It was early one summer evening when my husband and I were driving to a small town north of Seattle. We noticed a brilliant rainbow which seemed to be leading us to our destination. At the same time, a young daughter opened the living room drapes so that her dying mother could see the vivid colors of this same rainbow. The family had gathered for a very special evening. When we arrived at her home, this terminally ill mother said, "I’ve been asking for a sign--something that would tell me the time was right. This rainbow is my answer." After weeks of phone calls and visits, we had been invited to be present on the night this woman had chosen to hasten her death.

What brought us to this moment in time? Most of us have personal stories to tell. My mother had been ill with Alzheimer’s disease for sixteen years before she died, spending the last nine years in a nursing home. My sisters and I wished we could do something for her, because she frequently said she didn’t want to go to a nursing home and die a lingering death. We didn’t know what to do or how to do it.

My husband’s story is similar. "My mother died of ovarian cancer. Her last six months were very difficult. My father, brother, and I watched her grow gaunter every day. Although we did as much for her as we possibly could, we always wished there had been more we could do. When she finally died, I vowed that I would never put my family through the travail that we had experienced. The only alternative I can see now is to hasten my death when I am no longer able to care for myself."

Our response was to become part of the "right-to-die" movement in the State of Washington. The organization gained prominence by sponsoring the first "Death with Dignity" initiative to overturn an 1854 Washington State law banning assisted suicide. It was this initiative which brought "death" out of the closet. Eventually, the whole nation was talking about death and the rights of terminally-ill patients. Although the initiative did not pass, the momentum it gave the movement was phenomenal.

Buoyed by the gains the movement was making, but feeling sad and disappointed for the patients who were hoping for help, some of us began the journey through the idea that we do something more than just talk about death. It was out of this sharing of ideas that Compassion in Dying was created in April 1993. Eleven people from diverse backgrounds had one common goal: To be with terminally-ill patients through their journey in making end-of-life choices, including being present at a hastened death, if that was their wish. Compassion was the first group in the United States to provide this type of counseling and assistance.

For several months we struggled with organization and structure, developing firm guidelines and safeguards, and establishing clear criteria for qualifying the kind of patients we could help. We planned the first press conference so the world would know about Compassion. And then the phone calls began--from the local area first, then statewide, and eventually from all over the United States and other countries. Curious people wanting information; interested people offering to help; hurting people wanting relief from their suffering. A letter sent by one of our board members in response to a newspaper advice column resulted in over 12,000 favorable letters to Compassion. We learned that many people felt as we did.

Although we began as volunteers, we soon reached the point where we needed to hire an executive director and an office manager. These people field all the phone calls from patients, their families and friends, news media reporters, and students doing research for school projects. Patients calling from outside the Seattle area receive as much information, counseling, and support as the staff can adequately give via telephone. Our volunteer medical team provides specific information when it is needed.

In the Greater Seattle area, our Case Management Team (also volunteers) provides individual help to patients who request our services. We provide support, answer questions, give advice, make home visits, consult with the medical team, and make sure all options have been explored and that the patient is receiving adequate pain management. We developed a Patient’s Bill of Rights and Responsibilities and counsel patients in how to talk with their doctors. If the patient requests it, two case managers will be present at the time of the hastened death to guide them through the necessary steps. We believe that no one should have to die alone. There is no charge for our service. All financial support comes from individuals and foundations dedicated to expanding the rights of terminally-ill patients. One friend wrote:

"My income is so tight that sometimes I must choose between food or medicine. But I must send you something to help support such important work. Were I not disabled, I would be a volunteer for you."

Another supporter wrote:

"Of course, our appreciation can’t be expressed in terms of money alone, no matter what the amount. Your emotional support was so unwavering, so open--and so personal! I guess I expect people in organizations, even those dedicated to the best causes, to be distant, but all of you were not the least bit so."

