing people he didn’t think should live. This is not a far stretch from that.”

While waiting for the case to play out, Egbert has agreed not to attend suicides. He wouldn’t talk about the cases, except to say one thing: “As far as I’m concerned, I’d do it again.”

***

The Final Exit Network is guiding people to their deaths again. Egbert is no longer the group’s medical director. He hopes to resume working as an exit guide after the Georgia case. Volunteers say he’ll find a changed organization, one that is more restrictive and less daring or, depending on one’s perspective, less reckless.

“After the Arizona case, we began to stress [family notification] even more than we had been,” says Wendell Stephenson, a Fresno City College philosophy instructor who recently became Final Exit Network’s president. “The problem is that ultimately we have to respect the wishes of the individual who wants his life to end.”

Egbert has estimated that he approved 95 percent of applications. “His presumption is that they’re going to be a good candidate,” Rivas says of Egbert. “I don’t think we have that presumption anymore.” The group is also enforcing its requirement for a three-member medical committee, he says.

“The organization, by being tighter, is saying very clearly that they’d like to reduce the likelihood of this happening again — legal stuff happening again,” Egbert says. I ask him if he considers the changes a direct criticism of him. “Definitely,” he responds. “I was annoyed.”

Egbert is an original member of the network and remembers heated debates in 2004 when the group was formed at meetings in Chicago. Egbert participated by phone, arguing that they should take patients with long-term depression who did not respond to treatment.

Earl Wettstein, an advertising executive who served as the network’s first president, opposed because he thought taking depression cases would push “the envelope beyond our original intent. ... It was a matter of it was hard to diagnose, and, to me, it was not a terminal or life-ending condition.” He lost the argument and resigned in protest.

With the imprimatur of the board, Egbert took the case of a depressed woman in the Midwest; he won’t say exactly where to protect her anonymity. He went to her home with Jerry Dincin, a psychologist who later became president of Final Exit Network and confirmed the basic outline of the case as related by Egbert. (Dincin recently resigned as president because he suffers from terminal cancer. He has purchased helium and a hood, but said in an interview that he isn’t sure whether he’ll “be courageous enough” to use them.)

The woman was a 65-year-old teacher who had suffered from extreme bouts of depression since she was a teenager and was prone to violent outbursts. Still, “I had very lively mixed feelings, just looking at her,” Egbert says. “Very attractive, very intelligent. A woman who could walk for miles — pretty much do anything.”

He decided she qualified, though, because she had tried antidepressants and electroshock therapy without success. Egbert and Dincin rented a car and drove to her home. She put on a bathrobe and followed their instructions to sit with her head tilted slightly up. She released the valves, pulled the hood over her head and Egbert told her to “breathe normal.”

“At that time I took her hand,” Egbert says. “My colleague took her other hand.” He was comforting her, not trying to stop her from removing the hood, he says.

When it was done, they collected the equipment and left.

“We did her,” Egbert recalls. “I can feel the discomfort [about making that decision] still.”

***

Helium tanks and a hood wait in June Lennon’s closet in Bayonne, N.J. Once, she came close, incredibly close, to using them.

June, now 46, suffers from chronic obstructive pulmonary disease, better known as COPD, and when the summer heat greets the pollutants from the factories near her home town, she says she can barely breathe. She has lost count of how many times she has been hospitalized or placed on a ventilator.

Asbestosis had taken her Uncle Walter. His face was grayish-blue the last time she saw him alive; his breaths, mere puffs. Emphysema got Uncle Al. Lung cancer snatched Great Aunt Eileen. But Mom, also named June Lennon, she was the worst. Six months on and off ventilators because of COPD. She gasped for breath to the end, which came in March 2005.

Lennon fell into depression, then the summer arrived, and summers are always bad. Lennon, who works as a doctor’s office administrator, decided death would be preferable. She searched the Internet for “painless suicide methods,” or as she was thinking of it, “serene ways to do yourself in. Some were painless if you’re a really good shot.”

But shooting herself would be “messy,” she says, and Lennon doesn’t like messes. She knows a lot of cops, and she didn’t want to leave them with such an image.

Her Internet search brought her to the Final Exit Network, and to Lawrence Egbert. Lennon says Egbert tried to talk her out of it but agreed to her request when he saw her struggle to walk up a set of stairs. And so it was that one day in 2005, not long after her mother died, Lennon scheduled her death as if it were an appointment at the dentist.

It might have happened if Egbert hadn’t insisted on a friend being there. It was a guideline that he says he generally followed, though he sometimes made exceptions. Just before Lennon was to die, the friend she had chosen called to say she had gotten a great acting gig. “Darling,” Lennon says her friend told her. “You’re simply going to have to reschedule your death. I can’t go on with that hanging over my head.”

And so it was that Lennon canceled her own death.

Still, Lennon likes keeping her helium tanks around. She figures she might use them someday. It’s odd to hear her say this because she seems so utterly alive: funny, inquisitive, engaged in life. Our conversation at the bar at Hendrickson’s Restaurant, her neighborhood hangout, is interrupted often by her buddies. “Miss June!” the bartender calls out. “Chuckie!” she says. “Chuckie-poo,” she confides, “he knows my routine.” A few minutes later, she’s flagging down a young waiter. “Hello, angel. Hello, love. Did you start school again? Good luck to ya.”

She’s trying to lose weight. She looks healthy. How then could she be thinking about ending it all? Why not get rid of the tanks? She tells me things might look different — come summer.

***

Egbert can’t find his wife, Ellen. He has been calling for the past two days since arriving at the annual general assembly of the Unitarian Universalist Association of Congregations in Charlotte.

