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The book advised against such risky suicide methods as running a car engine in a closed garage and breathing in the carbon monoxide, and instead suggested taking sleeping pills and then putting a plastic bag over your head, with a rubber band around your neck. You were to hold the rubber band out so that air could get into the bag until the sleeping medication took effect, at which point your arms would drop, the rubber band would snap and the air would stop flowing. Death would come quickly and painlessly.
By the book's third printing, Humphry had added a method that involved using helium with a plastic bag.
The Hemlock Society had financed Final Exit's initial publication. When the book became a bestseller, it provided a strong financial backing for the group.
Humphry left full-time involvement with Hemlock in 1992 to return to writing. By then, the right-to-die organization had about 46,000 members and eighty chapters. "It was getting so big," Humphry remembers. "I didn't want to be a CEO of a multi-million organization; it wasn't my thing. I'm a writer and a journalist." Still, Humphry has remained involved in the right-to-die movement in a variety of capacities since stepping down from Hemlock.
After Humphry's departure, some Hemlock chapters started talking about going their own way.
Following a discouraging attempt to change state law, in 1993 one Washington group broke off and formed an organization that would come to be known as Compassion in Dying. "We decided we would work with people and advise them and tell them what medications to ask their doctor for and stay with them through the whole process," says Susan Dunshee, a founding member of the group. "It was kind of a mutual agreement that we should separate."
Although Compassion in Dying wasn't able to get the medication, it worked with many people who were living with AIDS around Seattle, where there was a large population of sympathetic doctors. "We never actually did anything that broke a law," Dunshee adds. "The patient got ahold of the medications by him- or herself, and the patient took the medications by him- or herself."
The right-to-die movement had more luck in Oregon, where in 1994 voters approved the Hemlock-supported Death With Dignity Act. The law essentially allows terminally ill patients to obtain a prescription from a doctor for pills with which they can end their own life -- if they can prove they are mentally competent and physically able to take the drugs on their own. The law also protects the prescribing doctors from prosecution.
The law survived numerous court battles, as well as a ballot measure that called for its repeal. In 1998, the first Oregonian legally ended her life with a doctor's prescription. Another 245 people followed over the next seven years.
As the right-to-die movement took new forms, the Hemlock Society was shrinking, with members opting out to join smaller state groups, some of them spinoffs. The bank account was shrinking, too. John Pridonoff, the man who'd taken over for Humphry, was accused of overspending. (He is now deceased.)
In 1996, looking for a more central location, the Hemlock Society -- with a national membership down to just 16,000 -- moved to Denver. Faye Girsh became the CEO that year.
"All we could offer them at that time was to read Final Exit and call us in the morning," she remembers. She decided it was time to kick activity up a notch.
In 1998, under Girsh, the Hemlock Society organized a national group of volunteers who were trained to consult, advise and support people who were considering terminating their own existence. This is what Compassion in Dying was already doing in Washington -- but unlike Compassion in Dying, Hemlock also offered its services to people suffering from diseases that weren't necessarily terminal, such as multiple sclerosis and Alzheimer's. During Girsh's tenure, about half of the people who killed themselves with Hemlock's support used medication to do so, and the other half used a method outlined in Humphry's book.
The Hemlock Society also decided to get more active in pushing legislation. At a 2002 meeting, boardmembers discussed whether the group's name was too in-your-face, too radical for working with lawmakers. After Girsh voiced her opposition to a name change, she was demoted to senior vice president. The next year, the Hemlock Society became End-of-Life Choices. A year later, Girsh was fired.
"I was too radical, or maybe I wasn't a good administrator, I don't know," she says. "I increased the membership, and I more than quadrupled the annual income."
Girsh has stayed active in the right-to-die movement, often working with other Hemlock refugees.
"All movements eventually become fragmented," says Dennis Kuby, whose Berkeley chapter left the organization. "The natives are restless in the movement, and it's far from a unified thrust. We feel that the organization in Denver is just too centralized and building its own bureaucracy."
Ted Goodwin was a chapter leader of the Hemlock Society near his home in Atlanta. After the group changed its name to End-of-Life Choices, he joined the board.
Advising people on how they could best end their lives was what attracted him most to the right-to-die movement. "This is important stuff in our movement," he says. "This is where the rubber meets the road in helping others. Legislation will come very slowly."