This has been published in conjunction with The Big Roundtable.
On the morning of Thursday, April 12, 2007, Wye Hale-Rowe watched out the window of the plane as U.S. Airways Flight 180 descended into Phoenix. She surveyed the landscape that unfolded on the ground below — blue swimming pools, elevated freeway interchanges, and a flat grid of streets studded with slender desert palm trees. When Hale-Rowe left her apartment in Aurora, Colo., that morning and drove 20 miles by taxi to the Denver airport, the air had been frigid. In Phoenix, however, the temperature was expected to climb to 75 degrees. But Hale-Rowe wasn’t a snowbird, the local term for retirees who flock to Arizona in the winter and stay through spring to enjoy the weather. Her trip to the Valley of the Sun would be short. She was there to help Jana Van Voorhis commit suicide.
Jana was 58 years old, never married, and without children. As a young woman, she wanted to be a nurse, but had worked instead for a couple of years on the night shift as a legal transcriptionist, a position secured for her by her mother, who was friends with the firm’s founding partner. Hale-Rowe was 79, a great-grandmother and a retired family therapist who had grown up in a Mormon colony in Star Valley, Wyo. She was also a volunteer with Final Exit Network, a national right-to-die organization based, at that time, in Marietta, Ga., with members and volunteers across the United States. Hale-Rowe had been active in the right-to-die movement for more than a decade. She had achieved the status of senior exit guide, not because of her age but because of the number of suicides she had attended. The Network has a name for these suicides: They call them death events. At the time of her visit to Phoenix, Hale-Rowe had been to nearly 20 of them. She and Jana had never met.
Frank Langsner, who was 82, picked up Hale-Rowe at Sky Harbor Airport. Born and raised in New York City, Langsner was a retired professor of health and physical education at Morgan State University in Baltimore, and he now lived in Scottsdale, Ariz. He and Hale-Rowe had met once before, in December 2005, at an exit guide training program in San Francisco, at an airport hotel called the Inn at Oyster Point. Over the course of two and a half days, Langsner and around 16 others learned about the laws regarding suicide in the 50 states and practiced the steps required to help others achieve what the Network calls self-deliverance. Langsner had been brand new to the organization. A friend had told him about it. He agreed with the group’s mission, and he was sympathetic to people who were dying or in pain, so he signed up. Hale-Rowe was an instructor at the program.
On Feb. 13, 2007, two months before Hale-Rowe’s arrival in Phoenix, Jana had written a $50 check to Final Exit Network. Four days after that, Harry Lien, a Network first responder, contacted Jana. A tall, bony man with a stooped back, Lien had for 33 years taught fourth grade in Arlington Heights, Ill. Now he lived in Green Valley, Ariz., a retirement community about 20 miles south of Tucson. He kept busy as a hospice volunteer, helping to feed and dress those who were nearing the end of life. He also volunteered with Final Exit Network. With Jana, his job was to conduct an intake interview over the phone.
According to Lien’s notes, Jana reported that she was suffering from porphyria, a rare blood disorder that causes severe abdominal pain, light sensitivity, and seizures. Because of these symptoms, the condition is sometimes called the “vampire disease.” Jana also told Lien that she had lesions on her liver and an enlarged spleen, and that her gallbladder and silicone breast implants had been removed, the latter because they were leaking into her body. She said that she’d had a hysterectomy in 2006 and that she might have breast cancer. She reported that she’d suffered multiple head injuries and overexposure to radiation, and had ingested rat poison. She provided Lien with a list of medications that she said she was taking daily: a combination of mood stabilizers, sleeping pills, and painkillers that included Lexapro, Klonopin, Ambien, Vicodin, and Tylenol PM.
Jana told Lien that her next of kin were her sister, Viki Thomas, and brother-in-law, Tom Thomas, who lived nearby, and that they did not know of her plans to die. In the section of the intake form labeled “prognosis,” Lien wrote Jana’s response: “Doctors have said nothing.” Lien noted on a separate sheet of paper that Jana’s lack of knowledge about her prognosis was “unusual,” and suggested that the Network’s medical committee “ask her some specific questions about that.”
In fact, Jana was not dying. She did not have most of the ailments that she said she did. The truth was that she had a long history of mental illness and believed that she was physically ill. According to family members, Jana had begun to talk about suicide when she was a child. “She’d threaten to run out into traffic,” her sister Viki told me. She did poorly in school and had trouble making and keeping friends. Jana was first hospitalized in 1970, at 21, and over the years, she had been admitted to the psychiatric wards of several local hospitals. Family members say that as Jana got older, her condition worsened. On May 7, 2006, her psychiatrist, Michael J. Fermo, noted in his records: “She reports having depressed mood swings, periods of irritability, difficulty shutting off her mind, especially at night, erratic sleep, low energy, nervous, socially isolative and an ongoing feeling that bugs are eating her. The patient has been increasingly becoming psychotic, claiming that roof rats have been overtaking her home, sneaking into her house, and attacking her.”
Jana was especially close to her mother, and when her mother died on July 15, 2006, Jana’s mental health began to deteriorate further, according to Viki and Tom. On Feb. 2, 2007, Jana called Dr. Michael S. Roberts, the Phoenix oncologist whose office she had phoned 10 times a week for 11½ years, to say that she was ill and bedridden. When Dr. Roberts called her back, Jana told him that she wanted to be moved to hospice, which is where her mother had died. Jana had recently been to Dr. Roberts’ office complaining of two different types of blood infection: bacteremia and toxemia. She believed that the latter was caused by Mexican people bringing pesticides across the border.
“Clearly, at this point I don’t think any further testing would benefit her unless there are symptoms or more objective evidence,” Dr. Roberts noted in Jana’s file. “This has been discussed with Jana frequently.”
Having completed the intake interview for Final Exit Network, Lien went to Busy Bee Printers and faxed the form to case coordinator Roberta Massey at her home in Cherry Hill, N.J. In turn, Massey faxed the intake form and other materials sent to her by Jana to the Network’s medical director, Dr. Lawrence Egbert, in Baltimore.
