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Lethal Advice : Fast-selling ‘Final Exit’ has made suicide a hot topic. Some say the how-to guide shatters taboos. Others call it dangerous.

TIMES STAFF WRITER

Dostoevsky said there are two reasons we don’t all kill ourselves: pain and the fear of the next world. Now, with the book “Final Exit,” there appears to be one reason less.

The first commercially marketed how-to book in the United States for pain-free “self-deliverance,” “Final Exit” has made the topic of suicide a hot one.

What promised in April to be the publishing novelty of the year has achieved--and sustained--full star status for close to five months.

While climbing bestseller lists on both coasts, the book has been on all the morning news shows, CNN and the evening news. It has commanded the cover of Newsweek and a full page of Time, rated a story in every big newspaper in this and most other Western nations and stands ready to be translated into all major languages.

The success of “Final Exit,” it seems, has almost overshadowed its content. Almost. Not much can steal the spotlight from 188 pages of large-print practical advice for killing yourself and a four-page table of lethal drug dosages. The latter is what makes this book so “uh, special,” as one flustered interviewer put it.

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Although intended as a euthanasia manual for the terminally ill, the book has been aggressively marketed by publishing whiz kid Steven Schragis for a far wider audience. Quickly sold out at most stores, “Final Exit” is headed for its fifth printing and, Schragis says, could sell more than 400,000 copies.

“We’re seeing (buyers) of all ages, from the mid-20s to the late 80s,” says Ellen Ross, manager of the Beverly Center’s Waldenbooks. “If I had the book in stock (now), I could sell 50 or 60 copies a day.”

For some people, she says, there seems to be “a personal need for the subject. . . . There’s just a sense of urgency about getting the book.”

In Pasadena, the venerable Vroman’s bookstore has piled up more than 300 orders. Younger customers are curious, says assistant buyer Tanya Davis, but the greatest number of orders are from older patrons. “I recall one rather typical couple who came in,” says Davis. “She was in a walker and her husband said she was very interested in purchasing this book. It was quite extraordinary, I thought.”

Today, from the eye of the storm created by “Final Exit,” author Derek Humphry says boldly, “This book has smashed the taboo. . . . The walls are coming down.”

Here, boasts the author, is a book for the ‘90s. It may have been written for people who are dying, but it is clearly attracting those who are not. “Personal autonomy concerning one’s bodily integrity has taken hold in the public imagination,” says Humphry. The book, he says, is for “anyone who wants death with dignity and who wants to plan for it.”

Every day, about 2,000 people worldwide kill themselves--80 or so of them Americans--according to international health agencies.

Chris Aguilar, director of the Suicide Prevention Center of Los Angeles, worries that “Final Exit” will increase those numbers.

“Let’s face it. Everybody thinks about suicide,” Aguilar says. “Anybody who says he hasn’t is lying. But when the subject is constantly in your thoughts, then you need to talk to somebody and get some help for those feelings.”

What you don’t need, he argues, is a book that tells you how to do it--especially in California, which has one of the highest suicide rates in the country, ranking 12th with 13.7 per 100,000 people. Although many theories try to explain suicidal behavior, no one knows exactly why people end their lives.

Nor does anyone seem to know why American men kill themselves three to four times more often than women. Or why that ratio is reversed when it comes to failed attempts. Or why, despite the explosion of hot lines and prevention centers, the national rate has remained steady for years.

“We need a bushel basketful of good knowledge if we’re going to drop the rate. And all we have is a thimbleful,” says Dr. David C. Clark, president of the American Assn. of Suicidology, a Denver-based prevention organization.

Clark, like other critics of “Final Exit,” worries that the book may send a dangerous message.

“This (book) could cause a lot of suicides, or might not hurt a soul, and there is probably no way for us to ever discover its full impact,” says Clark.

“This book is for people with a terminal illness, for people under a physician’s care,” says Humphry. “The drugs listed in the tables in this book cannot be obtained without a prescription. I don’t believe we are offering just anybody the tools for self-deliverance.”

In 1975, Humphry, founder of the National Hemlock Society, helped his terminally ill wife, Jean, commit suicide and then wrote about it. Although helping another person die is a crime, Humphry was not charged. “Our message is protected by the First Amendment right to free speech,” says Kris Larson, editor of the society’s Hemlock Quarterly. “We’ve been distributing this information for 11 years, and we’ve not had one threat of litigation.”

Humphry’s 1981 book, “Let Me Die Before I Wake,” first set down the fatal drug combinations. Although the book sold steadily by mail through the Hemlock Society, it escaped public attention.

“There is a certain fascination with self-destruction. It’s human nature,” says Humphry, who lives in Eugene, Ore. “But that’s not why (“Final Exit”) is on bestseller lists. People are buying this book because there is a huge interest in the euthanasia question. People want to know their options for release if they get a terminal illness and it becomes unbearable.”

Subtitled “The Practicalities of Self-Deliverance and Assisted Suicide for the Dying,” the book was written, says Humphry, to give terminally ill adults, their families, nurses and doctors the information they need to end a life of suffering. Medical professionals are included because the drugs required for the nonviolent, painless and “rational” death the book promises are available only by prescription.

