‘In Love: A Memoir of Love and Loss’ by Amy Bloom

In a memoir dedicated to him, Amy Bloom tells the story of the death of her husband, Brian Ameche. Throughout the 222-page book, the couple travels to Switzerland so that Brian can have an accompanied suicide at Dignitas, a not-for-profit organization. Amy weaves together vignettes of how the couple met and fell in love, and the story of how Brian’s illness unfolded. Brian’s decline begins with troubles at work, an early retirement, and behavioural changes that lead to his diagnosis with early-onset Alzheimer’s disease. By Amy’s account, Brian decides that he wants an assisted death 48 hours after receiving his diagnosis, and tasks her with finding a way for him to obtain one. In her research, Amy comes across and is comforted by cultural productions dealing with Alzheimer’s disease and assisted dying, including Terry Pratchett: Choosing to Die. Because medical aid in dying was illegal in their state of Connecticut, Amy seeks out Dignitas, which has been providing legal, assisted suicide in Switzerland to non-residents since 1998. Amy describes the difficulties they faced in Dignitas’s approval process, including a neurology report that incorrectly noted that Brian was depressed, disqualifying him from Dignitas’s services. Faced with these setbacks, Amy researches various options for how Brian might die at home as they await Dignitas’s approval. These include death by drowning, suffocation, and voluntary suspension of eating and drinking. With increasing desperation, Amy obtains a prescription for sodium pentobarbital, which is used in medically assisted deaths, but is unable to fill it. In the end, she turns to her own therapist, a psychiatrist who assesses Brian and writes a letter that secures Brian’s approval from Dignitas. Nearing the memoir’s close, Amy describes the final hours of Brian’s life, as he dies with her at his side in Zurich. The final pages recount Brian’s memorial services and his and Amy’s wedding thirteen years prior.

Brian asked Amy to write about his death because he valued the right to die and thought his story would be useful to others contemplating such a choice. The copyright page contains a notice that nearly all people except their family members are referred to by pseudonyms in the book. The notice reminds the reader that while Brian’s death was legal, some of the avenues for death that were explored in the memoir are not. This notice sets the tone for a memoir that oscillates between Amy’s profound gratitude that Brian was able to die in the way he wanted and her frustration at how difficult it was for her to provide him with the opportunity to do so. Amy writes that right-to-die laws in the United States are deliberately narrow and that, ‘people who do wish to end their lives and shorten their period of great suffering and loss–those people are out of luck in the United States of America.’ Despite that, her husband was able to have an assisted death through Amy’s persistence and the couple’s financial and social privilege. Amy does not shy away from those realities. She writes that they received a cash gift of $30,000 from Amy’s sister and her husband that allowed them to travel to Switzerland. She writes that they used personal connections with physicians and therapists to explore alternatives to Dignitas and to secure positive assessments for Brian’s application to the organization. The inclusion of Amy’s ‘Plan B’ for Brian’s death in the memoir paints a dire picture of what would have happened had they not been able to use Dignitas. It is a stark portrayal of the state of medical aid in dying in the United States.