LAWRENCE EGBERT COMES to his cramped third-story office almost every weekday, taking calls on an old white push-button phone with a handset darkened by years of smudged newsprint and perspiration. Egbert, a slightly built, genial, and energetic retired anesthesiologist, turns to his computer, content to answer an email while I sort through a pile of plastic tubing in a lumpy white garbage bag. Once I finish untangling the tubes, I hold in my hands a curious plastic sack, about 21 inches long and 18 inches wide.

Egbert calls it an "exit hood." It's a contraption that can end a life in minutes. The 84-year-old doctor, who formerly served as a campus Unitarian Universalist minister and has taught as an assistant visiting professor at Johns Hopkins University, explains how it works. A tube connects the hood to two helium tanks, he says. He lifts the hood over his head and lowers the open end, letting go as an elastic garter clamps to his forehead. Then, he says, you release the valves on the tanks, streaming helium into the hood.

"You fill it up until it feels like a New York chef's hat," he says, stretching the hood to demonstrate. Then, he says, you pull it down and cinch it tight at the neck with a sweat band.

In those final seconds before his patients lose consciousness and die, the words they utter sound like Donald Duck, he says, imitating the high-pitched, nasally squeak familiar to any child who has sucked a gulp from a helium balloon.

Egbert estimates that he has been present for 100 suicides in the past 15 years, a figure that puts him in the same league with Jack Kevorkian, who claimed to have helped more than 130 people die. Egbert says he approved applications for about 300 suicides, most as medical director of the Final Exit Network, a loosely knit group that claims 3,000 dues-paying members. Even within his own organization, Egbert is controversial. The vast majority of the network's members suffer from painful physical ailments such as late-stage cancer, he says. But unlike the group's current leadership, Egbert is also willing, in extreme cases, he says, to serve as an "exit guide" for patients who have suffered from depression for extended periods of time.

With Kevorkian gone — he died in June — two indictments of Egbert have transformed him into the public face of American assisted suicide. It has been more than 17 years since Oregon voters passed a ballot initiative approving the nation's first assisted-suicide law for terminally ill patients. Only one other state, Washington, has legalized the procedure, and the American Medical Association remains firmly opposed.

Facing a trial that could further shape national opinion about assisted suicide, Egbert lacks Kevorkian's public relations flair — he's not one to dress in costumes — and he lacks Kevorkian's certitude. I expected to find an absolutist, a proselytizer for a cause. Instead, I encounter a man whose zeal is tempered by self-doubt.
"Once I am a true believer, that's the time I should quit," he says. "I never get used to it. I'm not used to it now."

Egbert has worked with patients who used barbiturates or morphine to speed their deaths, but he says those treatments can be hard to acquire in the quantities necessary to end life. Helium, on the other hand, is easy to get. Final Exit's patients are instructed that they can buy helium tanks at party stores, Egbert tells me. Remnants of his clients' visits to party stores lie at the bottom of Egbert's garbage bag: a pack of balloons, pink, blue, yellow, and green.

He says patients lose consciousness within 30 to 60 seconds of pulling the hoods over their faces and are usually dead within five to 10 minutes. "They turn blue or bluish — we can say gray," Egbert says. "After they're unconscious, their muscles start twitching. That's very upsetting to relatives. Some think they're trying to wrench the bag off."

ON FEB. 25, 2009, law enforcement agents climbed the stairs of Egbert's Baltimore office and placed him under arrest as part of a probe by the Georgia Bureau of Investigation into the death of a 58-year-old man from Cumming, Ga., named John Celmer. The officers seized Egbert's computer and took files from a cabinet, he says. Curiously, the garbage bag full of exit hoods was left untouched.

The arrest paralyzed the Final Exit Network. Exit guides, fearful of prosecution, began canceling suicides. Three months later, Egbert, who was free on bond, was indicted along with three others in an Arizona case, this one involving the 2007 suicide of a 58-year-old woman from Phoenix named Jana Van Voorhis. Her sister did not know about her plans and had complained to authorities. Egbert was not present for either the suicide in Georgia or the one in Arizona. But he was the common thread in the cases. Indeed, he was the common thread in the entire Final Exit Network, as he was responsible for signing off on all suicides for the group.

The Georgia case, which centers on Celmer's death, in June 2008, is moving slowly. Celmer had discovered a lesion in his mouth in 2006 that was eventually diagnosed as cancer, his wife, Sue Celmer, said in an interview. The Celmers had lived separately for 10 years. But they occupied townhouses in the same development, and he remained on her health insurance policy, she said.

