“I’ve never done anything as important as this in my ministry,” he tells me during the drive. “I think it’s the reason I’m placed on this planet. I’m a midwife to the dying—for those who want to hasten their deaths.”

George is cheerful, giggly, a gay, liberal, libertarian Unitarian preacher. He says he often carries around a large inflatable alligator to his suicides in case the police stop him en route. Should this happen he’ll pretend he’s a children’s entertainer. The alligator will explain the canister of helium in the trunk. Helium is one of his methods.

But lately he’s begun phasing the alligator out.

“It’s been making me feel conspicuous,” he says. “I want to not be noticed. If I’m carrying a big alligator, people are going to notice me.”

“Plus,” I say, “surely the last thing your clients would want to see in the minutes before their death is a large inflatable alligator coming through the door.”

“Exactly,” says George. “Anyway, I’m always careful and I always work quietly, like the Lone Ranger. I do so generally at night and for the most part I make it look like they just died in their sleep. I’ll prop a book up on their lap so it looks like they just expired.”

There’s something Laurel and Hardy–ish about George. Earlier he had demonstrated the helium method for me by attaching a hose to the end of a tank, but he did something wrong and the gas tank practically exploded, shooting the hose across the room and whiplashing his stomach. He shrieked.

“Does this kind of thing happen when you’re helping people kill themselves?” I asked.

“This has never happened before,” George replied, looking sheepish.

Pam lives in a decrepit old country cottage on the outskirts of Baltimore. She looks as crumbling as her house. She’s fifty-nine but looks far older. We sit on her sofa.

“Tell me about your illness,” George asks her.

“This is a difficult disease to cope with,” Pam replies, “because they run all the tests and they come back negative. Then they decide that . . .”

“It’s all in your head,” says George.

“Right,” says Pam.

They smile at each other.

“They start wanting you to go to psychiatrists,” says Pam. “But of course that’s totally useless.”

“Sure,” says George softly. “Sure.”

George says nothing to Pam that might make her reconsider suicide. Instead they talk about the “mechanics of the dying” (what pills and gas and apparatus Pam will need) and she seems delighted to have someone there who isn’t questioning her symptoms or intentions at all. Then she turns to me.

“I’ve learned what I can from this,” she says. “I don’t judge much of anybody for anything. Because until you walk in somebody else’s shoes, you do not know.”

George says he drifted into assisting suicides in the early nineties when he was a Unitarian minister in Pittsburgh. Unitarianism is a middle-class, liberal religion and Pittsburgh is a tough, working-class town, so he had barely any parishioners. He’d look at his tiny congregation and wonder if he was wasting his life.

One day a parishioner approached him and said, “My husband has got ALS [amyotrophic lateral sclerosis, a form of motor neuron disease] and your name has been given to me as someone who might help.”

“It was that vague,” George says. “But I knew what she meant. Two weeks later he said to his wife, ‘It’s time. Call George Exoo.’”

That’s how George found his calling. He says he’s assisted 102 people, including Pam, who killed herself, with George at her side, a few months after our visit.

It didn’t go smoothly. “We [George and his partner, Thomas] began chanting the Heart Sutra,” George tells me later, “which we did for half an hour. Then she got up and said she wanted to have a bagel. So she proceeded to get up and toast a bagel. And put cream cheese on it. And sat there munching very slowly on the bagel and proceeded to tell us that this woman who lives in the same house as her was expected to return about eleven-thirty p.m. Well, by then it was eleven-fifteen p.m. Sheesh! And she’s still munching on the bagel. I said, ‘I can’t stay here! I will not leave until I’m finished here but I simply can’t stay here and run the risk of all this audience coming in.’”

“It sounds like she’d changed her mind,” I said.

“No, she was very much decided,” said George. “Very much decided. I was thinking, there was one other time this happened. I was in Pittsburgh. And the woman didn’t follow my instructions. She was sitting around eating stuff in some kind of crazy way, too, I remember. At one point somebody came into the house and I had to hide in the basement. It was horrible. I was scared to death. So I didn’t want to repeat that circumstance. So that’s what happened.” So George left without helping her to die. “She had enough pills to sleep soundly but not enough pills to zap her,” he said.

And then he returned to her house a few nights later, and was more successful.

In early 2004, the Irish police formally instigate extradition proceedings against George. They ask the FBI to arrest him. George telephones me. Can I come to Seattle? He has something he wants to tell me, he says. Something very important.

I meet him in the lobby of a Seattle airport hotel.

“So?” I say. “What’s the news?”

There’s a strange, almost coy smile on his face.

“I’ve ordered a magic potion because I certainly don’t intend to travel to Dublin,” he replies. “So I may be the first right-to-die martyr. Maybe I should call you over to Beckley for the big event.”

“I don’t want to sit there watching you die,” I say.

He looks disappointed.

“Sorry but no way,” I say. “That’s the last thing I want to see.”

George is in Seattle for a private meeting of international right-to-die activists. The biggest names in the movement are here, such as Derek Humphry, a former British Sunday Times journalist who wrote a best-selling memoir, Jean’s Way, about helping his terminally ill wife commit suicide in 1975. Jean’s Way pretty much began the movement: A network of right-to-die groups inspired by it sprang up across the world in the late 1970s. These activists meet once a year in an anonymous hotel somewhere to discuss advances in suicide technologies.

“It’s very hush-hush,” George says. “I’m surprised they’re letting you in.”

The delegates sit around a table in a conference room. George begins by announcing, with a somewhat dramatic flourish, his intention to kill himself rather than face extradition. When he finishes he falls silent and awaits the outpouring of shock and sympathy, or whatever. But there’s none. The other right-to-die activists look unimpressed and unemotional. In fact, they seem much more interested in discovering which method he’s intending to go for. George says liquid Nembutal.

“My curiosity is why would you go with a drug approach?” one delegate asks. The others lean forward, paying attention.

George’s reply is that when one uses helium, the person killing themselves often tries to involuntarily remove the bag once they’re unconscious, and he consequently has to forcibly hold their hands down.

“I don’t want to involve anyone else in my passing,” he says.

He changes the subject. He says Rosemary Toole Gilhooly in Dublin had promised to send him a message from beyond the grave. The message would somehow take the form of roses. And she fulfilled the promise the day after she died.

“What happened was Thomas and I flew out the next morning to Amsterdam,” he says, “and a man brushed by us on the street. He had roses flung over his shoulder. I’ve never seen anybody with so many roses. There must have been ten dozen roses! And Thomas said, ‘There she is! There she is!’”

There’s a silence. Then Dr. Pieter Admiraal, a pioneering Dutch advocate of euthanasia, coughs. “Oh, dear George,” he says. “To meet somebody with roses in the Netherlands is not so extreme, because we are growing them to export to the world.” There’s muted laughter from the others. “And now you are in trouble,” Dr. Admiraal continues. “Maybe God can help you.”