Death news: requiem for the Hemlock Quarterly.
I recently learned that the last issue of 1993 would be HQ's final edition. The Hemlock Quarterly was to be replaced by a bimonthly called Time-Lines, which would cover fast-breaking legislative news; a graphic artist was enlisted to effect a modest redesign; a public relations expert was consulted to attract a more influential audience of physicians, politicians, and academics--in short, the humble gadfly was going corporate. When I heard this, I decided to reread all fifty-three issues, the complete HQ oeuvre from 1980 to 1993. Perusing them one by one, every three months, had been like looking at a collection of still pictures. Reading them in rapid succession, in a two-day thanatological orgy, was like thumbing through a macabre flip-book that charted the entire course of the modern American right-to-die movement. As the Hemlock Quarterly's swiftly evolving notions of what was morally acceptable flashed past, the face of Karen Ann Quinlan dissolved into that of Elizabeth Bouvia, who became, in turn, William Bartling, then Arthur and Cynthia Koestler, then Roswell Gilbert, and finally, like a grinning death's head, the face of Jack Kevorkian.
The Hemlock Society's First Voluntary Euthanasia Conference was held in the spring of 1983 in a drafty Unitarian church on the outskirts of downtown San Francisco. In that innocent, pre-Kevorkian era, the Hemlock members were already old, tired, and none too healthy-looking, but the right-to-die movement was still young and pure. I was one of only two journalists present. The sound of rain against the stained-glass windows contributed to the atmosphere of reverent sobriety. The small audience of mostly female partisans huddled together in the front pews, umbrellas furled at their feet. This was a congregation far too decorous to shout "Hallelujah!" but a WASP susurration of assent swept through the nave of the church whenever one of the speakers formulated a particularly high-minded aphorism: "Let us value the quality of life, not the quantity." "Suicide ends the living process; euthanasia ends the dying process." The featured speaker was a professor of ethics who declared that although self-determination for the terminally ill was a praiseworthy cause--indeed, a sacred trust--the members of Hemlock must never compromise their moral probity by going too far. She referred to this concept as the Camel's Nose Argument. Once the camel's nose was under the tent, one had to take careful precautions to prevent the rest of the beast from following suit.
I remember thinking, as I looked around the church, that the camel didn't have a chance. I had expected a cell of wide-eyed sansculottes and had found, instead, a genteel sorority of senior citizens. I was sure they would never let their movement go anywhere untoward. In fact, I wondered if they had the chutzpah to let it go much of anywhere at all.
That night, however, I lay on my motel bed and idly scanned a copy of the Hemlock Quarterly that I had picked up on my way out of the church. It was printed on cheap, uncoated, canary-yellow paper--an "up" color, as Hemlock's founder, Derek Humphry, explained to me later, "because although we support self-deliverance, we don't want to seem a death-and-doom type of an organization." Its logo was the Rx symbol superimposed over a hemlock plant. Though the Hemlock Quarterly looked like something that might be published by a particularly unsophisticated PTA, I knew before I had reached the second page that I had found the true cradle of the revolution.
Most of the presentations at the Hemlock conference had been about passive euthanasia, or letting people die: hospices, living wills, plug-pulling. The Hemlock Quarterly was miles ahead. It advocated active euthanasia, or helping people die. Its lead article was headlined LET DOCTORS SUPPLY LETHAL DRUGS. Lest this seem too avant-garde a concept, the newsletter slyly reprinted a concurring opinion on the subject, dated 1516. (In Sir Thomas More's Utopia, the victim of a painful, incurable disease, convinced he was already leading "a sort of posthumous existence," could be "given a soporific and put painlessly out of his misery.") The conference had dealt in abstract principles; HQ dealt in the real miseries that real people wanted to be put out of--quadriplegia, dementia, lung cancer, breast cancer, brain cancer, stomach cancer, ovarian cancer, Parkinson's disease, amyotrophic lateral sclerosis, macular degeneration, emphysema, strokes, colostomies, catheters, bedpans, bedsores. All of the conference speakers had hewed to the official Hemlock line, which sanctioned suicide only in cases of terminal illness; HQ intimated that terminal ignominy might sometimes be sufficient cause. The issue I had picked up featured two accounts by readers of the suicides of their elderly mothers. One woman, after trying unsuccessfully to kill herself by pressing on her jugular vein, spent thirty-three days starving herself to death; the other died from an overdose of painkillers. Though the self-starver was comforted in her final days by the scent of carnation leis and the sound of Beethoven's Moonlight Sonata, it was not hard to guess which death the editors favored. I had underestimated the members of Hemlock. In the pages of their newsletter, the camel was already in up to the first hump.
