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Volume 2, Issue 4
Winter 2006:

Healthy Suicide

Mark Bernstein, M.D.

Cell 2 Soul. 2006 Winter; 2(4):a7

The story is told that it started in northern Europe with a group of post middle-aged academics. It caught on in North America in the late 1990's but remained underground for a few decades. Newspapers reported the deaths in the obituary column without any special attention being paid. Successful people with financial and every other form of success and security were the main participants in the practice.

The closest person to me who had done it was one of my surgical partners at the hospital — his selected date was a few months following his 50th birthday. I clearly recall chatting with him just a few weeks before the event on a day when he was operating in the theatre beside mine. We chatted casually, each of us leaning against our respective scrub sinks between surgical cases. I recall he had a small fresh shaving cut on his chin. He spoke openly about it and seemed to be at peace, even in a state of equanimity. When the day came he carried through on his plan without a hitch.

I remember feeling both awe and an uneasy shiver at the fact that he could so easily leave the world of the present which included two teenage daughters, a second wife with whom he was madly in love and so completely compatible, a great job, a passion for fine wine and cycling, and all the rest. It gave him in death a sense of ultimate strength and even untouchability and I found myself envious of his resolve and power. I marveled at how someone could be so in control of his emotions so as to embrace death willingly, especially when I was so fearful of it, among other things.

Of course suicide was as old as mankind and many visible people had put their stamp on it, like Ernest Hemingway and Jimi Hendrix, and countless invisible ones. It was usually attributed to depression or substance abuse, or a serious psychotic thought disorder like schizophrenia. The current situation was very different in that non-depressed, well-adjusted, highly successful people were doing it. Presumably they had just decided that they were comfortable enough with what they had achieved while walking on this planet and wanted to go out at the peak of their game. It sounded rather logical at first glance. Quit while you're way ahead. But was life so empty and barren that it was not worth sticking around as long as possible?

Some made a party out of it and a number of friends would do it together. Some surrounded themselves with family. Everyone seemed to be accepting the practice without any public outcry or outrage. It was not an illegal act because suicide had been decriminalized decades before. Experts from psychiatry, ethics, social sciences, philosophy, theology, and anthropology discussed it on television and radio talk shows, and numerous well-known commentators published lengthy exposes about it in places like The New York Times Magazine. One articulate man performed it publicly on a television talk show in exchange for a handsome financial settlement for his family from the television station. When asked to explain his actions, he stated simply: "If I can laugh death in the face and meet it head on while I'm still of healthy body and sane mind, this will be the ultimately victorious life."

But some leaders were concerned at the growing popularity of this practice which became known as Healthy Suicide because ostensibly mentally healthy people were ending their lives. It was seen as a new "yuppie epidemic" that could have detrimental effects on society like decimating the upper middle classes and thus derogating important generated tax dollars for local economies, and the like. Also to be considered was that successful and valuable contributors to society like doctors , artists, and thinkers were being removed from the work force well before their time.

It was the third decade of the twenty-first century. The world had been free of major conflict for almost 40 years — longer than any other such period in history. The HIV-AIDS crisis in Africa and other developing countries was stable and actually improving due to the widespread availability of inexpensive medications that these countries could produce within their borders. The Middle East had not seen a casualty in over a decade since the leadership of the region had been assigned to a team of career politicians and administrators headed initially by an Icelander. The United States had its third consecutive Democrat president. In general, life had never been so comfortable for so many for so long.

I had had a pretty blessed life myself — a warm and uneventful childhood surrounded by loving parents, sisters, cousins, aunts, and uncles. I got married during medical school to a gentle intelligent Asian woman. But our marriage became a casualty of my neurosurgery residency training during which time I was seldom home and when I was I usually fell asleep at the table with a dinner fork in my right hand. I remarried a wonderful woman from the western United States while I was doing some research studies there. We moved back, I finished my training and I embarked on an exhilarating and successful career as an academic neurosurgeon at a large teaching hospital. I had a great practice focusing on patients with brain tumors, wonderful teaching opportunities, and the chance to do some exciting research. I wrote a few books and lots of other scientific papers, and became full professor before I was 45.

On the home front we raised three wonderful daughters who were now close to independence and we recreated at our beloved cottage a few hours north of the city, including countless hours spent doing one of my many passions — sport fishing. I got to travel to exciting places like India, the Orient, and all over Europe and North America. Besides a few surgeries for benign conditions and one or two brief flirtations with depression, my health had remained good. We were not drowning in money but were financially comfortable largely due to my decades of hard work and the financial skill and savvy of my wife. Life was good, or at least as good as it could be.

I decided to do it. It felt right for me. I had provided well for my family, my children were almost independent and I had no obligations that could not be fulfilled by others. Under any other circumstances it would be selfish to indulge in healthy suicide but I decided to forward with nervous excitement and a clear conscience. I thought about it a lot and felt I had accomplished every possible goal in my professional and personal life and beyond. Life was great and it couldn't get any better, only worse, so why not go out on a high?