A retired anesthesiologist and Johns Hopkins University professor, Egbert was then 79 years old. A slight man with prominent ears, Egbert pedaled around Baltimore on a bicycle decorated with bumper stickers that said “Bikes not Bombs” and “Don’t Waste Our Future, Recycle.” He considered Jana’s application. It included a surgical pathology report from 2005 that confirmed Jana did not have cancer, as well as a typewritten list of diagnoses and doctors that Jana had prepared herself. Not a single ailment was life threatening. All were treatable. The oldest and longest-running diagnosis on the list, dating to 1970, was for anxiety and depression. The notes indicated that Jana had been under the care of the same psychiatrist for 25 years.
Also included in the records faxed to Egbert was a copy of a handwritten note from Jana to Massey, on a sheet of personalized stationery decorated with a pair of Raphael’s winged cherubs.
Having hard time getting medical records … Could you talk to one of the doctors to come to Phoenix to help me. The pain is unbearable.
Sincerely,Jana Van Voorhis
Egbert didn’t go to Phoenix. Nevertheless, he approved Jana’s case, although he did express reservations: On the bottom of the intake form, Egbert wrote in red ink, “Accept 3/2,” for March 2, “but stay alert.” He underlined the last three words for emphasis.
With Egbert’s approval in place, Massey assigned Langsner and Hale-Rowe as Jana’s exit guides, and Hale-Rowe bought a plane ticket to Phoenix. Both guides were given a copy of Jana’s intake form, but it was not the form marked by Egbert with the warning to “stay alert.” Egbert had done his job by vetting the case, and now it was time for Langsner and Hale-Rowe to do theirs.
From the airport, Langsner and Hale-Rowe headed directly to Jana’s residence, a two-bedroom townhouse on East Hazelwood Street, the second-to-last house on a cul-de-sac in a Phoenix subdivision built in the late 1960s. A blue sticky note fixed to the front door greeted the pair when they arrived: “Frank and Wye, I put paper towels out for you to wipe shoes.” Jana had recently remodeled her home and removed its white wall-to-wall carpeting, believing it to be infested with bugs. She had replaced it with laminate flooring, but continued to insist that guests go barefoot. Langsner, however, had tired of the practice after meeting with Jana at her home several times already, and he and Jana had reached a compromise. A roll of white paper towels waited for Langsner and Hale-Rowe on a side table in the entryway. Instead of taking off their footwear, the two wiped the soles of their shoes, crumpled the towels, and walked through the narrow hallway into the main part of the house.
Jana was waiting for them. Five-feet-four-inches tall, pretty, and a little bit plump, with a round face and brown hair that hung to her shoulders, Jana was dressed that morning in a muumuu. She spoke with a high-pitched, girlish voice, and her skin looked rough, as if she had spent too much time in the sun. On the left side of her forehead, a pair of adhesive bandages formed an X over the spot where she’d been compulsively picking at her skin.
When Jana had first spoken with Lien two months earlier, she had been under the impression that the Network would supply the tools for her. But in the days leading up to her suicide, she followed Network protocol and purchased the items she’d need for the death event. There was a plastic hood with a length of vinyl tubing attached, which Jana had acquired after mailing a $45 check to a company in La Mesa, Calif., called Personal Options, which manufactured the hoods specifically for suicides. Also in her bedroom were two Balloon Time party-balloon kits purchased at a Party City store in nearby Paradise Valley. Each purple cardboard box was decorated with photos of smiling children clutching colorful balloon bouquets, and contained a squat, steel helium tank the color of tomato soup, along with 50 multicolored latex balloons. One tank would do the job, but the Network advised that a second tank be on hand in case one proved to be faulty.
Langsner and Hale-Rowe rehearsed the suicide with Jana. First, they had her prop the pillows up on her bed so that she would be in a semi-reclining position, which would keep her airways open as she inhaled the colorless, odorless, and tasteless gas. Then, Hale-Rowe showed Jana how to place the plastic hood over her head like a shower cap, so that it cinched just above her eyebrows. Jana also practiced connecting the vinyl tubing to the tank’s nozzle.
What Jana did not do was pull the hood over her face or open the valve on the helium tank. Those actions would have to wait until the actual death event, which was to take place that evening. “When you do that,” Hale-Rowe told her, “you’ll be asleep within two minutes, maybe three. You will go to sleep and it will be a deep sleep. That is the last that you will know. Be very, very sure that this is what you want to do before you pull the hood down, because there isn’t any turning back.”
Jana wanted to know if the process would be peaceful and quick. She was convinced that anything that would end her life would be terribly uncomfortable, and she wanted reassurance that the helium method would be pain-free. Hale-Rowe said that it would be, and that other people had died the same way, but that Jana would need to follow instructions carefully and do exactly as she was told.
Jana’s anxiety level gave Hale-Rowe pause. “Are you trying to tell me that part of you doesn’t want to go through with this?” Hale-Rowe asked, sympathetically. “That’s OK,” she told Jana. “You can back out any time you want.”
But Jana was insistent, according to Hale-Rowe. “Oh, no,” she said. “I want to. Yes, I do.”
Hale-Rowe had other concerns. Langsner had told her that Jana had difficulty communicating, and now Hale-Rowe was seeing this firsthand. When Jana spoke, she would make a statement, but the second part of the statement bore no relationship to the first. In her training as a family therapist, Hale-Rowe had worked with clients like Jana, and so she sat with her patiently, asking her questions and redirecting her train of thought. This approach seemed to work. The talking also appeared to calm Jana’s nerves. Hale-Rowe knew that Jana’s sister and brother-in-law lived nearby, and she decided that it was time to bring up the subject of Jana’s family. “Have you talked to them?” Hale-Rowe asked. “Do they know how desperate you are?”
Hale-Rowe says that with this question, Jana became agitated. “She’d put me away,” Jana said, referring to her sister. “She’d put me away.”
The suicide run-through lasted about an hour. Before they left, Langsner and Hale-Rowe presented Jana with a Final Exit Network form letter: “Statement of My Decision Following Medical Consultation.” It opened with this declaration:
I believe I have the mental capacity to make informed decisions about medical and end-of-life issues. Physicians have determined that I have a terminal or hopeless illness, with no expectation of improvement.