“I’m assuming my wife’s in jail,” he tells me.

Just this morning, Egbert spotted a small newspaper article about antiwar protesters being arrested at the U.S. Capitol, and he assumes — correctly — that she is among them. She estimates she has been arrested almost 200 times.

“An arrest is what drew us together,” he says. They were demonstrating in Nevada against nuclear weapons. Egbert was 29 years her senior and married to his second wife when he took up with Ellen Barfield, who is now 55. His wife found out and asked him to break it off, Egbert recalls, smiling. “We had a rational discussion about it,” he says. “I was having such a good time I wasn’t going to quit.”

Egbert and Barfield moved in together in 1991, but just got around to getting married in 2010 when someone pointed out that she would receive Social Security benefits after his death if they were wed. One of Egbert’s three great-grandchildren joined them to celebrate the nuptials, which they sealed at a Baltimore courthouse. Egbert also has five children and nine grandchildren.

Being a doctor, Egbert lends special skills from time to time to Barfield’s antiwar activism, her full-time vocation. Last year, he drew blood from his wife and one of her friends, who then sprinkled it on dollar bills. They yelled “Stop this war!” and tossed the blood-spattered bills into the aisle at a Senate Foreign Relations subcommittee hearing just as Sen. John Kerry (D-Mass.) was about to speak.

Barfield might have accompanied Egbert to Charlotte if not for withdrawing from the Unitarians in a dispute over whether to condemn the Israelis for attacking a supply ship headed to Gaza.

Egbert almost didn’t make it here, either.

After his arrest, even the Unitarians — certainly among the most amenable of religious organizations on the subject of assisted suicide — raised concerns about him and the Final Exit Network. The Rev. Sarah Lammert, director of ministries and faith development for the Unitarian Universalist Association, questioned whether the Unitarians might seem to be endorsing the Final Exit Network by renting a booth to the group at the general assembly. “Do we lend them a higher level of credibility, and thus share any moral or ethical responsibility for their actions?” Lammert argued, according to an informational handout prepared by Egbert.

In a brief interview, Lammert says she raised concerns because she was “questioning whether they are capable of following through with their own standards.” She had also cited a complaint by a member of a Florida congregation who claims a Final Exit Network volunteer counseled her father to commit suicide in a casual conversation at a coffeehouse — a claim disputed by the Final Exit Network. After the group’s attorney sent her an “exhaustive list” of safeguards the group now uses, Lammert relented, and the Unitarians allowed Egbert and his colleagues to take part in what she called a “marketplace of ideas.”

Still, Egbert feels stung. At the assembly, he confronts Lammert as she leaves a panel discussion, jabbing his right index finger at her face. “You didn’t do your homework!” he barks.

Egbert, for all his self-doubt, relishes the chance to argue about his work. It’s as if the process of arguing helps convince himself that he is doing right.

Another time, he is invited to debate a Catholic priest in front of public health students at Johns Hopkins University, his alma mater. In the days before, he pores over biblical texts, settling on the story of Saul, who is said to have fallen on his sword, committing suicide, after leading the Israelites into defeat during a battle against the Philistines. Saul’s story, Egbert reasons, will help him argue that the Bible does not frown upon suicide.

The priest, the Rev. David Mott of the Church of Sts. Philip & James in Baltimore, argues that only a depressed person would commit suicide. Mott tells the audience that there is a Catholic tradition of caring for the sick and dying as an act of “mercy, like feeding the hungry and visiting the imprisoned.”

“From the perspective of Catholic thought, the process of dying should not be viewed as a useless experience,” Mott argues. “A death that allows us the time to come to terms with our lives and those with whom we have lived it — to thank and be thanked, to forgive and be forgiven — is a good death.”

Afterward, as Egbert removes the lock from his bicycle, I ask Mott if he considers the doctor a sinner. “Yes, he’s sinning,” Mott says as Egbert listens. “But I would add that it is based, I think, on a misunderstanding or ignorance.”

“You’re not going to imply I’m ignorant,” Egbert shoots back.

Mott smiles. “I will.”

***

On a wet September night in 2009, the tires of Egbert’s bicycle skidded through a patch of soggy leaves, and he was thrown to the roadway.

He had been on his way to deliver a sermon at Johns Hopkins. (Since his arrest, the university has not renewed his position as Unitarian campus minister, and he has not been asked back to review medical school applications, he says.)

The accident cracked the front and back of his pelvis. Surgery wouldn’t help, the doctors told him. He would have to learn to walk with a broken pelvis. Every time he shifted his weight or tried to take a step, pain shot through his body.

In his agony, Egbert, who has witnessed the endings of so many lives, considered ending his own. “There are some people who like to suffer — that there is a religious gain in suffering,” he says. “I don’t believe that.”

But he began to mend, and thoughts of living pushed aside thoughts of dying.

When the end does come, Egbert figures, he’ll “go into the ground and rot.” He doesn’t believe in an after-life, though many of his patients have found comfort in the belief that they will be going to a better place. “I don’t think it’s worthwhile to worry about what happens to you when you’re dead.”

He has been explicit about his wishes for his own death. He doesn’t want to die in a nursing home or on a ventilator. When he’s gone, he wants his body taken to Johns Hopkins University. He’d like it to be given to the researchers in the Parkinson’s laboratory.

They can place his body next to the bodies of people who died from Parkinson’s disease, he reasons. He wants his body to be the scientific control. He hopes his body can be an example of a human being who died “a natural death,” a death without extended suffering. A death without a hood.

PHOTO:
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Manuel Roig-Franzia is a Washington Post staff writer