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'In Love' tells the true story of a writer supporting her husband's euthanasia choice

In Love, by Amy Bloom
Random House

Amy Bloom's In Love announces itself on its cover as "A Memoir of Love and Loss." Of course, that would describe so many personal accounts about the pain of losing beloved parents, partners, children, and friends (and the joy of sometimes finding new love, too). But Bloom's memoir certainly isn't run-of-the-mill.

As in her novels and short stories — Come to Me, A Blind Man Can See How Much I Love You, Love Invents Us, Lucky Us, Where the God of Love Hangs Out -- Bloom's subject is, once again, love writ large. But the question overshadowing this memoir is how far you'd be willing to go for the one you love. Would you agree to help your beloved end his life when he receives a hopeless diagnosis?

That's what Brian Ameche, Bloom's husband of 12 years, asks of her after being diagnosed with early-onset Alzheimer's in his mid-60s. His diagnosis follows some three years of marked cognitive slippage and struggles with balance and proprioception. He tells her emphatically, "I'd rather die on my feet than live on my knees." In the succeeding months, his decision to end his life before he becomes less and less himself is unwavering.

In writing openly and heartrendingly about euthanasia, Bloom breaks new ground. Be prepared to be shaken. Arm yourself with tissues, and don't even think about reading this book in public.

Not everyone will agree with Brian's decision, or with Bloom's agreement to support his wishes. Bloom understands that euthanasia is a controversial subject, and she addresses it with the gravitas it deserves. At various points, she worries "that a better wife, certainly a different wife, would have said no, would have insisted on keeping her husband in this world until his body gave out." In Brian's sharper moments, she worries that they're acting too soon. She also, rightly, rails at a system that allows animals to be put out of their misery, but not human beings.

A big man with robust appetites, Brian played football at Yale and designed senior housing, apartment buildings, and corporate offices in his four decades practicing architecture. He is an avid fisherman and reader. Although childless himself, he is an adored, playful grandfather to the four young daughters of Bloom's three grown children from her first marriage. He's the oldest son of a large, close Italian family. His 84-year-old mother, who has lost close friends to Alzheimer's, supports his decision.

Bloom makes it clear that he — and she — would be losing a lot by terminating his life.

Painfully aware that he is no longer capable of handling such arrangements himself, he asks her to research his options for assisted suicide. He doesn't want to do it alone.

Bloom quickly finds that there aren't many choices. Although several states have passed physician-assisted right-to-die laws, they involve "intentionally eye-of-the-needle" requirements: You must be a local resident who is mentally competent and can be medically certified that you have only six months to live. In addition, you must be able to "express your wish to die, usually three times, twice orally and once in writing, to two local physicians."

Brian's best option turns out to be Dignitas, a nonprofit organization in Switzerland which is "the only place in the world for painless, peaceful, and legal suicide."

But there are hurdles to surmount before Dignitas will accept Brian as a client, including health and dental records and an autobiographical statement. (Brian actually brings up a possible connection between his football playing and dementia in this personal history.)

In multiple interviews with Dignitas personnel, Brian must prove that he is cogent enough to show "discernment and determination." The couple know that if they wait too long, he will no longer be capable of passing this test. They hit an upsetting delay when they learn that Brian's neurologist had written on the MRI report that the reason for the test was a "major depressive episode." Depression is a deal-breaker for Dignitas, which does not want to be in the business of helping clinically depressed people commit suicide. Brian and Bloom have to prove that the neurologist's note is simply not true.

Bloom, reflecting on her role in all this, writes, "It seems to me that I'm doing the right thing in supporting Brian in his decision, but it would feel better and easier if he could make all the arrangements himself and I could just be a dutiful duckling, following in his wake. Of course, if he could make all the arrangements himself, he wouldn't have Alzheimer's..."

In Love begins on Sunday, Jan. 26, 2020, when the couple flies to Zurich on a "not quite normal version" of the traveling they used to love. Then Bloom circles back to the first inklings of Brian's illness, his diagnosis, and her frantic, weepy, monthslong efforts to arrange for the ending he wants. She also recalls how they fell in love and left their partners, grabbing their chance for happiness. By the time we return to their portentous week in Zurich, we've learned quite a lot about this couple.

In Love is an unsettling profile in courage. It certainly took uncommon courage and compassion for Bloom to live this story, and still more courage for her to accede to Brian's request that she write about it. She sheds buckets of tears during the course of events described in this devastating, ferociously well written memoir, and readers will too.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Heller McAlpin is a New York-based critic who reviews books regularly for NPR.org, The Los Angeles Times, The Washington Post, The Christian Science Monitor, The San Francisco Chronicle and other publications.

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