The letter went on to include three additional statements, which Jana was asked to indicate her acceptance of by writing her initials, “JVV,” beside each one. By doing so, Jana affirmed that she had been offered consultations with physicians and mental-health professionals, that her condition was “intolerable,” and that she was therefore seeking information “to help me explore my options for a hastened death.” She also affirmed with her initials that she had “considered the feelings” of family, friends, and loved ones, and that the choice to die was entirely her own. Finally, she affirmed that she understood her right to change her mind “at any time.” Jana’s looping signature appeared at the bottom of the form. She had signed it first on March 24, 2007, in an earlier meeting with Langsner. On the morning of April 12, with Langsner and Hale-Rowe as her witnesses, Jana did so again for the last time.
When Langsner and Hale-Rowe returned to East Hazelwood Street that evening around 9 o’clock, they let themselves in to Jana’s garage using the remote-control door opener that she had left for them in her mailbox. Earlier in the day, during the rehearsal, Hale-Rowe had instructed Jana to dress in nightclothes for the death event, since the plan was to make it look as if she had died in her sleep. When Jana greeted Langsner and Hale-Rowe, she was wearing a white long-sleeved nightgown and slippers. Jana had also left on her dining room table an envelope that contained a note to her neighbor, Anne Shimmel, who was 81. Langsner and Hale-Rowe were to place the envelope in the elderly woman’s mailbox after the death event to ensure that Jana’s body would be found.
“Dear Ann [sic],” it said. “I’ve been feeling so bad all day. It’s the worst ever. Could you check on me tomorrow and call Viki … I love you, Jana.”
In Jana’s bedroom, her brass headboard picked up the tones of the gold-colored sheets and comforter, which she had already turned down in anticipation of Langsner and Hale-Rowe’s return. Three pillows were stacked at the head of the bed, and Jana had pulled her hair up into a ponytail, since during the practice session strands kept getting caught in the apparatus. Jana got into bed and drew up the blanket so that it rested just below her breasts.
Hale-Rowe sat on the bed with Jana, while Langsner was off to the side near the helium tank, which was still in its box in order to keep the container stabilized. Hale-Rowe and Langsner then watched as Jana performed the tasks just as she had done that afternoon during the dry run, placing the hood over her head and crushing out any residual oxygen. The tubing was already connected to the tank’s nozzle, and Jana slowly turned to the left the valve on the helium tank. Any faster and the force of the gas would have blown the hood off of Jana’s head. The helium made a gentle, steady sound as it was released from the tank, and then there was a slight pop from the pressure. Jana adjusted the gas flow and the bag quickly inflated, rising about 12 inches above her scalp like a clear, ceremonial headdress.
“Are you ready to pull the hood down?” Hale-Rowe asked.
Jana nodded her head yes.
“Whenever you’re ready you can pull it down,” Hale-Rowe said. “But you know that after you go to sleep you won’t be able to wake up.”
“Good!” Jana said.
Jana exhaled, pulled the bag down over her face, and tightened it around her neck with the bag’s Velcro fastener. She inhaled deeply twice.
The helium began to take effect. But instead of falling asleep within two to three minutes as Hale-Rowe promised Jana she would, Jana was conscious for about eight minutes before she drifted away. Then her arms and legs began to twitch. Her heart continued to beat for 10 to 12 minutes, with Langsner and Hale-Rowe standing by to monitor the dying process. And then, Jana was gone.
Langsner and Hale-Rowe continued to sit with Jana’s lifeless body for several minutes before removing the hood from her head. Hale-Rowe lifted Jana’s eyelids and shined a small flashlight at her pupils. There was no reflex. She and Langsner took away the extra pillow that was propping Jana up and fanned her hair out on the two pillows that remained. They lifted Jana’s limp hands and rested them at her side. Then, Langsner and Hale-Rowe stuffed the helium tanks into large black garbage bags and dropped the hood in a separate trash bag, following Network instructions. The idea was that if the contents of the bags were discovered after being disposed of in dumpsters that had been pre-scouted by the guides, the mingling of the tanks and the hood wouldn’t arouse suspicion. They loaded the bags into Langsner’s car and left Jana’s house at 10:15 p.m., about one hour after they had arrived.
Langsner backed his car out of the garage and returned Jana’s garage-door opener to her mailbox. Just as the garage door closed, it dawned on Langsner that he’d left on the dining-room table the letter Jana had written to her neighbor. With the house locked up, Langsner and Hale-Rowe were in a jam. They got out of the car and looked for an open window or some other way through which to reenter the home. It was late at night and dark, and all this snooping around made them look like burglars. It was a good way to get caught, Hale-Rowe thought to herself.
“Frank,” she said. “We’ve got to get the hell out of here.”
A Harris/BBC World News America poll released in January 2011 showed that a majority of Americans — 70% — believe that terminally ill patients with no hope of recovery “should have the right to choose to end their lives.” A more recent survey, conducted in 2013 as part of the Pew Research Center’s Religion & Public Life Project, showed that 62% of adults found suicide to be morally acceptable when “a person is suffering great pain with no hope of improvement” and that 56% of adults believed that a person has the moral right to suicide if he or she “has an incurable disease.” On the issue of physician-assisted suicide, however, Americans were sharply divided, according to the Pew poll, with 47% saying they approve of laws that allow the practice for terminally ill patients and 49% saying they disapproved of such laws.
In 1997, the issue went before the United States Supreme Court. At the time, Michigan pathologist Dr. Jack Kevorkian had been attracting national attention for nearly a decade for his use of a homemade device to help terminally and chronically ill patients self-administer lethal medication. Washington v. Glucksberg, however, wasn’t about Kevorkian, but was born out of a challenge by Dr. Harold Glucksberg and three other physicians to Washington state’s ban on assisted suicide. In its decision, the court ruled that Americans do not have the right to commit suicide or to be assisted in doing so. Chief Justice William Rehnquist delivered the opinion of the court. In it, he offered a challenge: “Throughout the Nation, Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.”
In essence, the court left it to the states to decide whether or not to allow physician-assisted suicide. Since this ruling, several states have wrestled with the issue, and laws have been passed both to permit and to forbid the practice now commonly referred to by advocates not as assisted suicide, but “aid in dying.”
Four months after the Supreme Court handed down its decision, Oregon became the first state to enact “Death with Dignity” legislation, making it legal for doctors to prescribe to terminally ill patients a lethal dose of medication. In most cases, it’s 100 bright orange Seconal capsules, their powdery contents stirred into water or mixed with applesauce or yogurt to help mask the taste. Twelve years later, in 2009, Washington’s law went into effect. That same year, a decision by the Montana Supreme Court also effectively legalized physician aid in dying, though it remains uncodified. In 2013, Vermont became the third state to enact Death with Dignity legislation.
