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In ‘The Suicide Plan,’ Frontline Explores Hidden World of Assisted Suicide

Joan Butterstein watched as the end came in steady waves of misery for her husband. “Chemo, radiation, and then more chemo and more radiation … and he was sick and miserable frequently, if not most of that time,” she said.

When the lung cancer finally took him after more than 50 years of marriage, Joan said goodbye to her husband with a promise to herself: “I was going to make sure that I don’t go that way.”

She did just that. With the guidance of an end-of-life group called Compassion & Choices and 60 pills that she ingested in 15 minutes, Butterstein would guarantee that she would die on her own terms.

“I just checked off exactly what I needed, and it came in the mail,” Butterstein said of the cocktail that would end her life a month after her 81st birthday. “That was a big surprise. I couldn’t imagine that this is available.”

In “The Suicide Plan” — which airs Tuesday evening on PBS’s Frontline (check local listings) — fimmakers Miri Navasky and Karen O’Connor take viewers inside the surprisingly coordinated underground world of assisted suicide in the United States. It’s a story told from the perspective of those choosing to end their lives, the activists who put themselves in legal jeopardy by helping others to die, and the law enforcement officials trying to stop the practice that remains illegal in every state except Washington and Oregon.

For a preview of the film and further exploration of the hidden world of assisted suicide, we turn to the film’s co-producer, director and writer, Miri Navasky.

NewsHour: Why did you make this film and how was the experience different from making your previous ones?

Navasky: We’ve made a number of films on death and dying (Living Old, The Undertaking, and Facing Death). In all of them, we had seen doctors assisting in death in a variety of settings and forms — taking someone off a ventilator, increasing doses of morphine, palliative sedation, etc. While palliative care and hospice care have altered the medical landscape over the past decades, the arguments for and against assisted suicide have essentially remained the same. So we wanted to find a new way into the issue and not just rehash the same old debate. We decided to focus on what people are doing who want help dying but who don’t live in states where physician-assisted suicide is legal.

We were interested in examining more controversial and, perhaps, more explicit forms of assistance. Also, of course, we both have friends or family who have struggled with these issues in one way or another; just about everyone does, so the universality of the issue alone made it worth looking into. Then, lastly, we’re also both very interested in exploring “hidden worlds” and certainly the underground world of assisted suicide qualifies.

In terms of our experience making the film — it was a much different kind of film for us. In our last film, Facing Death, people were fighting to live. In this film, people are choosing to die — a very different kind of film, more shocking in many ways, but perhaps not as wrenching, because most of the people had come to terms with their death.

NewsHour: Most people will be shocked how easy it is to do this by mail or, in the case of Final Exit Network — one the groups you profiled — how organized it is. What surprised you most as you began putting all of these pieces together?

Navasky: We were completely surprised to find out that there are groups in this country that help people to die — even in states where assistance is not legal. Although we knew of Compassion & Choices, the right-to-die group spearheading the legalization efforts in the country, we had no idea of the extent of their end-of-life consultation program across the country. During our initial research meetings, when we followed the Compassion & Choices counselors and patients, it was eye-opening to learn just how detailed the information is that they provide.

We were even more surprised to find out about Final Exit Network, which helps non-terminally ill people as well as terminally ill people using a controversial method: death by helium, which requires a plastic hood.

But on the flipside, we were also astounded by the number of people who were yearning for this kind of information and for the comfort it brought to them — just knowing that “assistance” was out there, even if they never used it.

We also had no idea just how much time and money was being spent investigating individuals and groups involved in this issue. To give you an example that is not in the film, the FBI raided the home of a 91-year old woman in California who had been making the helium hoods for people to order online. We ourselves had ordered one from her –for research purposes — in my husband’s name, and one night, long after the raid, a New York City policeman showed up at our apartment building to make sure he hadn’t used it to commit suicide. It was what the police call a “wellness check.” They must have been going on all across the country.

NewsHour: You examine the ethical line that’s so controversial in all of this — and the justifications people on both sides make for their stances on assisted suicide. Describe that line for us.