Chemotherapy swelled John's face, and his skin was forever hot, she said. His gum tissue deteriorated, exposing sharp bones that sliced his tongue; a hole the size of a quarter formed under his chin. In late May 2008, doctors rebuilt his jaw with bone from his calf. They shaved skin grafts from his chest and thigh, exposing raw, irritated flesh, she said. "He was a mess," she said. "He was furious."

Unbeknownst to his wife, John had already contacted the Final Exit Network by the time he underwent the surgery. Sue believes her husband didn't tell her what he was considering because he knew she would disapprove on religious grounds. According to legal documents, he had bought an exit hood from a small company in California called GLADD, which stands for Good Life and Dignified Death. He had also bought helium tanks at a party store in Cumming.

At various times, Sue said, he was taking Chantix to try to quit smoking, and taking oxycodone or applying morphine patches to manage his constant pain. "Anybody who takes that many drugs is in no position to make decisions about their lives," she said. "He was like a drowning man, and they saw it as a grand opportunity to promote their agenda and drown him."

On June 19, 2008, Sue found him lying in bed dead. The scene seemed staged, she thought.

She sifted through her husband's things and found literature from the Final Exit Network. She prayed, and then she called the coroner. A postmortem examination showed that John was cancer-free at the time of his death, according to authorities.

The GBI took up the case and arranged a sting operation, contacting the Final Exit Network. During a meeting with two of the group's volunteers, Nicholas Sheridan and Claire Blehr, they allegedly showed the agent how they would hold down his hands so that he couldn't remove the hood, according to the GBI. The allegation, which the volunteers have denied, contradicts the Final Exit Network's claim that its volunteers do not actually "assist" in suicides, but merely provide information, guidance, and companionship. Shortly after the sting, Egbert, Sheridan, Blehr, and Ted Goodwin (the group's president at the time) were all arrested on charges of assisting in a suicide, tampering with evidence, and racketeering.

Since then, Sue Celmer suspects, the Final Exit Network has been playing a delay game, and she wonders why the prosecutors don't push ahead. She has already arrived at her verdict. "I call it murder," she said. "Hitler thought he was justified in killing people he didn't think should live. This is not a far stretch from that."

While waiting for the case to play out, Egbert has agreed not to attend suicides. He wouldn't talk about the cases, except to say one thing: "As far as I'm concerned, I'd do it again."

Even without him, the Final Exit Network is guiding people to their deaths again. Egbert is no longer the group's medical director. He hopes to resume working as an exit guide after the Georgia case. Volunteers say he'll find a changed organization, one that is more restrictive and less daring or, depending on one's perspective, less reckless.

"After the Arizona case, we began to stress [family notification] even more than we had been," says Wendell Stephenson, a Fresno City College philosophy instructor who recently became Final Exit Network's president. Egbert has estimated that he approved 95 percent of applications. "His presumption is that they're going to be a good candidate," Robert Rivas, the network's attorney, says of Egbert. "I don't think we have that presumption anymore."

"The organization, by being tighter, is saying very clearly that they'd like to reduce the likelihood of this happening again — legal stuff happening again," Egbert says. I ask him if he considers the changes a direct criticism of him. "Definitely," he responds. "I was annoyed."

ON A WET September night in 2009, the tires of Egbert's bicycle skidded through a patch of soggy leaves, and he was thrown to the roadway.

He had been on his way to deliver a sermon at Johns Hopkins. The accident cracked the front and back of his pelvis. Surgery wouldn't help, the doctors told him. He would have to learn to walk with a broken pelvis. Every time he shifted his weight or tried to take a step, pain shot through his body.

In his agony, Egbert, who has witnessed the endings of so many lives, considered ending his own. "There are some people who like to suffer — that there is a religious gain in suffering," he says. "I don't believe that."

But he began to mend, and thoughts of living pushed aside thoughts of dying.

When the end does come, Egbert figures, he'll "go into the ground and rot." He doesn't believe in an afterlife, though many of his patients have found comfort in the belief that they will be going to a better place. "I don't think it's worthwhile to worry about what happens to you when you're dead."

He has been explicit about his wishes for his own death. He doesn't want to die in a nursing home or on a ventilator. When he's gone, he wants his body taken to Johns Hopkins University. He'd like it to be given to the researchers in the Parkinson's laboratory.

They can place his body next to the bodies of people who died from Parkinson's disease, he reasons. He wants his body to be the scientific control. He hopes his body can be an example of a human being who died "a natural death," a death without extended suffering. A death without a hood.

©2012 by The Washington Post. Reprinted with permission.