In Oregon, Washington, and Vermont, each state’s health department carefully monitors deaths that result from the legislation. Under state guidelines, patients requesting aid in dying must be at least 18 years old and diagnosed with a terminal illness, with six months or less to live. Requests made by people who appear to suffer from mental illness are screened out, and those individuals are to be referred for psychological evaluation. Death is induced at the time and place of the patient’s choosing, by a lethal prescription ordered by the patient’s physician, who does not have to be present at the time the medication is ingested. Each year, these states report on the number of prescriptions made and the number of deaths that have occurred as a result. The latest figures released by the state of Oregon show that since 1997, when the act went into effect, 1,050 people have received prescriptions under the law, and 673 of them have died from lethal medications. In Washington between 2009 and 2012, a total of 353 people ended their lives with medication prescribed through the act. Data from Vermont is not yet available.
Death with Dignity laws in Oregon, Washington, and Vermont make the dying process bureaucratic, systematic, and regulated. Final Exit Network is bureaucratic too. However, the group operates outside of established programs and without external oversight by public health departments. It was founded in 2004 as an offshoot of the now-defunct Hemlock Society, the right-to-die group begun in 1980 by British journalist Derek Humphry in his Santa Monica, Calif., garage. At its peak, Hemlock Society had 50,000 members. Its first chapter was based in Tucson, Ariz., and the state soon hosted more than 10 local chapters. But after more than two decades, the national organization dissolved in 2003. Focus groups commissioned by Hemlock Society had shown that the public wouldn’t take seriously a political movement named after the plant-based poison that killed Socrates, so the society decided it was time to reinvent itself.
One faction within the original Hemlock Society went on to form End-of-Life Choices. The group later merged with another, Compassion in Dying, to form Compassion & Choices, which resolved to focus its efforts on creating laws that would allow terminally ill patients to end their lives through physician-assisted suicide, or physician-aid-in-dying. Today, the group says it has more than 60,000 members, supporters, and volunteers across the United States.
Another faction wanted to continue to focus on what it saw as the immediate needs of patients, just as it had done in Hemlock Society with the group’s Caring Friends program. Let Compassion & Choices lobby for legislative change, the group reasoned, and we will work with people who want to die now. With Humphry’s blessing, the group took its name from his suicide how-to manual Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. Published in March 1991, the book, by August, appeared at No. 1 on the New York Times hardcover best-seller list in the Advice, How-to, and Miscellaneous category, edging out Martin Handford’s oversize, illustrated children’s book The Great Waldo Search.
Egbert, the physician who approved Jana’s application, was one of Final Exit Network’s original members. Earl Wettstein, a former advertising executive, was the group’s first president. He held the post for a year but resigned in protest after another founder, Ted Goodwin, persuaded the Network to extend its services to people suffering from mental illness. “I think it makes the organization vulnerable,” Wettstein told me when I asked about the group’s decision to take on mental patients. “There are plenty of cases of physical pain where I don’t think we need to go looking at these other ones.” Despite his resignation from the group’s presidency, Wettstein, who lived in Tucson until his death by heart attack in January 2013 at the age of 81, remained devoted to the right-to-die movement.
According to federal income-tax filings, Final Exit Network ended the 2012–2013 fiscal year with total net assets of $886,836 generated through membership fees, donations, and investments. The group is registered as a 501©(3) nonprofit organization. On the Network’s website, which looks like an advertisement for a nursing home, with photos of smiling old people bathed in a heavenly backlight, the group claims to be the only right-to-die organization in the U.S. willing to work with people who are not terminally ill. The Network says that it will help people suffering from such diseases and conditions as cancer, emphysema, stroke, congestive heart failure, amyotrophic lateral sclerosis (ALS), and Parkinson’s disease. The website explains the group’s guiding principles: “We hold that mentally competent adults who suffer from a fatal or irreversible physical illness, from intractable physical pain, or from a constellation of chronic, progressive physical disabilities have a basic human right to choose to end their lives when they judge the quality of their life to be unacceptable.” Its leadership sees the right to die as the civil rights issue of the 21st century.
In Final Exit Network, decisions about who will be accepted into the group’s exit guide program are made not by an individual’s doctor, but by a physician with whom the person, in most cases, has never spoken or met. Death is induced not by prescription pills dispensed at a pharmacy — as is stipulated by states with Death with Dignity laws — but by helium, a colorless, tasteless, odorless gas that cuts off the oxygen supply in the bloodstream, resulting in rapid loss of consciousness, first killing the brain and then stopping the heart. The gas goes undetected in routine autopsies. A tank of it can be purchased at Walmart or Toys ‘R’ Us for less than $60.
“Death by the method we use is absolutely certain,” Jerry Dincin, a former Final Exit Network president and longtime board member, told me before his death from prostate cancer in March 2013, at the age of 82. “It’s quick. It’s painless. It’s bloodless. You are unconscious in 20 seconds, and you are dead in 10 minutes. That’s a real advantage if you don’t want to put a gun in your mouth and blow your head off.”
In Oregon, Washington, and Vermont, health department guidelines stipulate that the patient must make two verbal requests for lethal medication, 15 days apart. A written request must then be signed in front of two witnesses, at least one of whom is not related to the patient. The doctor must then wait 48 hours after the patient signs the final written request before filling out the prescription.
Guidelines established by Final Exit Network are loose by comparison, and in some cases, the time between joining the Network and dying can be brief. An 89-year-old man in Osterville, Mass., on Cape Cod, who had suffered two heart attacks in a year and who used a cane and walker to get around, completed the group’s intake interview on a Friday, was accepted into the program four days later, and died the day after that, with two exit guides by his side. “Weak arms,” the first responder noted on the man’s intake form. “But asserts he is able to put on and take off a hat (so should be able to handle a hood).”
Final Exit Network members vigorously deny that they help people commit suicide. They shun the s-word, preferring instead to call it self-deliverance. When I first learned about Final Exit Network, I found that I agreed with its mission, though I was disturbed by its method. A plastic bag and a helium tank just didn’t seem like the best way to go out, and it struck me as far from dignified, despite the organization’s claims. Still, I imagined that if I were suffering from a fatal illness or intractable pain, I’d want the choice to end my life on my own terms. I thought of my great-grandmother, who died in a nursing home, frail and shrunken at 103, after being kept alive by heart medication and begging, for years, “Let the good Lord take me.” Why should a person have to suffer like that, or save up enough pills for a fatal dose? Or worse?
