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And I'm Renee Montagne. In the wake of a suicide, typically families are devastated - not surprising. Rates of depression of those left behind are much higher than when a loved one dies a natural death. Today in your Health, we look at an unusual suicide - one that according to family members, actually made grieving easier. NPR's Alix Spiegel reports.
ALIX SPIEGEL, BYLINE: This story is in no way an endorsement of suicide. It's a description of a choice and what came of it. Five years ago, after doctors told her that she had irreversible brain disease that would eventually steal her ability to read, write and recognize the people she most loved, Sandy Bem decided to kill herself. Sandy was an unsentimental woman and strong-willed. And for her, a life without books and the ability to recognize people that she loved wasn't a life that she wanted. And so, by her lights, there was only one thing to do. As her daughter Emily Bem explains, Sandy's plan was to wait until the last conceivable moment it was physically possible for her to commit suicide alone, then go off and kill herself.
EMILY BEM: I think she always envisioned being really much more alone at the end - in all the ways. Like I think when she first was picturing killing herself she had some really tragic vision of, like, going down to the basement and, you know, being by herself.
SPIEGEL: See, Sandy wasn't a stranger to suicide. She and her husband, Daryl Bem, had volunteered at a suicide hotline for years and Sandy was a psychotherapist. So as Daryl explains, she did have an intimate appreciation of just how destructive suicide was.
DARYL BEM: She knew it would - committing suicide would impact - especially our daughter.
SPIEGEL: So how do you choose to die without hurting the people around you? For Sandy and Daryl Bem, the answer was to make her suicide a public process. A collective experience that Sandy and Daryl and the people that they loved all went through together. And so, Emily says from the diagnosis on, Sandy talked about her suicide constantly.
E. BEM: She talked about it a lot. It was just sort of sprinkled throughout life. Often she would say, well, in two years I'm going to do it. Then two years would go by and she wouldn't. She hadn't declined enough where it warranted it. So then she'd say well, I'll probably do it in two years. There was sort of a very matter-of-fact way that she talked about it, which is very her.
SPIEGEL: In fact, though Emily says that she did support her mother's choice - at least in theory - her mom's constant suicide talk graded.
E. BEM: Across the years, I did sort of say look, don't talk about this so much or maybe find somebody else to talk about it with.
SPIEGEL: Which brings me to two months ago - shortly before her 70th birthday -when Sandy's theory about killing herself started to become a reality. Over the last year, Sandy's decline got steeper and it was clear that her window of opportunity for killing herself without assistance was closing so quickly that if Sandy really wanted to do it she needed an actual date.
D. BEM: And so we looked at the calendar and said OK, if it's going to be next week, you know, what day should it be? And so we just picked one.
E. BEM: Tuesday. And that was in a week.
SPIEGEL: Now again, Emily says she did support her mother's choice. Even so, when her mother and father gathered everyone together at their home in Ithaca, New York to explain that Tuesday would be Sandy's final day on earth, Emily we found it very, very hard to accept.
E. BEM: Well, at that moment I did get angry at them. And I objected and I said I thought she seemed too well and that it was too soon. I felt really angry and I felt that they were all wrong.
SPIEGEL: And so to ease the process for their daughter and their friends, Sandy and Daryl Bem announced that the family would gather for a big meeting the Sunday before.
D. BEM: We thought that would be a nice thing. That it made a lot more sense than a funeral where she wouldn't be.
SPIEGEL: And so on Sunday, family and friends gathered in the living room to talk about Sandy's life - much of which, Emily says, Sandy had by that point forgotten.
E. BEM: She just listened and listened and listened and at the end would say wow, I did that? Amazing, amazing.
SPIEGEL: Emily says that when she showed up to the meeting she was still very, very angry - convinced her mother should hold on. Emily had a toddler. She wanted more time. But over the course of the meeting, this feeling began to ebb.
E. BEM: It was really hard to be thinking wow, this is lovely. It was lovely. Like, it was just so obvious that this was about as good as it gets for a human exit, given the givens. She was surrounded by everyone who loved her, everyone was telling her how and why they loved her and this is not a bad way to go.
SPIEGEL: Two days later, as Sandy got ready to kill herself, everyone gathered across town at the home of Sandy's best friend. They all met for dinner. The one exception was Daryl, who spent the time with Sandy. They went on a long walk, watched a last movie -Mary Poppins, one of the few films Sandy could still follow - then Sandy went into the bedroom alone to drink the drug overdose she'd gotten off the Internet. Then finally, she called her husband of 49 years into the room to ask for a last favor.
D. BEM: She asked if I would, sort of, get into the bed with her, which I did. And so I held her and I could hear her breathing - just sort of watching every moment. And her breathing finally just stopped.
SPIEGEL: I mean, that must've been such a strange moment for you.
D. BEM: Well, it was. Yeah.
SPIEGEL: But here's the thing - everyone I spoke to agrees - something in this process made Sandy's death much easier.
E. BEM: This is going to sound funny but I wouldn't have had it any other way. And I do think it absolutely changes the grieving process because it made it less like a, sort of, horrible thing that had happened and more like something that made sense and felt right and actually had some joy to it in its own way.
SPIEGEL: Now obviously, there's no systematic research on suicides like this but there is some work on assisted suicides in Oregon, where physician-assisted suicide became legal in 1994. A researcher named Linda Ganzini followed 95 family members left behind after assisted suicide for 14 months and compared them to family members left behind after natural death. And her findings are kind of shocking. She did assessments of depression and complicated grief and a bunch of other psychological measures and found that, actually, the families of the people who chose assisted suicide did slightly better. But Ganzini says it's very clear that's not because it's easier when a family member chooses to end their own life.
LINDA GANZINI: I don't think these slightly better outcomes were because the person chose assisted death. I think it's because the dying person prepared their family for the inevitability of their death.
SPIEGEL: It turns out that a lot of the people who chose assisted suicide in Oregon went through a process somewhat similar to the Bems. They gathered the people they loved and acknowledged life was ending - something that doesn't happen as often with natural deaths because it's so much more difficult to predict when death will occur. But it can.
BILL TOFFLER: Life does come to an end. I know that all too well now with my wife's passing just a few weeks ago.
SPIEGEL: This is Bill Toffler, a physician against assisted suicide, who is critical of Ganzini's study. He says the study's too small to make the assertion that it makes about assisted suicide not harming family members. Particularly since it doesn't include family members like him, who fundamentally opposed suicide for any reason.
TOFFLER: I know, personally having lived in Oregon, that there are people who are hurt - grieved very much by loved one who thinks so little of their relationship that they ended their life and it's a sad reality.
SPIEGEL: But Toffler does agree that finding a way to gather around before a death to memorialize life and acknowledge its end is profoundly helpful. Like the Bems, his family all went through the dying process together, even at the very end. There were four of them there, gathered around this person that they loved, helping her and themselves as she passed. Alix Spiegel, NPR News, Washington.
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