Joining the Final Exit Network costs $50, and the privileges of membership include this: When you're ready to die, the organization will send two "exit guides" to show you how to suffocate yourself using helium tanks and a plastic hood.
The Georgia-based organization says it is providing an invaluable and humane service. Authorities call it a crime.
Four members of the Final Exit Network, including its president and its medical director, were arrested Wednesday and charged with assisted suicide in the death of 58-year-old John Celmer last June at his home near Atlanta. Investigators said the organization may have been involved in as many as 200 other deaths around the country.
"The law is very clear, and they clearly violated it," said Georgia Bureau of Investigation spokesman John Bankhead.
Work based on best-selling manual
The arrests came after an eight-month investigation in which an undercover agent posing as someone bent on suicide infiltrated the Final Exit Network, which bases its work on "The Final Exit," a best-selling suicide manual by British author Derek Humphry.
Members of the Final Exit Network are instructed to buy two new helium tanks and a hood, known as an "exit bag," according to the GBI. In court papers, investigators said the organization recommends helium because it is undetectable during an autopsy.
The network, which was founded in 2004 and claims 3,000 members, donors and volunteers nationwide, has long operated in the open. It has its own Web site, and its leaders have held news conferences and appeared at paid speaking engagements.
The group's members bristle at the term assisted suicide, saying they don't actively aid suicides but rather support and guide those who decide to end their lives.
"We're just there to help," said Jerry Dincin, the group's vice president, who was not arrested. "People insist upon it. They want to do what they want to do. They're suffering, and if they have intolerable pain, then they want to sometimes get out of that intolerable pain."
Celmer did not appear to be seriously ill. While his mother said he had suffered for years from throat and mouth cancer, court documents quoted his doctor as saying he had made a "remarkable recovery" and was cancer-free at the time of his suicide. Authorities said he may have been embarrassed about his appearance after jaw surgery.
In pain because of arthritis
Also, his doctor told investigators that Celmer was in pain because of arthritis, but that it could have been lessened if he had taken his medication properly and stopped drinking and smoking.
Georgia authorities arrested the group's president, Thomas E. Goodwin, and member Claire Blehr. According to investigators, Goodwin and Blehr were with Celmer when he died, each holding a hand, and the two cleaned up the scene afterward by removing the hood and the helium tanks.
Maryland authorities arrested the organization's medical director, Dr. Lawrence D. Egbert, 81, of Baltimore, and Nicholas Alec Sheridan, a regional coordinator. Investigators said Egbert and Sheridan evaluated Celmer before his death and gave the OK for his suicide.
Up to five years in prison
Those arrested could get up to five years in prison on the assisted-suicide charges. They were also charged with evidence-tampering and racketeering. Oregon and Washington are the only states to legalize assisted suicide.
Authorities in Arizona are also investigating whether the group helped in the 2007 death of a woman who suffered from depression but was not terminally ill. As part of the probe, investigators searched 14 sites in Arizona, Georgia, Florida, Maryland, Michigan, Ohio, Missouri, Colorado, and Montana.
Goodwin said in a 2006 interview with The Atlanta Journal-Constitution that the organization had worked with 36 people who wanted to end their lives. In court papers, investigators said Goodwin alone had assisted in 30 deaths.
Members of the Final Exit Network said the group has clear policies requiring applicants to supply medical diagnoses. They are also encouraged to seek advice from a spiritual adviser, a psychiatrist and medical experts. The group's Web site said the people it helps must have an incurable condition that causes intolerable suffering, and they must be alert, aware and strong enough to perform the tasks required to kill themselves.
Driving assisted suicide underground
Celmer's widow, Susan Celmer, said in a statement that the family was gratified that authorities pursued the case. But Celmer's mother, Betty, said: "If they helped John to die, that is what he wanted. I would never find them guilty for helping him."
Advocacy groups on both sides of the issue have weighed in on the arrests.
Barbara Coombs Lee, president of the national advocacy group Compassion and Choices, said prosecuting assisted suicide only drives it underground.
"It's not the way to make it safe. The plastic bag is sort of the end-of-life equivalent of the coat hanger," she said.
But Stephen Drake of the group Not Dead Yet, an advocacy group for the disabled that opposes assisted suicide and euthanasia, said he wonders why the Final Exit Network's activities are not classified as murder.
"It's like approaching somebody who is on the ledge of a building and giving them a shove instead of pulling them back," he said.