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 Pacts More Common Among Elderly
"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."
"Sometimes it's done strictly out of illness and depression, but if it's an act of love, they have been through life and death and raised their children and gone through being married for better or worse," she said. "With a long-term couple, they say, 'Let us die together.'"
Society needs to be more tolerant of these choices, Lynn said, but at the same time, "We can't put our seniors out on an iceberg like the Eskimos."
There are no statistics available for how many couples die in suicide pacts, but Americans over 65 are more likely to die by suicide than their younger counterparts, according to the National Institute of Mental Health (NIMH).
While the elderly make up only about 12 percent of the population, they account for 16 percent of the suicides.
Seniors have a suicide rate of 14 out 100,000; the general population rate is 11 for every 100,000 deaths. For non-Hispanic white males over age 85, the rate is nearly 50 per 100,000, according to NIMH.
When Mary Witte found her parents in Milwaukee, beside their bodies was a briefcase containing a copy of the book, "To Die Well," and a DVD by author Derek Humphry, founder of the former Hemlock Society, now Compassion and Choices. Her father also left a note for his family.
The method he had chosen, inhaling helium and putting a plastic bag over the head, is recommended in the book.
"My mother started slipping at the end of 2007," Witte said. "My father did not want anyone taking care of them. She saw both of her parents die in a nursing home and my father swore they would not go to a nursing home. They made the choice together."
"I was so scared," said Witte. "Mom was so close to wiping out and breaking a bone and going into a facility, and then they would have had no control over it."
Two years ago, the couple began talking about suicide seriously.
Gute tried to gird up the courage twice in the last month, but failed, said Witte.
He discussed it with his three girls, Witte and two other sisters, 46 and 42.
"He wanted us on board," Witte said. "He had written all three of us a letter to say goodbye. ... We kept thinking they wouldn't do it."
"The irony was he was going to do it in a hotel, because he didn't want to taint the house or have us find him," she said.
But a dear friend and fellow doctor who knew about the plan convinced the Gutes that it would be "traumatic" for someone outside the family to find them and perhaps be blamed.
The day of their deaths, Witte called the house all day and got no reply.
That evening, she and her husband, an environmental lawyer, and their 17-year-old son -- who had also had a "talk" with his grandfather about his choice -- checked at the house.
Another sister, who had an earlier conversation with her parents, suggested looking in the garage.
"We reluctantly drove over nervously and the house was quiet," she said. "It was very strange, awful, and I was inconsolable."
Planned Suicide Still Controversial
Many Americans are still morally squeamish about suicide, despite stories like those of the Gutes.
Bill Jose, who has a Ph.D. in social psychology, recently led a special interest group discussion on suicide at the Osher Institute of Learning at the University of Southern Maine in Portland for seniors aged 65 to 80.
"It was a difficult conversation for people who come from a religious Christian background," he said. "There is a feeling that, 'Gee, suicide is something that locks you out of heaven.' It's a tough one for a lot of them."
His particular interests are the topics where "science, religious and morality all come together," and end-of-life care is just that, he said.
"Science can keep you alive beyond where most people want to be and it creates moral issues for the next of kin, especially if people have not talked about it with their spouse or children," he said.
Sometimes, he said, "If you want to die a good death, you have to be proactive in your own death," said Jose.
Sometimes suicide efforts fail.
Last year in Britain, a terminally ill doctor survived a suicide pact that killed his wife because a bag he tried to suffocate himself with was too small.
Dr. William Stanton, 79, and his wife of 52 years Angela, 74, both pulled bags over their heads while lying in bed together. He initially was charged with murder, but died of cancer before the case was resolved. The couple had been happily married for 52 years, said his children.
But for the Gutes, a community came out to celebrate their lives at a recent memorial service. Witte said her father and mother died with all their affairs in order. Her father even chose 2010, the zero-tax year for the wealthy to die.
"Since he left this world, my admiration has gone sky-high for this guy," she said. "He was a very controlling person, a surgeon with a little bit of narcissism, but he was literally devoted to my mother."
Witte, who had her political differences with her father, finds his ultimate choice inspirational.
"My father, a total right-wing conservative, pulled a true libertarian act of defying the law," she said. "He didn't feel like he had to march off to Oregon."