Since all of our case managers have personal stories to tell about what brought them to this work, some of our motives may be a bit selfish. If we are terminally ill, we want a dignified, humane death, surrounded by family and other compassionate friends. We want our choices to be followed. In the meantime, while we’re still healthy, we’ve chosen to do all we can for those who need our help now. We hear their cries and willingly do what we can to relieve their suffering. Letters like this one from a patient’s family are all the reward we need:

"My family and I would like to extend our gratitude and thanks for your advice, assistance, and compassion. My mother passed mercifully and quickly. Thanks to Compassion, her desires were granted. I dread to think how long her suffering might have continued, if not for your organization. The day following her ‘transition,’ I swear I heard her say, ‘Yeah! We did it!’ It was both the hardest and the easiest thing that I have ever done. I doubt that we would have been able to accomplish it without your kindness, intervention, and support."

Legal questions were answered by a young attorney whose company offered her pro bono services to the group. She encouraged Compassion to challenge the Washington State law in federal court. We were also involved in a similar case in New York. Both cases won in the Ninth and Second federal district courts.

However, Attorneys General from those two states asked the Supreme Court to review these landmark decisions which would have legalized assisted suicide for terminally-ill patients in twelve states. A hearing took place in January 1997, and the decision to uphold the old state laws was handed down in June. This decision essentially turned everything back to the states but left the door open for future review.

This was a disappointment for patients who had hoped the Supreme Court would rule in our favor. One patient said, "It’s my choice, my decision, to be discussed only between my doctor and me." Compassion has assured patients that our work will continue. In fact, we have recently announced the formation of Compassion in Dying Federation of America, in order to have affiliates in other states. Then more patients will be able to have the personal help with end-of-life choices that case managers are able to give in the Greater Seattle area.

An important discovery we have made is that once patients know they are supported in their decisions and that someone will be available for them when needed, they tend to live longer and with better quality in their lives. Their thoughts of a long, painful death are gone, and they can spend their remaining time really living. During this time, relationships have been healed, memories have been shared, and a more loving atmosphere has been created by all who have been part of this experience. One patient said, "Actually, I feel stronger and happier just knowing the help is there."

After a hastened death, a family member wrote:

"The purpose of this letter is to tell you of the great amount of comfort and confidence which was provided by having the information and means at hand. He frequently told me of the comfort and peace of mind that simply having the knowledge and means provided him. I shared in his feelings and was comforted by knowing that we had some control over the time and method of his death."

Another case manager and I were privileged to be invited to attend the hastened death of a terminally-ill patient a few years ago. She welcomed us into her home on the night she had chosen--with vacuum cleaner in hand. She was a very organized person who had planned her own bon voyage party, which was to take place a few days after her death. Even though her adult children wanted to spare her this chore, she was determined to do it herself. After the house was cleaned to her satisfaction, she went back to bed and began the steps toward hastening her death. She said her last day had been pleasantly spent with her children and best friend, and now she was ready to leave her pain and illness behind. After taking the prescribed medication, she said: "I don’t feel tired at all. Are you sure this will work?" Within minutes she was in a deep sleep, and she died peacefully within the hour. She was a strong woman who knew what she wanted and was in control to the last minute of her life. We admired her courage. It was truly a spiritual experience and a privilege to have been invited into this most sacred moment. The other case manager said, "She died as she had lived--clearheaded, decisive, and in full control."

Shortly after this patient’s death, her friend sent the following letter to Compassion:

"Two weeks prior to her death, I came to Seattle to help my friend with some of her personal affairs. Looking back, those days are among the most meaningful of my life. They were sad but joyous, difficult but easy, cruel but kind, hurtful but loving. We, her family and friends, had our love of one another to carry and support us. But I also truly believe we all had the ‘assurance of a humane death’ for my friend which ‘enhanced the celebration of life.’ I feel blessed and privileged to have been a part of it and since then have thought continuously about the many benefits I derived because of the help members of your organization provided. I sincerely thank you for all the efforts put forth to make it possible for my friend to have had her last hope and wish realized. Because of your willingness to step forward with courage and conviction, those who so choose, and are able, have the option of a merciful death. Your efforts are commendable."

Sympathy sees and says, "I’m sorry."

Compassion feels and whispers, "I’ll help."

If you would like further information about the work of Compassion, or to make a tax-deductible contribution to its work with terminally ill patients and their families, please write to: