Review: THERE AT THE END: Voices from Final Exit Network

A compilation of nearly 40 accounts of people grappling with death and “self-deliverance,” publication of THERE AT THE END: Voices from Final Exit Network coincides with the 20th anniversary of the launch of the now 3,000-member Final Exit Network.  The national nonprofit supports people facing chronic or debilitating illness who want to act on their belief that “any competent person unbearably suffering an intractable medical condition has the option to die legally and peacefully.”

Edited by retired librarian and Potrero Hill resident, Jim Van Buskirk, this unique anthology is dedicated to FEN’s more than 70 volunteers, including “exit guides” who provide clients with “compassionate presence” and education on effective and comfortable death options.  While sometimes subject to police suspicion, guides, who may travel cross-country to lend moral support, are instructed to provide neither termination of life means nor physical assistance to avoid prosecution. 

The book can be a distressing read, with first-person stories, as well as accounts from families or volunteers, some of which originally appeared in FEN’s newsletters. The narratives include accounts of peaceful suicides with family farewells, failed attempts to escape pain or an otherwise intolerable life, and tales of volunteer involvement in right-to-die advocacy, told with unflinching candor, and some anger amid heartbreak.  

As FEN’s Exit Guide Program Director Lowrey Brown asserted, individuals should be allowed to control their deaths “without society getting its collective knickers in a twist.”  While medical advancements have prolonged lives, “must we be cursed to endure exhausted, painful bodies or demented minds…?” 

While California has permitted terminally ill patients to receive medical help in ending their lives since 2016, state laws vary, with widespread confusion about how to overcome the logistical and cultural roadblocks to terminating one’s life. There are poignant descriptions of loved ones enduring chemotherapy or dying alone for fear of placing their family or friends in legal jeopardy. Providers can be reticence to offer palliative care services; conflicts emerge with staff to honor do not resuscitate orders. One provider suggests a memory care facility notorious for contagious diseases to end a patient’s suffering.

The 183-page collection paints portraits of idyllic passings, such as a couple of more than 55 years embarking on their next “grand adventure” holding hands in bed.  Yet things also go awry. In a suicide pact without FEN guidance, a man dreading a future with heart failure and his wife’s dementia, shoots her and himself.  He dies immediately, but she lingers 12 hours after the gunshot before succumbing.  Their daughter joins FEN following the trauma.

Van Buskirk conceived of Voices a year ago to share resources with a broader audience; he’s thrilled that the San Francisco Public Library has ordered copies.  

“The important thing is to get it out into people’s hands,” he said, hoping readers will “pass it along, initiate conversations.”  

Van Buskirk learned of FEN while facilitating a Death Café discussion at the Potrero Branch library.  

“People were starving to ask questions and tell stories,” he recalled of the sessions, which he started around 2015.  Participants were “so eager for a safe place to share beliefs, fears.”  

One woman invited him to support her during her journey with FEN, an experience he found profoundly moving. “She was so grateful,” he recalled.  After witnessing a second, similarly peaceful FEN-shepherded death, he was so struck by volunteers’ compassion and professionalism that he signed up for training.  He’s since found his niche as an unpaid phone counselor, answering initial queries and coordinating guide assignments regionally.

The anthology ends with an expression of gratitude from a client confronting a progressing tumor.  “It feels right to be closing out belongings and past accomplishments, to linger over pictures before I discard them,” she shared.  Without FEN’s support, “I think one would be too ill or stressed to have this luxury of time for reflection and appreciation.”

There at the End will be featured at the San Francisco Public Library on October 22, 6 to 7 p.m.