The difference in Jana’s case is that she wasn’t physically sick. She was mentally ill, and I knew something about the severity of her illness because she was one of my mother’s friends.
Jana Van Voorhis had been in love with my stepfather, John, with whom she’d have a brief relationship before he married my mother. John was a part-time construction worker and carpenter who in the late 1960s performed in a local rock ‘n’ roll band called Poland. Jana was a groupie. I first heard her name when I was 10 years old. It was the early 1980s, and Jana called our home repeatedly one evening, crying and threatening to commit suicide. There was a small party going on at our house when she phoned, and I remember my stepfather coldly placing the receiver on the kitchen countertop and turning back to the stove to tend to a bubbling skillet of chicken cacciatore. I could hear Jana pleading on the other end of the line.
Just once did I meet Jana. It was in the early ’90s. I was in college, and I’d gone home to Arizona to visit my family during my school’s winter break. My mother asked me to have lunch with her and Jana, and I accepted the invitation. We went to La Madeleine, a French bakery and café located at the Biltmore Fashion Park, near Jana’s house. We sat at a booth and Jana cooed over the baby at the table near us, but she barely spoke to me. She would not make eye contact.
When I reread the Network’s mission statement with Jana as my point of reference, I didn’t understand how the group could possibly see her as mentally competent, and therefore an acceptable recipient of its services, even if they did believe she was as sick as she said she was. But mental competence is, after all, a designation usually applied only in the judicial system. It is not synonymous with mental wellness. So when it came to Jana’s suicide, I couldn’t help but wonder, did she jump or was she pushed?
The day after Jana’s death, Wye Hale-Rowe made a phone call to Jana’s sister, Viki Thomas.
“I’m a friend of your sister Jana,” she said.
She told Viki that she was from Jana’s church, and that Jana had given her Viki’s number in case she ever needed it. The reason for the call, she explained, was that she hadn’t been able to get in touch with Jana and she was worried about her.
“You know how Jana’s sick a lot,” Hale-Rowe said. “You should go check on her.”
Viki, who was then 60 years old, thanked Hale-Rowe for calling. She also asked for her name and telephone number, so that either she or Jana could call her back, but Hale-Rowe refused to give Viki the information.
“It’s not important,” she said. “A group of ladies and I are just concerned.”
Hale-Rowe’s attempt at anonymity was not successful. Before hanging up, Viki looked at the caller ID display on her phone and jotted down the number and the name associated with it — Frank Langsner.
Viki called her sister’s house and left a message on the answering machine.
“It’s Viki,” she said. “Will you please call me in the morning?”
Viki called again the next day. “It’s about 10 to 5 on Saturday,” she said. “Give me a call when you get a chance.”
On Sunday around 3:45 p.m., Viki called her sister a third time.
“It’s Viki,” she said in a message. “I’m getting worried about you. Give me a call.”
Viki then called Jana’s neighbor, Anne Shimmel. Like my mother, Shimmel had driven Jana to the ER on several occasions. She, too, had shouldered Jana’s frequent threats of suicide. After a while, Shimmel stopped taking them seriously. “She wanted somebody to pay attention to her,” Shimmel told me when we met at her Phoenix condo. Despite Shimmel’s age, her brown hair was only lightly streaked with silver, and it was pulled back with a narrow headband. “She really wanted to know people and get out and do things, which she felt she couldn’t do. She always thought she was ill.”
Viki’s phone call gave Shimmel the feeling that something was terribly wrong. She noticed that Jana had taken her City of Phoenix garbage bins to the curb for pickup on Thursday night, but that she hadn’t put the empty trash bins back in her garage the next day. The oversight was unusual, Shimmel thought, but at the time she hadn’t been worried. With Viki’s phone call, however, Shimmel flashed back to a conversation she’d had with Jana just a few days earlier, in which Jana had talked about wanting to “end it all” and being ready to “leave this world.” Jana had given Shimmel her house key, telling her that she might need it soon.
“Viki,” Shimmel said, “I think you better get out here.”
Viki and her husband, Tom, a retired phone company executive, arrived quickly. As Tom approached Jana’s front door, he noticed the blue Post-it note that Jana had fixed to a pane of glass on the lower right-hand side of the door, asking Langsner and Hale-Rowe to wipe their shoes before entering the house. On a hallway side table was a roll of white paper towels and a single, used paper towel crumpled alongside it.
“Hello, Jana, it’s Tom,” he called out. “Jana, are you home?”
The master bedroom was at the end of the hall. When Tom entered the room he saw Jana in bed. Her body was tucked under the golden bedspread with her head tilted slightly to the left atop a burgundy pillow, hands resting neatly at her side, just as Langsner and Hale-Rowe had left her, three days earlier. Tom saw that the tips of her fingers were blue. He touched her skin and found it cold. A small amount of vomit crusted around Jana’s lips.
Viki was devastated. She called 911, and later, a call was placed to Jana’s last physician, Dr. Roberts, who, in a letter dated March 29, 2007, had dropped Jana as a patient, citing “non-compliance.” Roberts now declined to issue a death certificate. The Maricopa County Medical Examiner’s office was contacted instead, and Dr. Kevin Horn would later rule the death to be from natural causes. In the autopsy report, he noted significant coronary disease. Of all the illnesses Jana said she was suffering from, heart disease wasn’t one of them.
Viki and Tom suspected suicide. In the months before Jana’s death, social workers had urged Viki to petition the state to institutionalize her sister, and Viki had declined to do so for fear that Jana would never forgive her. Would her sister still be alive, she wondered, had she followed through? Her brother, Dr. Wesley Van Voorhis, an infectious disease professor at the University of Washington in Seattle, and his wife, Debra Jarvis, a hospital chaplain who would deliver the homily at Jana’s memorial a few days later, flew from Seattle for the service and to help clean out Jana’s house. As they combed through her belongings, clues about Jana’s death began to emerge. They found a Final Exit Network pamphlet and a receipt for two helium tanks. They also heard a message on Jana’s answering machine, from a man with a New York accent:
Hello, Jana, this is Frank. I tried to locate the company … Evidently, they have a mailbox in the UPS store. They don’t have a telephone number. We’ll just have to wait a few more days to see if you get your hood.
