Exit Strategy: Should Assisted Suicide Be Legal?

When Boca Raton Police Officer Lora McHugh entered Sandra Snow's bedroom around 4:30 p.m. July 22, 2008, she found the plump 62-year-old lying face up on the bed, a green blanket pulled up to her neck. Snow was dead.

The officer checked for signs of foul play but found none. Snow's nephew, a 49-year-old realtor named Jeffery, said he'd discovered his aunt's body just 15 minutes earlier, when he'd arrived to take her car in for service.

Jeffery dialed a number and handed the phone to McHugh. Snow's doctor advised that Sandra hadn't been in good health. He offered to sign the death certificate. The cop hung up and concluded in her report, "Apparent cause of death was natural causes."

Photo by Russel Odgen, published with a study in the Journal of Medical Ethics

The "exit hood" recommended by the group Final Exit.

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• Sandra Snow
• Robert Rivas
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But the truth was far more complicated. It involved lies, secrecy, a tank of helium, and something called an "exit hood" that would lead to suicide.

A year later, authorities connected Snow's death to a little-known assisted-suicide group called Final Exit that has 30-year-old roots tracing to California journalist Derek Humphry. In 1991, Humphry published a bestselling manual that not only considered the ethics of suicide but also included instructions on how best to do it.

Humphry founded the nation's best-known assisted-suicide group — the Hemlock Society — which would eventually fracture, with some members going on to found Final Exit. It made headlines throughout the 1990s, at the same time as "Dr. Death," Jack Kevorkian, who spent eight years in jail and assisted in 130 suicides. The issue came back into focus last month when the Belgian Senate ignited controversy by approving euthanasia for kids under age 18.

Most states have provisions against "aiding" or "assisting" in a suicide, though several allow physician-assisted suicides for terminally ill patients. Florida law holds that "every person deliberately assisting another in the commission of self-murder shall be guilty of manslaughter, a felony of the second degree."

"Final Exit Network never encourages anyone to self-deliver," says Robert Rivas, a Tallahassee-based attorney for Final Exit. People who apply for assistance, he says, are "screened very carefully" by the group's medical committee. They need not be diagnosed with a terminal illness but must be deemed to have "no hope." Those individuals are accepted and assigned two exit guides, who "give information... and moral support," Rivas says.

Criminal statutes, he asserts, are applicable only if a volunteer were to physically help a person die — like "crush a pill or hand them a drink." Yet "some prosecutors in some states still think [what we do] is illegal assistance," Rivas says.

Prosecutors in Minnesota in 2012 charged four Final Exit volunteers with assisting in a suicide. That case is being reviewed by the Minnesota Supreme Court. Rivas believes appeals could take the case to the U.S. Supreme Court — and eventually invalidate at least six other similarly worded state laws.

Until that happens, and as Sandra Snow's case illustrates, Final Exit volunteers carry out their mission with significant legal risks. This small but committed group is today the most fascinating voice in the national right-to-die debate.

Almost a year after Snow's death, Georgia authorities investigating a death there seized records from Final Exit and discovered the organization's involvement in cases in other states — including Snow's. Georgia police forwarded those records. On May 19, 2009, Boca police summoned Jeffery Snow to the station. In a videotaped interview, the realtor said that Sandra had never been diagnosed with a terminal illness but that in her final days, she had been so frail she couldn't pick up a cup of coffee. She was bedridden and used a wheelchair.

Asked if he knew anything about Final Exit, he said Sandra had received mail from the organization. But "Jeffery's body language indicated he wasn't being completely truthful," Det. Mynor Cruz wrote in a report. He suggested that Jeffery think things through and get back in touch if he remembered anything.

The next day, Jeffery faxed a letter through an attorney. In it — and in follow-up meetings with police — he confessed that in April 2008, he'd sat in on a meeting between his aunt and a Final Exit volunteer he remembered only as "Mike." Sandra Snow had initially considered suicide by overdosing on drugs, Jeffery said, but was afraid she would end up in a vegetative state.

Mike explained she could end her life by inhaling helium, warning her that this method "was secret and should not be shared with children," Jeffery recalled. He advised that Sandra would need to get tanks of helium from Costco and then buy an "exit hood" — a plastic bag that would cover her face and include a tube to connect to the helium tank.

"Snow would have to be able to put the mask on by herself and also turn the helium tanks on by herself," a police report explained. "Starved of oxygen, she would get light-headed and pass out, then die painlessly in a matter of seconds. Mike would then remove the mask within minutes and leave with the mask and tank."

The Georgia records led to a Palm Beach Gardens man, Michael McGoldrick, and a Sarasota man, James Chastain, who were the "exit guides" assigned to Snow's case. An "exit log" included handwritten notes that said, "Snow was a hospice nurse. She planned all details perfectly... She laughed a lot, then said she was ready, had her dog on the bed with her. She had arranged for a nephew to find her at 3:30. All went smoothly according to plan — no complications."