I've read HQ ever since, courtesy of Hemlock's unflagging media comp list. It arrived like clockwork every three months, a totally subversive little rag that seemed endearingly unaware of its own bizarreness. Though some of its subject matter was highly technical, the space it allotted to letters from readers lent it a cozy tone, a kind of kaffeeklatsch approach to self-annihilation. In its homely pages, moral questions that had traditionally been co-opted by philosophers were returned to the more experienced hands of M.B., of Laguna Hills, California, and Mrs. F., of Arizona. The pleasures HQ afforded me were entirely voyeuristic--I was young and healthy and knew nothing of suffering--but I liked and trusted M.B. and Mrs. F., and I always looked forward to the newsletter's arrival, even though it always made me sad.
The Hemlock Society was launched in Los Angeles in the summer of 1980 by Derek Humphry, a British journalist who had helped his terminally ill first wife take her own life, and Ann Wickett, Humphry's second wife, an American academic. The name was Wickett's idea. She and Humphry agreed it had a noble Socratic ring, although they did not recommend hemlock as a suicide method, since it can cause painful convulsions. The society's general counsel advised Humphry to spread his gospel of peaceful self-deliverance via the printed word; the First Amendment would be Hemlock's shield. Thus was the Hemlock Quarterly born. Its maiden issue appeared in October 1980. Humphry and Wickett edited it, wrote most of it, laid it out in their garage, trundled it around the corner to a printer of wedding and bar mitzvah invitations, and licked all the stamps themselves. It had 443 subscribers, most of whom had contacted Humphry after Hemlock's first press conference. Its final issue had 39,463. HQ never put on airs: though it grew from five pages to fourteen, though its paper stock changed from yellow to white, though its type-face enlarged to accommodate the uncertain eyesight of its elderly readers, the fifty-third issue of the quarterly looked just as rinky-dink as the first.
During the thirteen years that elapsed between issue No. 1 and issue No. 53, the right-to-die movement passed a succession of extraordinary milestones that HQ both recorded and influenced. If any matter concerning euthanasia appeared on the front page of the New York Times, one could be certain that it had already been reported--sometimes years earlier--by the Hemlock Quarterly. The very first issue contained a bellwether article about physician aid-in-dying in the Netherlands. Six months before Dr. Kevorkian facilitated his first suicide, HQ ran a brief profile of him and noted that he would be the next speaker featured by Hemlock's Michigan chapter. When Robert Harper, the first Hemlock member to be charged with murder, was tried for assisting his wife's suicide, HQ not only covered the case but raised $14,000 to pay the defense team Hemlock had engaged. Harper, who wore a Hemlock GOOD LIFE, GOOD DEATH pin throughout his trial, was acquitted.
In addition to covering news, HQ reviewed books, movies, and plays with suicidal themes; published jokes about terminal illness; ran obituaries of prominent suicides, noting with pride if the deceased had used a Hemlock-approved method of self-deliverance; printed the addresses of inmates convicted of mercy killings so that Hemlock members could send them sympathy cards; and, aware that it was blessed with an elderly readership with bequests on their minds, solicited contributions ("All gifts, donations, legacies to the Hemlock Society are tax deductible under 501c3 of the IRS tax code"). HQ also offered Hemlock videos for $20 ("ideal to show friends"); GOOD LIFE, GOOD DEATH posters for $6 ("a striking wall decoration"); and publications ("Why not give some of Hemlock's books as Christmas presents this year?").