Frank Langsner was the name that had come up on the caller ID when Viki received the phone call from Hale-Rowe. His name was on the sticky note too. And now it was on the answering machine.
For almost two months, Viki and Tom made phone calls to the Phoenix police, urging them to investigate Final Exit Network in connection with Jana’s death. Who were these people who said they were from Jana’s church, Viki wondered? What made the church connection even more suspicious to the couple was that just three months before Jana’s death, she had changed her will, removing Viki and her brother, Wes, as beneficiaries, and naming Unity of Phoenix pastor Richard Maraj as the sole recipient of her estate, which was worth more than $600,000. Maraj, however, would never come forward to claim the funds, and an investigation by the Phoenix Police Department would later show that there was no link between Maraj and Final Exit Network.
Another of Jana’s neighbors, Alice Farrell, told me that three months before Jana committed suicide, Jana had told her while standing in her driveway one evening that she was in love with a man from her church, and that when she died she was going to come back and kiss the man all over his body. Jana did not name names, but both Viki and my mother told me that Maraj had been Jana’s latest unrequited love interest. “Jana was a dear soul,” Maraj told me in an email. But he declined to answer questions about Jana and her involvement with the church, saying that he wished to “honor her privacy.”
At 9:10 a.m. on Wednesday, June 6, 2007, homicide detectives Lois Weiss and Jennifer Mellinger visited Frank Langsner at his Scottsdale home. For their mismatched looks, other detectives in the unit had nicknamed the partners Blair and Jo, characters in the ’80s sitcom The Facts of Life. Mellinger, with her designer shoes and manicured nails, was Blair, the show’s preppy WASP, and Weiss, a lesbian from the South Side of Chicago, was Jo, its tomboy mechanic. The women told Langsner that they were there to ask questions on behalf of Jana’s family. They explained that Jana’s relatives had told them that she was interested in groups like Hemlock Society and Final Exit Network, and that they had come to investigate the possibility that Jana had committed suicide. Langsner didn’t know it, but Weiss was making an audio recording of the interview.
“What information do you want from me?” Langsner asked. “I don’t know who assisted her or who might have assisted her. That’s up to her. I’m called an exit guide.”
At first, Langsner was guarded about his role in Jana’s suicide, but eventually he admitted his involvement.
“I was there, I was there,” he told Weiss and Mellinger. “Now the policy is we don’t touch anything.”
Langsner also told the detectives that Hale-Rowe was with him when Jana died. He said that in the weeks before her death, Jana had called his home in a panic about the suicide hood arriving late, and that this was “a sign of someone who wants out.” He also explained that the role of the exit guide, when working with a member who has contacted the Network for assistance, is to “help get them in a frame of mind that they want to do it.” Langsner’s attorney, Antonio Bustamante, later denied that his client made this statement.
Jana’s death had now become a homicide investigation. Six days later, Weiss and Mellinger returned to Langsner’s home with a search warrant.
“You don’t have to look through the house,” Langsner told the detectives. “The only thing you have to look for is in my room, my briefcase. All the stuff is in there.”
From the soft brown case tucked under the desk in Langsner’s bedroom, Weiss and Mellinger removed a Final Exit Network training manual; two applicant files, one of which belonged to Jana; a MapQuest printout that gave directions from Langsner’s house to Jana’s; and Jana’s obituary from The Arizona Republic.
“She loved babies, animals, angels, heart-shaped rocks, writing poetry, her friends, family, and her church,” the obituary said. “She is now with her beloved angels.”
Weiss and Mellinger next traveled to Aurora, Colo., to serve a search warrant on Wye Hale-Rowe at her home in Buckingham Gardens, a 120-unit public-housing complex for the disabled and the elderly.
“What is being investigated here?” Hale-Rowe asked, as she stood in the doorway of her ground-floor apartment, studying the search warrant. “Intentionally aiding another to commit suicide? How do you allege we did that?”
By the time the search was over, 90 minutes later, detectives had removed 26 items as evidence, including a folder labeled “Network Trip to Phoenix 4/12–14/07,” indicating that the trip had lasted just two days, April 12–14, 2007. Inside the folder was a typewritten log — written by Hale-Rowe in the third person and initialed “W.H.R.” at the bottom of the page — that documented what she and Langsner did on the day Jana died and how the suicide was carried out.
A story about Jana’s death appeared in the Phoenix New Times soon after. Journalist Paul Rubin spoke with Hale-Rowe about the case. “Jana was in the throes of what we call existential suffering,” she said. “Even though her physical pain may be managed, just being alive is a burden. They’re not able to function much in reference to other people.”
Hale-Rowe continued, “Jana knew what it was like to have had a very functional, active life, and that was part of her angst, that she had lost it and there was no way she could get any of it back.”
In May 2009, two years after Jana’s suicide, the Maricopa County Attorney’s Office announced the indictment of four people in relation to her death. Network exit guides Frank Langsner and Wye Hale-Rowe, case coordinator Roberta Massey, and Medical Director Dr. Lawrence Egbert were charged with manslaughter, and all but Massey faced an additional charge of intentionally aiding a suicide. In a press release, county attorney Andrew Thomas accused the right-to-die group of preying upon the vulnerable.
Hale-Rowe and Massey later pleaded guilty to reduced charges and agreed to testify for the state.
The trial of Franklin Royal Langsner and Dr. Lawrence Deems Egbert began on April 5, 2011, in downtown Phoenix, in Maricopa County Superior Court’s east court building, a boxy, brown judicial edifice across the street from a CVS pharmacy and a Lucky Strike bowling alley. Judge Paul J. McMurdie presided over courtroom 413. A tall, trim, middle-age man, McMurdie often wore under his black robe pink or purple pastel button-down shirts and suspenders. In a pre-trial ruling, he had decided that evidence and witness testimony related to Jana’s mental and physical health would be inadmissible at trial. In other words, Jana’s reasons for committing suicide didn’t matter as far as the law was concerned. My mother was on the state’s original witness list. If asked, she intended to tell the court that within five minutes of meeting Jana, it would be clear to a stranger that she was mentally ill. The judge’s decision, however, made my mother’s testimony irrelevant.