I presented the idea to my wife at dinner one night between bites of grilled salmon; she was mildly alarmed but accepting. She had probably been expecting me to do it — she knew me pretty well. It was becoming so common that many of us almost felt it was expected of us. Perhaps it was even like some twisted status symbol — only the most successful and secure could do it. I guess peer pressure played a role in some peoples' decisions but not with me — it just felt right. Later when people asked me why, I couldn't say anything more eloquent or illuminating than: "It just feels right".

I picked a date two years hence in order to give adequate opportunity to have my life and affairs in as excellent order as possible. My life would not change substantially - I would continue to work, travel, relax at my cottage when I could, go fishing, walk the dogs, carry on. Except that I would be thinking of and planning for the day of the grand exit.

Getting things in order meant winding down my practice and making sure all my patients had been referred to other surgeons to carry on their care. For the few manuscripts which were still in the review process I wrote a letter to the journal's editor informing them of others they could contact to check galley proofs or attend to other details, in the event of anything happening to me. I created a list of who should get what possessions of mine, most of them going to my children and wife but some special ones to other special people in my life. I left my big boat to a good buddy who lived up near our cottage. He would get the best use out of it and would never be able to afford to buy one on his own. I had to decide what to do with all my files on my computers at work and at home, including hundreds of great photos from my travels. Everything was rigorously documented in a lengthy file in my home computer, a printed copy of which I had been over with my wife with a fine toothed comb. Many of my clothes would be given to a charity — there would be some handsomely dressed people out there after I was gone. I did pick the outfit I wanted to be cremated in — the beautiful dark blue suit I had had custom-fitted and tailored for my oldest daughter's wedding.

The time approached and I became increasingly nervous. I purchased the requisite drugs and equipment at a special government-run outlet created specifically to monitor the numbers of individuals involved in this practice. Society could not legislate against it but at minimum they wanted to keep track of the numbers. The drug and syringe cost $1200.00 and it was not refundable. Also you had to fill out a written application and wait several weeks to get the go-ahead to walk away with the product. No-one was sure what happened during that waiting period to justify it. No psychiatric or other evaluation was required. Maybe it was designed just to give people some extra time to think over their decision.

The technique had evolved from a crude one involving various homemade recipes for suicide, to a sophisticated and ingenious one developed by an inventor. You purchased a special syringe loaded with a lethal dose of barbiturates and inserted the small needle connected to the syringe under the skin on the thigh or abdomen. You then sent an e-mail to the address: healthy.suicide AT homesuicide.com. You were then automatically located by a satellite and an electronic message sent back which activated a small motor mounted on your syringe. This drove the plunger down and the drug home. Unconsciousness followed in a few minutes and death in about half an hour. There were of course many other ways to end one's life but this method became the vogue for the successful clientele that undertook a healthy suicide.

A few days before my designated time I was very uneasy. I dreamed up excuses and had a few really good ones. The cancellation rate from planned healthy suicide was easy for the government to track. Yearly numbers of syringes and drugs sold were compared with the death certificates for that year from those who purchased the equipment. This cancellation rate was substantial (about 40%) so it was not as if I would be a social outcast if I did likewise.

On the designated morning I had a large "weekend breakfast" and then sat at my computer with my wife and dogs by my side. I gave my wife final instructions and we discussed some logistic and practical issues in a calm conversation. But we had been over everything several times — my obsessive-compulsive personality had not changed since my big decision two years before. I felt the damp collecting in my armpits and my scrotal skin tingling with anxiety.

My heart was pounding as I gently inserted the small needle into my thigh without cleansing the spot with an alcohol rub. I smiled at the irony of worrying about such an irrelevant detail when the small possibility of a mild superficial infection was quite moot at this point. I first sent an e-mail to my children who I had spoken to by phone the day before in their various cities, and we had exchanged fond farewells. I was a little disturbed that everyone seemed so calm with my decision. Would I be so unmissed?

I typed in the e-mail address and put my name in the subject line. I typed into the text box the words prescribed in the instruction booklet given out at the government store where I had purchased the syringe weeks before. My mouth was dry when I kissed my wife gently on the lips and gave my beloved dogs a last scratch behind their ears. Surely they would miss me!

I clicked the "Send" button on the computer. I avoided eye contact with my wife as I waited, feeling strangely calm and maybe even a little disconnected.

The deafening sound of my heart pounding was suddenly replaced by the metallic sound of the little motor turning on as if by magic and the small gears turning in the sugar cube-sized unit fixed to the barrel of the syringe.

Almost by reflex, my right hand quickly darted out and grabbed the syringe dislodging the needle from my leg. The plunger ejaculated the slightly viscous yellow liquid harmlessly onto the wooden floor of my office.

Explanations all around tomorrow seemed much better than death today. My wife grinned a little anticlimactically. I guess I was not ready just quite yet to leave this world voluntarily. The dogs followed me as I walked downstairs. I put my coat on, grabbed some pooh bags, and took them out for a walk.

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