The note on the door said, “Don’t come in alone.”
Inside, police and coroners found a lifeless body ravaged by AIDS and suffocated with a plastic bag. There was a bottle of Seconal and a handwritten note carefully explaining that this was not an assisted suicide.
Stephen, a close friend of the victim’s, knew otherwise.
He says his suicidal friend had “discussed it with me but I wouldn’t help him. I have nothing against the guy who helped him, but it doesn’t feel right to me. I believe life is sacred and taking life isn’t.”
A committed Jew who is also HIV positive, Stephen, who prefers that his real name not be used, speaks of a suicide underground that has been operating in the Bay Area for a decade. It’s an underground with careful rules and an argot all its own.
“There’s a code,” Stephen explains, “when a doctor says, `Let’s make him really, really comfortable.’ The more `reallys,’ the more morphine.”
Another code: Ask for sleeping pills of increasing strength until the prescription is for Seconal, the brute-strength barbiturate commonly used by AIDS patients to end their own lives.
“There is a lot of this going on,” Stephen says. “A lot.”
Last week, the Supreme Court agreed to decide whether states can prohibit doctor-assisted suicides. Although a ruling on the issue probably won’t come before June, Jews here already are grappling with the spiritual implications of choosing to die.
Each year, Jewish Family & Children’s Services works with some 100 people with AIDS. In support groups, the topic of suicide almost always comes up, says Jody Reiss, coordinator of JFCS’ AIDS Project.
The groups exist to help their members with living, not dying, she stresses. Her clients talk about how to survive with pain and uncertainty, how to live with the ghosts of lost friends and lovers.
Reiss, however, knows that information and assistance with the particulars of dying are not hard to find.
“Anybody knows where to go for that, frankly. A lot of doctors are very helpful. Basically, they’re not gonna say, `Here’s a lethal dose.’ But there are ways of making sure a patient gets what he needs,” she says.
Physician-assisted suicide is illegal in California. Reiss, a clinical social worker, is supposed to intervene if she knows a patient is suicidal and “not of sound mind.”
It is “a very, very gray area clinically,” she says, noting that this is only one of many delicate areas in a wrenching national debate on assisted suicide.
While the upcoming Supreme Court decision may clarify such protocols, there are deeper issues, she says.
Reiss admits that, sometimes, planning a “rational suicide” gives patients a sense of control over their own deaths. She worries, however, that it makes life more difficult for those left behind. “Loved ones go along with the plans; but after the fact, I’ve always sensed it’s very damaging for survivors,” she says.
When no one is listening, Stephen still talks to his dead friend, filling him in on the details of life. And sometimes, he still asks, “How could you?”
Jewish law forbids suicide. There are built-in deterrents: A Jew who has committed suicide can be buried only on the perimeter of a Jewish cemetery, and no eulogy may be read. Like most deterrents, says Rabbi Allen Bennett of Temple Israel in Alameda, those don’t work.
One of a handful of openly gay rabbis in the Bay Area, Bennett has often been called upon to minister to those dying of AIDS. They ask about Judaism and suicide; they ask what will happen to them after they die.
“I tell them it’s a simple, pragmatic, time-tested process. The body returns to the elements that originally comprised it. The body returns to dust, and the soul returns to the God who gave it,” Bennett recounts.
He reminds them that “Judaism is unalterably opposed to the ending of one’s own life.”
The rabbi also contends, however, that “if one is incapacitated, miserable, with no hope of improvement, if an individual chooses to stop living, I believe they should be entitled to that moral choice.”
Bennett admits he has been asked to attend suicides but will not comment further.
Legal, moral, insurance-related and patient-client confidentiality issues all wrap assisted suicide in a veil of secrecy. Rabbi Eric Weiss, who ministers to AIDS patients through Ruach Ami: Bay Area Jewish Healing Center, will say only, “I uphold the sanctity of life, through prayer, listening and helping someone to identify where they have moments where life has some kind of sweetness.”
In fact, the Union of American Hebrew Congregations, the umbrella for Reform synagogues, is still debating the issue, and to date has no official stance. Daniel Chesir, a lawyer for Kaiser-Permanente in Oakland and member of UAHC’s bioethics committee, says, “The committee’s general thrust is to emphasize the need for adequate care at the end of life, to alleviate pain and provide emotional support.”
Many in the Orthodox movement are taking a harder line.
“You open the door to assisted suicide, you’ll wreak havoc on society,” says New Jersey Rabbi Maurice Lamm.
Lamm, president of the National Institute for Jewish Hospice and author of “The Jewish Way in Death and Mourning,” says that not only will physicians lose their credibility, but Jews in particular will give up the power of retaining hope through suffering — a skill that has time and again proven crucial to Jewish survival.
Lamm uses the Holocaust as an example.
Jews “were singing in the cattle cars, `I believe the Messiah is going to come,’ as they looked at smokestacks. They didn’t commit suicide. Three years later, you have Israel. The national anthem is `Hatikvah,’ hope.
“This doesn’t mean I don’t understand the anguish of AIDS patients. I do. I have deep compassion. I believe people with AIDS should have hospices, guarantees to reduce their pain.”
Sometimes, though, there is no guarantee. Even with promising new drug therapies, lives may be longer and healthier, but some deaths will always be excruciating.
Last year, Dr. John Stansell, medical director of San Francisco General Hospital’s AIDS clinic, told the San Francisco Examiner, “There are some patients for whom we cannot make death a tolerable process.”
In that interview, Stansell admitted prescribing barbiturates to several patients close to death. He was reportedly reprimanded by his bosses, and has not granted an interview since.
Even Lamm, who staunchly opposes legalizing suicide, concedes there is a very small percentage of AIDS patients whose suffering cannot be mitigated by drugs or counseling.
“That’s one hell of a life. I wouldn’t choose it either.”
He wouldn’t choose it, he wouldn’t end it, but even Lamm would understand it.
“I’ll turn my eyes away from their asking the right doctors the right questions,” Lamm says.
That’s where Lamm parts company from less moderate Orthodox leaders, most of whom denounce even end-of-life hospice care as a means of curtailing life.
The Conservative movement, however, was quick to accept the hospice concept, according to Rabbi Alan Lew, spiritual leader of Congregation Beth Sholom in San Francisco and president of the Northern California Board of Rabbis. Like Lamm, he says there isn’t much flexibility in Jewish law on the subject.
“Life isn’t something that belongs to us; we aren’t free to dispose of it as we see fit.”
Despite the clear-cut mandate, Lew would also condone “a little creative hypocrisy,” for the case of unbearable suffering. “I wouldn’t waste too much time condemning someone in hideous pain who couldn’t go on living. I’ve been with too many people like that.”
So has Stephen. He has watched several loved ones die — some from AIDS, some from assisted suicide, some from an ambiguous combination of both.
Four years ago, he sat by the bedside of his dying longtime lover who had slipped into an AIDS-related coma. Stephen tried to speak in Yiddish, which was the sick man’s mother tongue. The doctors said Stephen’s lover couldn’t hear him, but the nurses insisted he could.
There is a rule of thumb in the world of the dying, Stephen will tell you. If you’re well enough to pick up the pills yourself, you shouldn’t.
Looking back now, he remembers his lover’s doctor speaking in a now-familiar code, making the comatose man “really, really comfortable” as he expedited a quiet journey from the hospital and the perhaps-incomprehensible murmur of broken Yiddish.
“When I understood the code later,” Stephen says, “I was grateful.”