O n June 9, 2016, a law permitting physician-assisted suicide went into effect in California. The same day, Dr. Lonny Shavelson, an emergency medicine physician, opened the Bay Area End of Life Options clinic to provide the newly legal service.

A longtime activist for the cause, Shavelson’s interest began in adolescence. In an interview last year , he describes how, when he was fourteen, his severely depressed mother “enrolled me in pacts for her death.” Despite acknowledging that her request was “pathological,” he eventually chose to become a doctor “not only to help her in her illness but also to help her die.” In his 1995 book A Chosen Death , Shavelson recounted underground assisted suicides he witnessed. In one case, “Sarah,” the leader of a local advocacy group, took an especially active role when “Gene,” an elderly, partially paralyzed alcoholic man, asked for help with ending his life. But things did not go as planned, when Gene jolted awake in the middle of the process:

“It’s cold,” he screamed, and his good hand flew up to tear off the plastic bag. Sarah’s hand caught Gene’s at the wrist and held it. His body thrust upwards. She pulled his arm away and lay across Gene’s shoulders. Sarah rocked back and forth, pinning him down, her fingers twisting the bag to seal it tight at his neck as she repeated, “The light, Gene, go toward the light.” Gene’s body pushed against Sarah’s. Then he stopped moving.