The Hemlock Quarterly did not merely report to its readers; it actively courted their participation. The very first issue noted that "each of us has a story to tell; by sharing it we can all grow." The letters department functioned as a community bulletin board that allowed Hemlock members, even those who would never again leave their beds, to get acquainted, lend one another support, trade advice, and complain about their infirmities (but never to excess, because they were chin-up sorts). Mary K., of New Jersey, the victim of a paralytic stroke, noted briskly that the essentials of her life were "Shake-speare, a bedpan, soap, water, and wash cloths, in that order." J.B., of Pennsylvania, who was afflicted with degenerative muscular atrophy and fecal incontinence, noted, "I freeze vegetables all summer from my husband's garden; I go out for dinner or Atlantic City Casinos when my bowels allow me." Both women ended their testimonies by saying that if they became further incapacitated, they wanted the option of suicide. Even those HQ readers whose health was not yet precarious let it be known that they were keeping a weather eye on their futures. Gloria Moorer, of Tacoma, Washington, whose mother had died a lingering death, wrote that she had failed to obtain liquid morphine for her own stockpile and had therefore turned to high-risk sports:
When I began to be concerned about
the possibility of suffering a similar fate
to my mother's, I decided to take up
every dangerous physical activity that
I could think of. I learned to down hill
ski at 50, to windsurf at 55, to roller
skate at 60, and I started cross country
biking this spring at 64.... I kept think-
ing I'll go over a cliff, or drown at sea
having a wonderful adventure, and in-
stead, I get healthier and healthier!
There is a terrible irony here, as my
fear is not of dying, but of dying slow-
ly. Can you suggest any solution for me
if my doctor doesn't buy the insomnia
Some readers simply wished to share cheerful stories about family members who had made their exits after drinking champagne, eating blueberry yogurt, listening to favorite pieces of classical music, or, in the case of the mother of J.R., of Canada, reciting the Twenty-third Psalm before she took a dose of barbiturates and was asphyxiated by a plastic bag her daughter had secured with a silk scarf. "On occasion," noted J.R., "I still wear that same silk scarf, with pride."
To fathom why nearly 40,000 readers spent $25 a year for four measly issues, you need to understand the genre of periodical to which HQ belonged. You might be tempted to compare it with other journals that have political agendas, such as, say, International Socialism or Libertarian Digest, but that would be a misconstruction of its true nature. HQ was really a how-to magazine, like Needlepoint News or Bon Appetit. Its readers were recipe clippers. They were seeking a recipe they would use only once, but whose ingredients, and methods of preparation and consumption, had to be nothing less than perfect.
The editors of HQ knew this from the start, but in the newsletter's early days, they were prohibitively fearful of being prosecuted for furnishing the instructions their readers craved. The first year of HQ's publication, 1980, was a dangerous time for suicide promoters. Hemlock's British analogue, the EXIT Society, was in deep trouble: its general secretary had been charged with aiding and abetting suicide, and its executive committee was too scared to publish its Guide to Self-Deliverance. HQ's early issues were full of nervous statements by Hemlock's attorney about "the risk of serious criminal charges" that the organization might run by merely advocating suicide as a responsible option for terminally ill patients, even if it didn't publish "any recipes or other procedural advice."
HQ ran no risks, of course, by telling its readers how not to commit suicide, so its editors filled many pages with methodological caveats. Because "most Hemlock members are gentle, civilized people and would not wish their loved ones to witness their bodies mutilated by gunfire," firearms were out. Hara-kiri was also advised against. Since I doubted that many Hemlock members had contemplated death by disembowelment and decapitation, I initially wondered why the editors deemed the subject worthy of coverage, especially in a full-page article so richly detailed as to seem almost prurient:
In a very few cases hara-kiri was car-
ried out without the ritual execution. In
these cases the hara-kiri man cut the ab-
dominal wall first and then cut the cer-
vical artery next. This is very important
because one cannot die of bleeding by
cutting the abdominal wall only.
It occurred to me that the readers of HQ were not just potentially suicidal; they were connoisseurs of suicide. They might enjoy reading how to slice up an abdomen in the same armchair spirit as a subscriber to Gourmet might relish learning how to slice up a wild boar, knowing that it was so hard to buy, so hard to cook, and so laden with cholesterol that she would never actually make it.
Inch by inch, year by year, the camel crept into the tent. In the very beginning, HQ printed only vague references to "barbiturates" and "sedatives." Then, in 1981, it ran a short list of books in the public domain--Toxicology, the Basic Science of Poisons; The Pharmacological Basis of Therapeutics; and three others--that contained "information on bloodless and painless lethal methods of self-deliverance." The information, however, was available only to those readers willing and able to go to the library, read hundreds of pages of small print, and ferret out the relevant material. As time passed and no police came knocking at their door, HQ's editors became incrementally more daring. Even if they could not publish recipes that looked like recipes, they realized that they could sneak the material into their newsletter by dressing it up in various respectable disguises. (Their determination to print drug dosages reminded me of Wolcott Gibbs's account of Life magazine's "bothersome and heroic struggle ... to figure out a way to print a picture of a living, breathing woman with absolutely no clothes on" in their G-rated pages, a challenge to which they rose by photographing a life-drawing class at the Yale Art School.)
