Mary Witte knew it was coming eventually, but it was still a shock to find her parents' bodies in their garage surrounded by helium tanks, tubes and plastic garbage bags.
For more than a decade, Dr. Daniel and Katherine Gute of Milwaukee, both approaching 80, had been planning their deaths, should one or both of them be forced to live in a nursing home or need extraordinary medical care.
Katherine "Kittie" Gute suffered from the painful condition polymyalgia rheumatica (PHR) and dementia and her husband of 53 years was "getting thinner and thinner" taking care of her, according to Witte, 48.
Daniel Gute, a community president, sailor and urologist, had been retired since he was 62 and was relatively healthy. An environmentalist, his wife was an avid tennis player and golfer.
"We are all absolutely in awe of them making that choice, being so unbelievably brave, dying with his wife of 53 years," said their daughter, 48, who also lives in Milwaukee. "There is no better love story and they avoided the awful end of life."
Their July 18 deaths are just one of many loving, married couples who have recently carried out suicide pacts.
"I can't stand that word 'suicide pact' because my parents chose to die with dignity," said Witte of Milwaukee. "This was not an act of desperation. He was declaring his undying love for my mother."
Experts on aging say that couples make the choice to kill themselves for a variety of reasons: illness, economics, isolation, guilt over being a burden, but also as an act of devotion.
"It is actually an act of love," said Washington, D.C., psychologist Doree Lynn. "There is some disagreement and some say it's an act of despair, but when a couple has been together for a very long time and they are simply care-taking each other, wondering what has become of their lives, they do this as an act of sharing 'until death do us part.' It's almost never spur of the moment."
The Gute case echoed other similar suicides from other parts of the United States in the last few months.
Just this month in Little Rock, Ark., an 81-year-old man, recovering from cancer, killed his 76-year-old wife, then himself. A neighbor said, "Its kind of mind-boggling. I can't fathom why and wish I could understand why, but they were great a couple. She adored Armistead and he adored her."
In July, an elderly couple in their 80s from Sedona, Ariz., were found dead in a Colorado cabin after the man shot his wife in the temple, then killed himself. The couple were members of Final Exit, the nonprofit group that promotes a "dignified death."
Their note to loved ones read: "Many years ago we decided to be in charge of the timing of our own death. Hopefully it would be when the lines of normal aging, health problems and finances all crossed. It is our intention to avoid the indignities of prolonged nursing home care or terminal hospitalization."
Also in July, the eldest son of an Exeter, N.H., couple found with fatal gunshot wounds in an apparent murder-suicide called their deaths a "suicide pact." The wife's health was failing and they were described as "childhood sweethearts."
"Suicide among the elderly is often pre-planned, especially if there is a long-term illness," said Doree Lynn, a Washington, D.C., psychologist and author of "When the Man You Love Is Ill: Doing Your Best for Your Partner Without Losing Yourself."