In her opening statement, prosecutor Sherry K. Leckrone, dressed in high heels, a pencil skirt, and a slim, tailored jacket, dangled in front of jurors a plastic exit hood like the one used by Jana, and lifted out of its colorful box a small helium tank. She spoke of Network members going to Jana’s home “in the dark of night” and characterized the Network as an organized-crime syndicate with Egbert as its leader. “They processed her file … and like a godfather gives a nod,” she said, referring to Egbert, “a plan begins, and his associates were ready to carry through.” She continued, “With that authorization, defendant Langsner was ready to do his job to ensure a successful killing.”
Egbert didn’t look like a capo. He came to court in casual suits, bolo ties, and Birkenstocks. Sitting behind him in the spectator gallery along with other Network supporters was his wife, Ellen Barfield, a professional peace-and-justice activist, who wore brightly colored Central American vests and anti-war lapel pins. And at the far end of the defense table, Langsner, the former coach, wore a navy suit jacket and a tie decorated with cartoon images of soccer balls and baseball bats. His right hand shook slightly, the result of a persistent tremor.
A local attorney, David Kephart, a 30-year-old who outside of court often used the word “dude,” represented Egbert. His law office in downtown Phoenix doubled as a coffee house, and from a desk set up in a loft overlooking the espresso machine and tattooed baristas, Kephart filed the legal briefs in the case. Kephart’s presence on the case also made it possible for attorney Donald F. Samuel, of Georgia, to travel to Arizona to serve as Egbert’s lead counsel.
Short and stocky, with a bushy head of salt-and-pepper hair, a scruffy beard, and a gentle Southern lilt in his voice, Samuel has been involved in several high-profile cases. In 2000, he defended Baltimore Ravens linebacker Ray Lewis against a double-murder charge, which was dropped near the end of the trial when the athlete pleaded guilty to a misdemeanor. Lewis was sentenced to 12 months’ probation. More recently, Samuel was part of the defense team for the rapper T.I., whose real name is Clifford Harris. Charged with felony weapons possession after his bodyguard purchased three machine guns and two silencers for him, Harris was facing a 15-year prison sentence. Ultimately, he was sentenced to a term of one year and a day. Harris went on to star with his wife in the VH1 reality television show T.I. & Tiny: The Family Hustle.
When it was his turn to address the jury, Samuel called Egbert a “fine American,” and lauded him as a doctor, a professor, and a humanitarian. He said that Egbert’s work with Final Exit Network kept terminally ill people from ending their lives by using a shotgun or jumping off tall buildings, as a man had done the previous week at a site not far from the downtown courthouse. He spoke about the Network’s belief that people have the right to make their own decisions about how to end their lives, and he addressed Egbert’s relationship with Jana: “He never met her, never communicated with her. He was not her doctor. They had no relationship whatsoever.”
Bustamante, a Phoenix attorney, represented Langsner. He described his client to jurors as “a man of compassion who cares for people deeply,” and held in his hands a set of notes that he consulted frequently while telling jurors about Langsner’s assignment as an exit guide for Jana. “His role was not to help her take her life,” Bustamante said, punctuating the air with a pointed finger. “His role was to provide information, to see that this was something that she really understood, that this was something that she really wanted to do … His job was to provide information and to be there for her. This was a matter that called for the highest in his human nature.”
About 15 Final Exit Network members and supporters filled the courtroom’s two rows of spectator seats on the defense side. During a break in the proceedings, the group talked and laughed. Former Network President Ted Goodwin was among those who traveled to Phoenix for the trial. He had a silver goatee, a red face, and round belly, and he spoke of spending time on his boat in Florida. A trio of gray-haired women gathered around him, and Goodwin shared with them his sex-on-the-beach cocktail recipe.
Across the aisle, Viki and Tom Thomas sat with their heads down. I sat behind them, alongside a local cameraman and his teenage son, who had been hired by Frontline producers to record the trial in its entirety. Viki, who was dressed in black slacks and a sheer black blouse decorated with green-and-white polka dots, had been the state’s first witness. During her testimony that morning, photographs of Jana dead in bed were displayed on courtroom monitors.
“Just to remind everyone, please speak softly,” Samuel’s co-counsel, Kristen Wright, told Network supporters during the intermission. “Don’t make any rude comments. Be respectful of them and the victim and everybody.”
“No cheering and no clapping,” one of the Network people responded sarcastically.
On Wednesday, April 13, 2011, four years and a day since Jana committed suicide, Wye Hale-Rowe testified for the state. Prosecutors had hoped that she would help their case, but were disappointed by what Hale-Rowe said in court. She spoke passionately about the work of Final Exit Network, and clearly explained its procedures. “I hope that he was holding her hand,” Hale-Rowe said when Leckrone’s co-counsel, Patrick Johnson, asked what Langsner was doing as she prompted Jana to place the plastic bag over her head and turn the valve on the helium tank. “Dying is a lonely business, and I like to have people have some human contact as they go to sleep.”
Leckrone later described Hale-Rowe as a hostile witness.
The trial spanned three weeks. On Thursday, April 21, 2011, around 3 p.m., after deliberating for a day and a half, the jury delivered its verdict. Egbert was acquitted. A note sent by the jury foreman to McMurdie later showed that jurors wished to make official note of what they believed to be the doctor’s recklessness, but McMurdie would not allow it.
When I spoke with Egbert by phone after the trial, he told me that Jana’s long struggle with her mental health factored in to his decision to accept her into the Network’s exit guide program. Despite the suggestion by Harry Lien, the volunteer who conducted Jana’s intake interview, to ask Jana about her illnesses and lack of prognosis, which Lien found to be unusual, Egbert asked no questions of Jana and consulted no one about her application. “It didn’t seem necessary,” Egbert told me. “She looked pretty darn obvious to me.”
I asked Egbert why he included the cautionary note. “The idea of staying alert is that the patient was a pretty odd character,” he said. To him, the list of diagnoses that Jana had shared with Lien was just plain weird. “She had been in a psychiatric hospital,” Egbert told me. “She had a lot of therapy over a period of a number of years.” To him, Jana was better off dead, if that was what she wanted.
Egbert added, “If you look at the case, the woman really suffered horribly. The idea of calling what she was doing living is a very debatable subject.”