One of HQ's favorite vehicles for suicide tips was its book reviews, which over the years must constitute one of the strangest bodies of literary criticism ever published. In a review of Exit House, a memoir by the artist Jo Roman, Derek Humphry casually mentioned "the final night when [Roman] took 4.5 grams of Seconal." Betty Rollin's Last Wish was praised for its writing but castigated for its pharmaceutical errors: "...the capsules specified in the book under the trade name Nembutal and of 100 milligram strength are described as 'shiny, red, gelatin-covered capsules, no bigger, each one, than the head of a match.' The 100 mg Nembutal capsules are a gold color (the only Nembutal which are even partially red are the 50 mg variety) and are much larger than any matchhead."
The most reliable Trojan horse for the conveyance of suicide formulas was the letters department. Eyewitness accounts of suicides, reprinted without comment, kept the editors' hands clean, the correspondents safely anonymous, and the readers apprised of how their fellow Hemlock members had handled situations they might in the not-too-distant future face themselves. A typical sample:
At the age of 89 years and five
months, on a beautiful sunny afternoon,
in a pretty feminine bedroom over-
looking a patio of flowers that she had
raised and tended for almost 20 years,
my mother went peacefully to sleep as
I sat and held her hand and talked her
over the rainbow with relaxing Yoga
She gave me the gift of life and I
gave her the gift of peace. Thanks also
to you. Enclosed is a donation to your
My mother's prescription for death
was one Dramamine (as anti-emetic),
then a 20 minutes wait, then tea and
dry toast. Another 20 minute wait, then
25 Seconal of 100 mg rapidly taken and
washed down with whiskey and soda.
Grateful member (Name and address withheld)
In 1988, HQ finally threw caution to the winds and published a straight-forward Drug Dosage Table listing the lethal dosages of eighteen common prescription drugs: Amytal, Butisol, Valium, Dalmane, Doriden, Noctec, Dilaudid, Miltown, Noludar, Demerol, Dolophine, Norflex, Seconal, Nembutal, Darvon, codeine, morphine, and phenobarbital. It was captioned: "Only for the information of members of the National Hemlock Society for possible self-deliverance from a future terminal illness.... Keep this document in a secure, private place." (Hemlock is no longer so circumspect. Today anyone can buy a copy of the drug table for $3.50. Call (800) 247-7421; Visa or MasterCard accepted.)
Knowing what dosages to take was of no help, of course, if HQ's readers couldn't get the pills. One recommended avenue was faking insomnia to procure barbiturate prescriptions. Another option was traveling to foreign countries where some of the recommended drugs might be available without prescription. Like any tourists eager to share shopping tips, HQ's readers sent in bulletins about their success in obtaining phenobarbital in Bangkok or Norflex in Vancouver. Mexico was the favored--though not a foolproof--drug mecca. Henry L. Brod, of Florida, wrote that he and his wife, equipped with "the immensely useful January 1988 Hemlock Quarterly," in which the Drug Dosage Table had been printed, "flew to Merida, in the Yucatan, and decided to mix holiday with some research into the availability of drugs rumored to be easily available 'over the counter.'" Alas, although the Brods did find some phenobarbital, their tour of seventeen farmacias yielded no Seconal, Nembutal, or Demerol, and their vacation was cut short when Mrs. Brod contracted a severe case of Montezuma's revenge.
Even if the readers of HQ did manage to obtain the right drugs, even if they stored them properly in 35-millimeter film cans ("Make sure the little cap is fastened tightly"), and even if they enhanced their toxicity with alcohol, death still was not guaranteed. They might lose consciousness before they swallowed the full dose. They might vomit. If they had built up a tolerance to medications they had been taking regularly, they might need more pills than they had anticipated. The only fail-safe technique was to back up the drugs with a belt-and-braces policy; namely, a plastic bag. The very idea seems to make many people--even Hemlock members--queasy, partly because suffocation is such a universal fear, partly because a person with a bag on his head doesn't look like himself, and partly because plastic bags are so cheap, so banal, so housewifely, as if Tupperware had been discovered to have lethal properties.
