Going Gentle into That Good Night

By Patricia Blake.

Do suicide manuals help create a bias toward death ?

There is only one prospect worse than being chained to an intolerable existence: the nightmare of a botched attempt to end it." So Arthur Koestler wrote in his 1981 preface to A Guide to Self-Deliverance, a suicide manual distributed to the 8,000 members of the British Voluntary Euthanasia Society. When the famed 77-year-old writer (Darkness at Noon), who suffered from Parkinson's disease, decided two weeks ago that his life was intolerable, he reportedly swallowed the finely calibrated dose of drugs prescribed by the society. Sharing the fatal potion was his wife Cynthia, 55, who apparently believed she could not endure life without him. When police found the Koestlers in their London town house, husband and wife were seated in an upstairs room, in a macabre tableau of family death.

For the growing number of proponents of "self-deliverance," the Koestlers' suicides seemed to epitomize the "gentle, easy" death celebrated by the Voluntary Euthanasia Society and 18 similar groups that have sprung up in Europe, Asia, Australia and the U.S. Still, the sensational case raised some disturbing ethical questions about suicide pacts in particular and, more generally, about the fast-growing movement that aims to facilitate the suicide of the terminally ill.

Did Koestler have a moral obligation to dissuade his apparently healthy wife from ending her life? Are organizations like the Voluntary Euthanasia Society encouraging suicide by presenting the act as dignified, respectable, even attractive? Koestler's effusion in the how-to book for which he wrote the preface was characteristic of the movement's publications: "The prospect of falling peacefully, blissfully asleep is not only soothing but can make it positively desirable to quit this pain-racked mortal frame."

Though the notes the couple left behind to explain their action have not yet been made public, close friends in Britain believe Koestler was the dominant partner. Said one physician who knew the couple well: "My guess is that she did not take a leading role but that Koestler said, 'The time has come.' " U.S. Psychiatrist Herbert Hendin, author of a 1982 study, Suicide in America, points out that in suicide-pact cases he has studied, a common factor is coercion, usually by the man. Says Hendin: "There is a tendency for suicidal people to say that what is a solution for them is a solution for others."

The suicide guide that Koestler promoted, like other how-to suicide manuals published in the U.S., Scotland and The Netherlands, was designed only for the use of hopelessly sick people, with the express purpose of reducing, as the British guide puts it, "the incidence of unsuccessful attempts." A Guide to Self-Deliverance is heart-wrenching reading. The manual stresses that suicide should be a last resort for those in intractable pain. It then offers the exact doses of drugs that will ensure death. The manual recommends that the drugs be used in combination with other methods, such as plastic garbage bags and auto exhaust. If the prescriptions are carefully followed, the end will presumably be painless and "the body when found should simply look dead and not disgusting." Because of the more than 20 known or suspected cases of suicide attributable to the Self-Deliverance manual, including that of a physically healthy 22-year-old music student, Britain's Attorney General is currently seeking to have the high court declare the booklet illegal on the ground that it violates a law that forbids helping a would-be suicide.

In the U.S., assisting a suicide is a crime, but under the First Amendment, how-to manuals may be published. Thus, Let Me Die Before I Wake, put out by Hemlock, a Los Angeles-based organization named for the potion taken by Socrates, has been sold freely in bookstores. A more compassionate work than its British counterpart, Let Me Die gives case histories of desperately sick patients who have sought to end their lives. In recounting successful attempts, the book gives the precise doses of the drugs used.

The proliferation of manuals romanticizing death troubles social workers and doctors who are intent on preventing suicide among healthy people, as well as those clergymen who oppose suicide for any reason at all. The worst offender is France's Suicide: Operating Instructions, by Claude Guillon and Yves Le Bonniec, a pair of anarchists who, with ineffable Gallic logic, have equated the act of suicide with revolt against the established order. Their book, which explains how to forge doctors' prescriptions for lethal drugs, has attracted more than 100,000 French readers and has provoked denunciations by scores of physicians and public health professionals, including France's Minister of Health. Most distressed have been the volunteers who operate France's suicide-rescue organizations, like Search and Encounter, which provide counseling. "We are absolutely terrified by the book," said an official of Search. "It's criminal. It goes against all our efforts. We're about rebirth. Their message is to flee from life."

In the U.S. too there is widespread concern that the manuals may push depressed, momentarily suicidal individuals over the brink. For every suicide in the U.S., 50 to 100 more are estimated to have been attempted and failed. The number of suicides (28,100 recorded in 1981) could increase if society comes to regard self-deliverance as acceptable. Daniel C. Maguire, a Roman Catholic theologian, who has argued for the right of terminally ill patients to take their own lives, is also strongly opposed to the manuals. Says Maguire: "Their publishers must be held accountable for introducing a bias in favor of death." Psychiatrist Hendin warns that people who are basically suicidal tend to want to make suicide seem "socially useful," sometimes striving to turn their own wishes into an acceptable movement. "Elderly people in particular may be made to feel that it is honorable for them to help relieve a burden on society or on their family," says Hendin. "It is a pity society should be able to do something to improve life, it might choose to sanction suicide as an answer to its failures." --By Patricia Blake.

Reported by Joseph J. Kane/Los Angeles and Arthur White/London

With reporting by Joseph J. Kane/Los Angeles and Arthur White/London This file is automatically generated by a robot program, so viewer discretion is required.