Navasky: Everyone draws their lines differently, both proponents and opponents alike. One of the biggest things we discovered during the course of making this film is that while it may seem like a black-and-white issue, it’s anything but. People, who might be opposed in theory can change their mind when it involves a loved one. And even people within the right-to-die movement have a wide-ranging opinions, with some believing assistance should be available to only the terminally ill and others believing it should also be available to anyone who is suffering, including people who aren’t dying. In general, there’s much greater consensus in support of providing assistance to those who are already dying, yet while clearly more complicated, most of us can relate to a person like George Brodigan, who was suffering from dementia and asked his son for help before he became incapacitated. And many of us can also relate to Bruce Brodigan, who provided the help, but was arrested for it. The issue is rife with complexity; we hope our film conveys some of that.

NewsHour: Do our laws reflect that complexity?

Navasky: Well, they certainly reflect our ambiguity, as does the response of the criminal justice system. It’s been nearly 20 years since Oregon became the first state in the country to legalize doctor-assisted suicide, and since then, only one other state, Washington, has actually legalized it. In Massachusetts, like many other states, a ballot initiate to legalize doctor-assisted suicide was just narrowly defeated. One of the things we found the most fascinating in the making of the film was the ways in which our ambivalence about the issue plays out in courtrooms across the country. Even in states where it is illegal, it can be very hard to convict someone. Not only are the laws vague, and they tend, perhaps purposefully, not to clearly define “assistance.” But even when it seems that someone has violated the letter of law, juries are often reluctant to convict, especially when a person is clearly acting out of compassion.

NewsHour: Some of the stories in this film are extremely personal. Describe one of them for us and tell us, as a filmmaker, what made them so compelling to you.

Navasky: During the filmmaking, we found ourselves swinging back and forth on the issue in all sorts of ways and we wanted the viewer also to be challenged emotionally and intellectually. So we included a range of cases — from people who are terminally ill to the more complicated cases that involve Alzheimer’s and mental illness. All of the stories were compelling in their own way, but the one that was most emotional for us was Joan Butterstein’s. She was the only person we followed as she was making these decisions, and we didn’t know how her story would end. She was 81, terminally ill with lung cancer and had watched her first husband die a long, painful death. She was determined to die in the way she wanted, and the way she wanted to die was at home with her family, before she became too debilitated. She was remarried, to a devout Catholic who was opposed to assisted suicide in principle, but who was supportive of her decision. As it turned out, in consultation with Compassion & Choices, she took a lethal dose of medication and ended her life before her illness had a chance to.

Because the laws are so murky, most right-to-die organizations require you to be physically strong enough to take the pills yourself, to die a “good death,” often you have to give up time. That’s exactly what Joan did; it was impossible to know how long she would have lived otherwise. In Joan’s case, partially because of her obvious determination and openness, it seems hard not to feel that she made the right decision for herself, but reactions, we’re sure, will vary.

NewsHour: Final Exit Network offered your crew unprecedented access to one of their training sessions in which they demonstrated their techniques for helping people die. Describe that session for us, and if you could, tell us why you think they were so open with you.

Navasky: The training session took place in a hotel, over the course of three days. It involved much more than we were able to show on camera, a lot of role-playing, discussion and debate, legal training and training specific to the helium technique. Why were they open with us? Probably because they feel they’re doing the right thing. They believe passionately in their cause. Not only do they view this as an individual rights issue, they’ve all had experience with death and dying, and many have dedicated their lives to the movement and trying to help people die peacefully and not alone. You can certainly question their methods; it’s much harder to question their motives. They viewed the film as an opportunity to get the word out about what they do and why. Also some people associated with the Network had seen some of our other films, and that may have also contributed to their cooperation, as well.

NewsHour: This is such an incredibly complex subject. Was there anything left on the cutting room floor that you wish you could have included?

Navasky: We examined what was happening in states where doctor assisted suicide is illegal (every state except Washington and Oregon). Here — in the underground world — doctors are reluctant to prescribe lethal doses of medication, so people who want help dying are relying of imperfect, cobbled-together methods. There were a variety of scenes showing these methods in detail, and some of them, Frontline felt, were too explicit.

The Suicide Plan airs Tuesday, Nov. 13, from 9:30 to 11 p.m. ET on PBS (check local listings).

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