During HQ's first eight years, the editors considered the notion of plastic bags so unsavory as to be virtually unmentionable. Then, in 1988, in the same brazen issue in which the Drug Dosage Table was printed, a British physician named Colin Brewer wrote, "Now some people are ... worried about appearances. They think that it is a bit undignified to be found by your nearest and dearest with a plastic bag over your head. I think they have a point, but I don't think one should worry about one's appearance at a time like this." Brewer recommended "something about the size of a bag that will fit into a rubbish bin," secured with two or three rubber bands. In a later issue, a reader mentioned that he had performed a dry run on himself and determined that it was easier to put on the rubber bands before the bag than vice versa. He noted that he had demonstrated this technique at his local Hemlock chapter meeting, where "everyone was both amused and impressed."
To understand how truly radical it was to publish explicit information about how to kill oneself, let us remove ourselves momentarily from the hermetic world of the Hemlock Quarterly and look at how the mainstream press was handling the question of suicide methods. In 1986, I wrote an article for Life about Lois and Paul Martin, terminally ill members of Hemlock who had committed suicide together three years earlier. I knew what drug they had taken, and how much--the dosage had been printed in their HQ obituary--but my editors and I decided to omit those details. In fact, in Mrs. Martin's handwritten medication chart, which was reproduced on the first page of the article, we even retouched the name of the drug so as to render it illegible. What exactly were we worried about? I don't know about the editors, but I imagined an elaborate scenario in which a depressed teenager, after stealing the pills from his parents' medicine cabinet, would be found dead with a copy of Life on his bedside table, page 71 turned down, paragraph one marked with a yellow Hi-Liter, and my culpable byline exposed to the world's damning scrutiny.
Last November, The New York Times Magazine published an article about the assisted suicide of a young, terminally ill woman. The drugs that killed her--forty Nembutals--were not only specified in the article, they were printed in 18-point type on the cover of the magazine. During the seven years that had elapsed between the publication of those two magazine articles, a monumental shift in popular thinking about suicide--about what is taboo and what is not--had taken place. I can think of no other major social issue of the last decade about which public opinion moved so far and so fast. The shift can be largely ascribed to the Hemlock Society's 1991 publication of Final Exit, Derek Humphry's nuts-and-bolts suicide manual, and its subsequent ascent to the top of the nonfiction best-seller list. The book received an enormous amount of publicity. Some critics praised its candor; others seemed incredulous that such incendiary material had been allowed into the public domain. None of them mentioned--probably because none of them knew--that Final Exit's most controversial chapters, including its drug chart, had been printed years earlier in the Hemlock Quarterly.
According to a recent study published in The New England Journal of Medicine, copies of Final Exit were found near the bodies of twelve New York City residents who committed suicide in 1992: my nightmare scenario come true. Three other suicides left notes they had copied nearly word for word from page 82 of the book. Of these fifteen Final Exit readers, five had psychiatric histories and six not only weren't terminally ill--they weren't ill at all. These deaths received little national attention, although fewer than ten years ago, when suicide manuals published in France and Great Britain similarly facilitated a series of "wrongful deaths," there was a flurry of headlines and lawsuits. I do not believe Final Exit should have been suppressed--for better or for worse, America was ready for it--but I find it unsettling that the slackening of suicide's taboos has relieved death not only of its impediments but also, it seems, of its sting.
In the fall of 1989, Derek Humphry left Ann Wickett three weeks after she had undergone a lumpectomy for breast cancer. Two years later, Wickett, who was depressed but not terminally ill, swallowed a fatal dose of barbiturates and left a note for Humphry that read, in part, "There. You got what you wanted." Shortly after Wickett's death, Humphry resigned his dual positions as executive director of the Hemlock Society and editor of the Hemlock Quarterly. He maintains that he had wanted to retire for years but could afford to do so only after Final Exit made him a rich man, or at least a man who didn't need a pension plan, something Hemlock had never been able to provide.
