Mixed in among the billboards for radio stations and fast food restaurants are controversial roadside ads appealing to the seriously ill who want help in committing suicide.
Emblazoned with the slogan "My Life. My Death. My Choice," the black billboards placed in San Francisco and New Jersey are part of a larger campaign by the Final Exit Network to spur discussion and raise awareness of what it considers the inalienable right to die with dignity.
While many right-to-die advocates argue for the legalization of physician-assisted suicide for the terminally ill, Final Exit Network offers "exit guidance" to those who wish to take their death into their own hands, with or without a physician's help.
"We thought [the billboards] were a great way to get different communities talking about the issue. We believe that the ultimate human rights issue of the 21st century is the right to die," says Frank Kavanaugh, Final Exit's spokesman.
The campaign began last month with billboards in San Francisco and New Jersey. The organization plans to put billboards in Florida later this summer and hopes to expand the campaign to other states as well, Kavanaugh says.
Final Exit Network's philosophy is soon to get even more exposure, thanks to an anonymous $50,000 deathbed donation to the like-minded Euthanasia Research and Guidance Organization, headed by Derek Humphry, who founded the assisted-suicide movement in the U.S. and wrote "Final Exit," a do-it-yourself guide to assisted suicide.
The $50,000 donation was made with the express purpose of supplying as many public libraries as possible with Humphry's book. So far, 2,000 copies of "Final Exit" have been sent to libraries around the country.
"No library has not wanted to carry the book. We've been getting thank-you letters," Humphry says.
"Final Exit" offers advice on the many issues surrounding assisted suicide -- how to do it without a physician, how to do it while not breaking the law, how to prepare your loved ones for it, even what to include in a suicide note.
Though Humphry did not know the person who gave the $50,000, the gift was the donor's "final act," presumably before he used "Final Exit" himself, says Humphry.
Dangerous Information or Benevolent Guidance?
Physician-assisted suicide is legal in Oregon, Montana and Washington for terminally ill patients who have less than six months to live, but Final Exit takes a broader approach to end-of-life care, offering its services to those who are seriously but not terminally ill in any U.S. state.
Unlike other aid-in-dying organizations that work within the legal system to try to change the laws on the practice, Kavanaugh says Final Exit Network was founded on the premise of "wanting to help folks now, outside the system."
But Final Exit's critics believe its actions go beyond the protection of freedom of speech that the groups often invokes.
Both Compassion and Choices and Final Exit Network undertake a thorough review with their patients that includes evaluating their mental health, reviewing their medical records and in-person counseling, but critics say that even when so hedged, assisted suicide is rife with problems.
"Anytime you have someone assisting another person in death, there's so many psychological influences that can come into play," Tim Rosales, spokesman for Californians Against Assisted Suicide says. "There are many times that people with serious illness have suicidal thoughts. That doesn't mean that that's the answer for them. They need to overcome those thoughts, but these [advocacy groups] take advantage of people in this tenuous state."
"Troubled youth, people who are depressed or going through a tough time in their life -- this type of activity preys upon those people in society," he says.
Not all right-to-die organizations agree with Final Exit's outside-the-law approach. Kavanaugh says the network was founded in 2004 by members who disagreed with the legal approach taken by another prominent advocacy group, Compassion and Choices.
Compassion and Choices is a large organization (40,000 members compared with Final Exit Network's 3,000) that fights for a legal framework to support assisted dying as a medical service for the terminally ill who wish to avoid undue suffering. They see it as a logical extension of end-of-life care in medicine today.
"We consider it our responsibility to follow the letter of the law in order to demonstrate that this is a safe, legal and rare, medical practice," says organization spokesman Steven Hopcraft.
"We focus on making it legal and helping people exercise their legal options."
The Right to Die as Policy
Helping a terminally ill patient die sent Dr. Jack Kavorkian to jail nearly a decade ago, but the how-to guides on suicide offered by some of today's right-to-die advocates are walking a fine line between freedom of speech and illegally "assisting" in suicide.
Final Exit currently faces charges of assisting suicide in Georgia and Arizona.
"We're on the edge of the law," Kavanaugh says. "What constitutes assisting is not very well-defined. If it is just providing information and support, than we are in trouble, but usually it means physically assisting or supplying the means."
Because Final Exit provides only information and support, it is considering filing a First Amendment lawsuit against Georgia and Arizona, Kavanaugh says.
As for the billboards, critics like Rosales are not too worried.
"We think it highlights the organization and their devious intentions. The more the public finds out what they're doing, the more it will naturally turn them against the organization. Quite frankly, they're hurting themselves."