The jury could not reach a unanimous decision as to the guilt or innocence of Frank Langsner. Instead of enduring a risky retrial, which his attorney feared likely — considering that Langsner had met with Jana several times to discuss her suicide and had been with her when she died, and that Judge McMurdie, in his written instructions to the jury, had determined that to “aid” a suicide “means to assist in the commission of the act, either by an active participation in it or in some manner advising or encouraging it” — Langsner pleaded guilty on June 30, 2011, to endangerment, a lesser charge.
In a pre-sentencing letter to Judge McMurdie, Tom Thomas expressed his family’s frustration. “It appears that Mr. Langsner could complete these proceedings with nothing more than a misdemeanor conviction and a paltry $250.00 fine,” he wrote. “Kinda like being convicted of shoplifting a twelve-pack.” (Thomas was not exaggerating. In Arizona, a misdemeanor shoplifting charge carries a $250 fine, and with the addition of an 84% statutory surcharge, the total fine is $460.) He added, “It is our hope that in the interest of justice, and as a deterrent to future involvement by others with death solutions for the mentally ill, the court take the strongest punitive measures possible against defendant Franklin Royal Langsner or reject the agreement as currently written.” For his role in Jana’s suicide, Langsner was indeed fined $460. He received no jail time and was placed on probation for a year.
A pre-sentencing statement by Detective Weiss had similarly harsh things to say about Hale-Rowe. Weiss, then a 17-year police force veteran with six years as a homicide detective, called the case the “most disgusting” she had ever seen and described Final Exit Network members as “cold-blooded killers” who presented as “narcissistic, grandiose, and omnipotent.” Hale-Rowe, she said, “coaxed and groomed Jana for suicide.”
Tom Thomas went further. “Others, over the years, from waitresses to teachers to sales clerks, gardeners, and children, have questioned Jana’s capabilities after brief exposures to her. It appears Ms. Hale-Rowe chose to ignore the obvious mental infirmities Jana exhibited. After all, she was the experienced, knowledgeable, ‘senior’ guide and had come all the way to Phoenix.”
On Sept. 26, 2011, Hale-Rowe was fined $1,840 and given a year’s probation. In addition, after more than two decades of activism, she was banned from participating in the work of Final Exit Network, or any other right-to-die organization.
The trial in Phoenix was the first for the Network. It laid bare the intimate details of the group’s activities. More insight may be coming soon: On Dec. 17, 2013, the Minnesota Supreme Court agreed to review a third case against the group that had previously been dismissed.
In February 2012, a second case against four members of the organization, including Egbert, who had been charged in 2008 with assisting the suicide of a 58-year-old Georgia man, John Celmer, was dropped after Georgia’s Supreme Court struck down a statute that made it illegal to promote assisted suicide, ruling that it violated the First Amendment’s free speech clause. The law had been enacted in the 1990s in response to the work done by Jack Kevorkian, who died of natural causes in 2011 at the age of 83. A year later, the Washington Post Magazine called Egbert “the new face of assisted suicide,” even though ongoing litigation in the Jana Van Voorhis and John Celmer cases kept Egbert from participating in Network activities for several years.
Still, the comparison to Kevorkian is valid. In the eight years Kevorkian was active, he claimed to have assisted 130 suicides. Egbert told me after the Phoenix trial that he had been present at the suicides of at least 100 people. Pretrial motions noted that he had in his Baltimore office 425 individual case files with “handwritten notations in red ink that refer to acceptance dates, exit dates, guide names, and other information.” Specific dates for suicides were listed in approximately 121 of the case files. Only a handful of the files were allowed as evidence in the trial.
Six months after the trial ended in Phoenix, I met with Jana’s brother, Wes Van Voorhis, in Boston. He was in town to attend the 49th annual meeting of the Infectious Diseases Society of America, and when I arrived at his hotel near the convention center, I was met by a phalanx of demonstrators holding fluorescent green poster-board signs to protest new treatment guidelines for Lyme disease. Wes’ specialty is malaria. A YouTube video shows him dressed in a suit and bow tie, standing before a lecture hall of students, performing with a hoarse voice a song he wrote about the illness, set to the tune of “Maria” from West Side Story.
Like his sister Viki and his brother-in-law Tom, Wes is not opposed to physician-assisted death in cases of terminal illness. During our meeting, his wife Debra, who had accompanied him on the trip, told me about a friend of theirs in Seattle who, after being diagnosed with stage four colon cancer, took advantage of Washington’s Death with Dignity Act and ended her own life before the disease did it for her. However, the couple sees Final Exit Network as vigilantes out to promote a radical agenda.
Final Exit Network would likely agree with that assessment. “As far as the Network is concerned, it is not morally objectionable to assist a person in that condition,” meaning mentally ill, the group’s general counsel, Rob Rivas, told me before the Phoenix trial began. This coming fall in Chicago, Final Exit Network will host the 20th biannual meeting of the World Federation of Right to Die Societies, Sept. 17–21, and assisted dying and mental illness are among the topics slated for discussion.
As a result of what happened with Jana Van Voorhis, however, Rivas told me that the group’s protocol had changed. “If the Network isn’t able to confirm that the nearest relative of a member who wants to die is on board and accepting of it, the Network backs off the case at that point,” he explained. The group also updated the homepage of its website, stressing in its guiding principles that its focus is on people in physical pain. (The “about” page got no such adjustment, however, and continues to refer to people whose “quality of life is personally unacceptable” as a condition for suicide.)
That’s little consolation to Jana’s siblings. They believe that her death could have been prevented. “She’d swallow eight Tylenol or something and then drive herself to the ER or call 911, and they’d come racing over,” Wes told me when I asked about Jana’s suicide threats. “I think we all kind of realized that this was her way of getting attention than actually doing harm to herself.” Like his sister Viki, Wes believes that Jana would still be alive if not for the intervention of Final Exit Network, which took seriously Jana’s persistent desire to kill herself and offered expert guidance on how to carry out the act.
Still, Wes told me, after Jana’s memorial service, there were some members of the extended family who expressed a different view: that Jana’s mental anguish was finally over, and that Viki and Tom should not pursue a police investigation. “They were pretty much saying, ‘Leave well enough alone; don’t look into this; she’s in a better place now,’” Wes told me. “But that wasn’t the issue, that she was in a better place. The way that she died was wrong. It just felt wrong to us.”