Thus far Humphry has enjoyed an energetic retirement. Last year he published Lawful Exit, a well-researched history of euthanasia-law reform. He also founded a new right-to-die group called the Euthanasia Research and Guidance Organization (ERGO!). Humphry is currently working on the inaugural issue of the ERGO! Journal, to be launched this spring, which will provide even more explicit procedural advice than HQ did. The kind of articles he plans to run can be previewed in "Self-deliverance from an end-stage terminal illness by use of a plastic bag," a two-page pamphlet available by mail order for $5--$50 for twenty copies--from his home in Junction City, Oregon. In it he spells out for the first time a suicide method that employs only over-the-counter medications rather than prescription barbiturates. The bag is not the backup weapon but the actual instrument of death. Humphry's text, which is printed in boldface, gets right to the point: a thirteen-step death plan so minutely detailed that only a fool could screw up ("11. With two thumbs, hold the elastic bands stretched a few inches from the Adam's apple ..."). There are even two "photo illustrations" of a simulated suicide, in which a young woman, wearing a dust mask (to prevent the inhalation of plastic into the nostrils) and an ice bag (to reduce heat), fastens a transparent bag around her neck. What could be more user-friendly? What could be more grotesque? After staring for some time at this little pamphlet, I began to wonder if Humphry had tried to make it repulsive in order to force the issue of physician aid-in-dying. If you vote no on your state's next euthanasia initiative, he seems to be saying, this is what you will see one day when you open your mother's bedroom door.
The last half-dozen issues of the Hemlock Quarterly were edited by Humphry's former assistant, Kris Larson, who will also edit TimeLines, HQ's successor. If issues No. 48--53 of HQ are any indication, TimeLines (whose very name seems designed to prevent people from knowing they are reading a periodical about death) will do its best to nudge the camel out of the tent and back to the desert. Although a few local Hemlock chapters are carrying on the fight, the national organization, which used to be the right-to-die movement's vanguard, has drifted to the center in an effort to distance itself from the radical new organizations--Compassion in Dying, Oregon Right to Die, ERGO!--that sprang up after Humphry's resignation. The sanitizing of HQ was part of Hemlock's conservative repositioning. Larson's HQs contained a great deal of political coverage and not much how-to material. Kaffeeklatsching was kept to a minimum. Humphry's last issue contained fourteen letters; Larson's last issue contained one. Instead of sending an occasional personal note to HQ, readers were urged to send their legislators "hundreds and thousands" of "pro-active postcards," available at nominal cost from Hemlock, featuring the "Good Life/Good Death Logo in glossy eye-catching colors" on one side and plenty of room on the other for "specific messages advocating particular legislative concerns."
The golden age of M.B. and Mrs. F. was plainly over, but that didn't mean that the voices of Hemlock's members were entirely stilled. In a recent article about AIDS and assisted suicide, there were some memorable offerings from a new Hemlock breed, the HIV-positive men who now constitute a significant minority of the society's membership. One man who had facilitated a suicide commented, "I couldn't do it for just anybody. It would have to be someone I love.... After all, friends help friends, because doctors usually won't." He explained how he had helped:
When he asked me again I got a big
three-quarter bag of heroin. He'd nev-
er shot up before. I was paranoid about
the syringe, and made sure I wore gloves
to get in and out of his apartment. I
shot him up and put his hands on the
syringe and made it look like an over-
dose. It took about two minutes to re-
ally hit him, because heroin builds to a
Their tastes in suicide methods may be different, but I like to think that when Mrs. F. read this--if she's still alive herself--she recognized a Good Samaritan and a kindred spirit.
My back issues of the Hemlock Quarterly have been piling up for more than ten years, and as I reread them all they began to weigh heavily on me. Death, death, death! My file cabinets seemed like a charnel house stuffed with rattling bones. I decided that when I finished writing this article I'd throw every last memento mori into the trash.
But my father is eighty-nine. Three years ago he underwent surgery for colon cancer, and last year he lost his vision to retinal necrosis. My mother is seventy-seven. She has arthritis and glaucoma. I kept my back issues. I kept Derek Humphry's plastic-bag pamphlet too, in the same spirit as I have kept--though I have yet to use them --a yellowing collection of newspaper articles about how to refinish a wooden floor, how to plant a window box, how to hang a quilt, and how to set up a saltwater aquarium. You never know when they might come in handy.
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|Date:||Apr 1, 1994|
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