An undercover agent describes the setup this way: A person seeking to commit suicide places an "exit hood" over his head and inflates it by turning on a tank of helium as the gas fills his bloodstream. After a few breaths, he loses consciousness. Ten to 15 minutes later, he dies.
The question now is whether four members of an assisted suicide ring facing criminal charges in a Georgia man's death actively helped him kill himself that way or merely gave him guidance about how to end his life on his own.
The distinction is still being hammered out by state, district and federal courts, legal experts say.
"There's not a big body of case law that distinguishes between the two," said William Colby, an attorney who is a fellow with the Center for Practical Bioethics.
"The reason society set up criminal laws was to stop behavior that many of us find inappropriate for civilized society. That's very clear in a murder. But it's far less clear in a situation where medical technology is deeply involved in sustaining our lives."
The U.S. Supreme Court ruled in 2006 that it was up to states to regulate medical practice, including assisted suicide.
Rules vary from state to state Oregon and Washington both allow doctors to help terminally ill people kill themselves, while other states impose penalties, up to five years in prison in Georgia's case. A judge in Montana has ruled that doctor-assisted suicide is legal there, though that could be overturned by the state Supreme Court.
Georgia authorities charged four members of a group known as the Final Exit Network with assisted suicide Wednesday in the death of John Celmer, 58, who suffocated himself north of Atlanta in June. A state law passed in 1994 defines assisted suicide as anyone publicly advertising or offering to "intentionally and actively assist another person" in ending their life.
John Bankhead, a spokesman for the Georgia Bureau of Investigation, says the network may have been involved in as many as 200 other deaths across the country since it was founded in 2004. Fourteen sites in nine states have been searched as part of the investigation.
Georgia authorities say assisted suicide cases are often difficult to prove, but the network is different because it's an organized group with clear guidelines and policies that an undercover agent was able to infiltrate.
Instead of trying to prosecute, for example, a husband who made the gut-wrenching decision to help his terminally ill wife end her life, they're going after people who barely knew Celmer. Prosecutors say he was recovering from cancer and merely embarrassed about his appearance after several surgeries, and family members say they are glad authorities are "zealously" pursuing the case.
Prosecutors are tightlipped, deferring questions to Bankhead.
Network members claim they carefully screen people who want to commit suicide, but there are also questions about the death of an Arizona woman the group helped in 2007. Police say Jana Van Voorhis was depressed but not terminally ill. According to court records, the group's leaders say they tightened their screening process after her death. But an undercover agent who went through the group's vetting process noted that he received no psychological or psychiatric screening.
Leaders of the network describe the process they promote as a humane and compassionate way of ending the lives of those suffering from incurable conditions.
The group offers guides who will hold the hands of people who decide to kill themselves and authorities say make sure they don't pull the exit hoods off their heads. But members insist they don't actively help with suicides.
Jerry Dincin, who became the group's leader after the president was arrested Wednesday, calls this type of end-of-life support the "great cause of the 21st century." Critics consider the practice murder.
Georgia began investigating the Final Exit Network shortly after Celmer died in June. Authorities cite a note in which he mostly discussed how his "deteriorated jaw caused him social embarrassment and financial hardship" but never mentioned extensive pain.
Dincin said the group believes in trusting its members and giving them repeated chances to change their minds in the days before they go through with suicides.
"There is one human being who should decide about his own life, and he did. It's not his mom, his wife, his pastor. One person decided about his life and he did," said Dincin, who got involved with the group in 2005 after he was diagnosed with prostate cancer and said he will use its methods himself if necessary. "Whose life is it anyway? My life is mine. It's not my wife's or my children's and that's how I feel about it."
Defense attorneys say their clients violated no state laws and will be exonerated.
"Whatever happened here is no more than what happened in a hospice," said Michael Kaminkow, an attorney representing two of the network members arrested Wednesday. "In reality, a hospice is a suicide. It's just a little slower."