“Why should we be surprised that rational people should wish for a rational and peaceful end to their lives?” asks Humphry. “Isn’t that what men and women have always wanted?”

Judging from the world’s oldest suicide note--written 4,000 years ago on Egyptian papyrus--the history of suicide is as old as world history itself.

Depending on the civilization and its place in time, suicide has been tolerated, encouraged, deified, vilified and, redundancy notwithstanding, punished by hanging.

Primitive people lived in fear of the spirits of anyone who died unnaturally, including suicides. Warrior tribes like the Vikings believed that, short of a bloody death on the battlefield, suicide was the best way to paradise.

In ancient Greece, the taboo against suicide prompted burial outside the city, the “guilty” hand cut off and buried separately. Yet the Greeks also developed hemlock, and their government distributed poison to any citizen with a sufficiently noble reason to use it.

But it was the Romans who turned the ancient world’s toleration of suicide into “high fashion,” according to “The Savage God,” British writer A. Alvarez’s seminal study of suicide. For the Romans, writes Alvarez, “one’s manner of going became a practical test of excellence and virtue. . . . To live nobly also meant to die nobly and at the right moment.”

For the early Christians, the notion of suicide had an irresistible theological appeal, according to Alvarez. If, as the primitive Church taught, life was a vale of suffering and sin, then suicide was a tempting release into eternal glory.

By the 4th and 5th centuries, self-sacrifice was so popular among Christians that some religious leaders feared it might wipe out the religion. “To kill themselves for martyrdom is their daily sport,” St. Augustine lamented.

Although there is no specific prohibition against suicide in the Bible, the theologians of the Middle Ages found one in the Sixth Commandment: Thou shalt not kill.

It didn’t take long for suicide to become the most deadly of all the mortal sins. It also became illegal. And, writes Alvarez, “The door slammed shut.” But in the last few decades, the door seems to have reopened, if only a crack. Although Christian and Jewish leaders still maintain that the right to take life rests with God, interpretations of both canon and Talmud have eased considerably.

On paper, the Catholic who commits suicide is condemned to hell. In practice, though, the judgment is neither swift nor sure, says Father Gregory Coiro of the Archdiocese of Los Angeles. “The question arises as to what is that person’s subjective state. That we cannot know. Only God can know. We can’t make a judgment about the afterlife other than to enunciate a religious principle: That knowingly taking an innocent human life is always a grievous sin.”

The Talmud provides a “quite rigorous” definition of suicide, says Rabbi Aryeh Meir of the American Jewish Committee in New York. “An example would be a person who climbs to the top of a tree or building and then falls to his death. That is not considered a suicide . . . not unless he said before he did it, ‘I am going to go up there and throw myself down to kill myself.’ And then it is suicide only if there are witnesses. . . .” If someone is deeply depressed about something, health or whatever, we would also have to ask if they are truly acting of free will.”

At some times, in some cultures, the act has assumed an aura of drama and romance that imbue the fatal act with a near-mystical quality.

The Romantic writers of the 17th Century, with their poetic dances with death, did not introduce the idea of suicide as the price one pays for genius--nor did very many of them actually kill themselves. But they may well have planted the seeds for the notion to fully bloom three centuries later when suicide as the “ultimate artistic statement” became a slogan for students of such authors as Ernest Hemingway, Sylvia Plath and Anne Sexton.

The modern view--that suicide is a psychiatric problem--is only the most recent effort by behaviorists to explain a phenomenon that seems to contradict the basic instinct for survival. The urge for self-destruction puzzled even Freud. As one of his colleagues, famed analyst Karl Menninger, conceded: “Suicide is a durn (sic) mystery.”

A Book of Do’s and Don’ts

“Final Exit,” which retails for $16.95, is 188 pages of matter-of-fact, sometimes joltingly conversational description of the steps to euthanasia. From the start, author Derek Humphry’s intent is clear. In the first chapter, he warns, “Read no further (if) you consider God the master of your fate.”

Here are some excerpts:

The book advocates overdose of prescription drugs. Here are arguments against some alternatives:

(HANGING): Almost always an act of protest, a desire to shock and hurt someone, so most euthanasists avoid it. . . . An unacceptably selfish way to die.

(DROWNING): Leaves too many unanswered questions for survivors: Was it deliberate? Will the body be found? Will there be an extensive search for the body, costly to public funds?

(SHOOTING): This is definitely not the exit of choice for believers in euthanasia. (Yet) in the U.S., between 50% and 60% of all suicides are by guns. . . . This method is not error-proof and is not favored . . . because it is messy (who cleans up?) and it has to be a lonely act, the opposite of the right-to-die credo, which aims to share the dying experience. . . .

The book offers suggestions for easing the pain and paperwork that suicide may create for others :

(FINAL CORRESPONDENCE): You should consider leaving letters to loved ones saying why you are taking your own life. Explain that you did not wish to tell them exactly when, to protect them from legal involvement. . . . A gentle, loving note of explanation could avoid a good deal of anguish among those you least wish to hurt.

(THE SUICIDE NOTE): Make two copies of this note because the police or coroner, if they become involved, will take the top copy and your survivors or attorney will need a copy also.


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