Back in November last year, I was contacted by a reporter at Milwaukee Magazine in preparation for a feature story on a local elderly couple who had allegedly died through a “suicide pact.”  I succeeded in a few things during our conversation:

• Made the point that if the death was a suicide pact, it was atypical of elderly homicide/suicides;’
• Referred him to Donna J Cohen to discuss her research on elderly homicide/suicide cases;
• Was able to document that assisted suicide supporters in this country want broader “eligibility” for assisted suicide than what is available in Oregon and Washington state.

The article was published in the March edition of the magazine earlier this week and is available online.  Those who are familiar with pieces that report on the (alleged) double suicides of a respected elderly couple will find what you generally expect – family and friends who saw it coming and who defend the action as brave or admirable.

But reporter Kurt Chandler found room to fit in some broader context in the story Tender is the Night.

The opening is typical of these pieces:

On that Saturday summer night, Daniel and Katherine Gute made the short drive from their River Hills home to the Milwaukee Country Club for an early dinner. They held hands walking into the restaurant and sat at a table near a window overlooking the Milwaukee River. They sipped chardonnay and shared a bowl of vichyssoise, a favorite soup of theirs, having a quiet, romantic evening.

But they must have known it was their last meal together.

It was July 17, 2010, just four days after their 53rd wedding anniversary.

The broader discussion on assisted suicide – and the players in the debate – is better than we generally get:

Physician-assisted suicide is only legal in three states. Oregon in 1997 became the first state to pass a law allowing residents who are terminally ill – certified that they have six months or less to live – to end their lives with lethal medications prescribed by a physician. A similar law was passed in Washington in 2008, and a state Supreme Court ruling made assisted suicide legal in Montana in 2009.

The issue is hotly contested. On one end of the spectrum, the Final Exit Network argues the Oregon and Washington laws are inadequate because only those who are terminally ill are allowed to receive lethal drugs. The 3,000-member group, an outgrowth of the Hemlock Society, believes people who are not terminal should also be permitted to end their lives.

“There are many illnesses, awful illnesses, with no time limit,” says Jerry Dincin, Final Exit’s president. “And you can suffer for years and years – Parkinson’s, Alzheimer’s, ALS, Huntington’s disease, strokes.”
Members of his group who wish to hasten their own deaths must provide a letter from their doctor corroborating their medical condition, Dincin says. With approval from a Final Exit Network committee, made up of three physicians, patients can request voluntary “exit guides” to advise them. Two guides will visit the patient’s home to discuss methods. At the patient’s request, the guides also can be present for the suicide. Dincin emphasizes that an exit guide is not allowed to purchase, operate or handle any equipment – pill bottles, syringes, helium tanks. Guides legally can attend a suicide as long as they don’t actively assist or participate.

Since 2004, between 200 and 250 people have died in the presence of an exit guide, Dincin says. “More than 50 percent of the people we have supported are religious. They rationalize their action by saying they believe in a loving God, and a loving God would understand.

“We feel very keenly this is a human right, that your life is your own,” he adds. “Given dire medical circumstances, there is no public interest in keeping you alive if you don’t want to be.”

On the other end of the spectrum is the group Not Dead Yet, operating within the Center for Disability Rights in Rochester, N.Y. The group was formed in 1996 after the acquittal of Dr. Jack Kevorkian, who facilitated the suicide of two nonterminal women with disabilities.

“We felt assisted suicide statutes, as they were being proposed by advocates, were targeted for old, ill and disabled persons,” says Stephen Drake, research analyst for the group. “Since then, what’s been put on the table has expanded dramatically.”

He cites a 2007 case in Arizona, where four exit guides were criminally charged after helping a 58-year-old woman kill herself with helium. The Phoenix woman suffered from chronic mental illness but was not terminally ill. Two of the guides pleaded guilty last year to facilitation to commit manslaughter.

To Drake, the right-to-die movement is heading down a slippery slope, pushing for assisted suicide of people who are nonterminal or physically unable to commit suicide on their own – including those with disabling diseases.

“When it comes to the euthanasia of children and adults unable to express a wish to die, I believe the goal for many is to have some sort of medical panel evaluate the request for killing the individual,” he says. 

The article also shares some doubts that Katherine Gute – who had alzheimer’s disease – could have had the cognitive capacity to consent to her death (through asphyxiation) and how that fits the larger context of elderly homicide/suicides:

An autopsy report released by Dr. Brian Peterson, Milwaukee County medical examiner, lists Dan Gute’s manner of death as “suicide.” Kitty’s death is classified as “undetermined.”

“It’s a hard one,” says Peterson. “If they agreed to do it together, it’s a tandem suicide. If someone’s demented, can they give consent, can they understand what they’re doing? In the world of forensic pathology, there are two equally valid possibilities, and we have no way to choose between the two.”

“If indeed she had the capacity to consent and sign, it’s a pact,” says Donna Cohen, a University of South Florida professor who has studied assisted suicide and suicide-homicides among the aged. “Suicide pacts are extremely rare. They account for less than one-half percent of all suicides” – just 150 of some 30,000 suicides annually in the U.S.

Cohen, however, questions the state of mind of the Gutes in their last days. “Even though they were strong-willed about living and dying arrangements, it’s quite possible they were depressed,” says Cohen, a former editor of the Journal of Mental Health and Aging. “The questions I would want answered in this situation: Were they getting the right help in dealing with depression? When men caregivers perceive there is nothing else they can do, [depression] could precipitate this act.”

We always wish there was more of our side represented in any coverage of these issues, but if more reporters exercised due diligence in the way Kurt Chandler did on this report, the coverage of these issues might be recognized as far more complex than they generally are.  –Stephen Drake