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Conscious Dying - A. Quindlen

Consciously, Rationally, Deliberately and Peacefully
 Wednesday, January 30, 2002

    It was the part about reading that got to me. By the time Joan and Chester Nimitz Jr. had decided to die together, their laundry list of physical losses was nearly as long as their rich and fruitful lives. Chester Nimitz, 86, a retired admiral and CEO and the son of the Pacific fleet commander in World War II, was suffering from congestive heart failure, constant back pain and stomach problems so severe that he had lost 30 pounds.  

    His wife, 89, who had gone to dental school in her native England but stayed at home to raise their three daughters, kept breaking bones because of osteoporosis and needed round-the-clock care. Once she went blind, she could no longer read.

    Audio books or no audio books, the very notion of becoming incapable of seeing words on the page gave me a bad case of the shudders, and suggested that the distinction between a life worth living and one worth leaving is probably different for each of us.

    Some may fear grinding pain unresponsive to medication. For others it would be the constant losses of physical degeneration or the end of independence, an existence supervised by caregivers. For Joan and Chester Nimitz, who until a few years ago lived a life full of gardening and golfing and reading, it was all of those.

    "Do not dial 911 in the event we are discovered unconscious but still alive," read a note left behind in their apartment at a retirement facility. It ended, "We wish our friends and relatives to know we are leaving their company in a peaceful frame of mind."

    The greatest advance in health care in our lifetime has not been transplants or new pharmaceuticals. It has been the rise of the informed consumer. Beginning with the natural-childbirth movements and breast-cancer activism of the 1970s, inspired by AIDS patients who refused to take no for an answer, Americans have increasingly demanded more information and more control. People who once took orders from their physicians are now willing only to take advice. They look for information on Web sites, in newspapers and magazines, and in conversations with friends, so that cocktail parties sometimes sound more like hospital waiting rooms than social events.

    Why would anyone expect people who have become knowledgeable about cholesterol and PSAs, chemotherapy and MRIs, to suddenly cede control at the end of life? Some medical professionals decried the decision the Nimitzes made, insisting that progress in pain management and advances in modern medicine made such draconian action unnecessary. Perhaps they have never been at the bedside of a dying person being tortured by continuing invasive treatment despite the fact that all hope of recovery is long gone. The truth is that modern medicine, which too often does things because they are possible, not because they are useful, has helped make some of this inevitable.

    That is apparent in poll figures that show that two out of every three Americans support the right to euthanasia. It was apparent when the people of Oregon twice approved a statute supporting physician-assisted suicide in the form of a prescription for barbiturates for properly screened terminally ill patients. When that law went into effect in 1997, opponents predicted a bloodbath, vans of the depressed converging on the state in a mass suicide binge. Of course it didn't happen. In three years 70 people ended their lives after doctors determined they were already near death.

    But there are still those so-called right-to-life groups fighting the statute, and they have found a friend in John Ashcroft. In the midst of all the other business of his office, the attorney general took time to try to subvert the will of the people by announcing that Oregon doctors would lose their prescription rights if they "participate in an assisted suicide."

    His opponents were skeptical when Ashcroft said in the opening statement at his confirmation hearing, "I well understand that the role of attorney general is to enforce the law as it is, not as I would have it." Their skepticism was well founded. Ashcroft, a proponent of states' rights, even did a bit of jurisdiction shopping to attack the Oregon law from his federal perch. The editor of Human Events, a conservative weekly, said on radio that this was entirely proper: "It is the job of the federal government to go in and protect the life of the person whose life is being taken, even if that person wants to commit suicide."

    How unspeakably paternalistic and condescending! How contrary to the American ethos of self-determination and the right to be left alone. Should the feds have sent marshals in to wrest pills away from the retired admiral and his well-read and tough-minded wife, united in their desire not to become shadows of their former selves?

    Chester Nimitz Jr., a man who had become accustomed in the service of his country to taking charge, left a meticulously organized file for his daughters labeled "when cwn dies." He ended his life sooner rather than later because he was afraid if he died first of heart disease his wife would not be strong enough to take pills on her own.

    "That's the one last thing I have to do for your mother," he told one of his daughters.

    Maybe you believe you could live with the pain, or the immobility, or the incontinence, or the fear, or the loss of literacy. Maybe you wouldn't mind the tubes or the injections or the medications keeping you alive even if you were only days from death, even if you were turned into a medical marionette. But those who can't bear those conditions should be able to use any means to avoid spending their last days or months or even years in a situation they find humiliating and degrading.

    Some doctors have determined that life ends with something called brain death; perhaps there are those who conclude that it ought to end with life death, the depletion and disappearance of those things that have defined them and given them solace and pleasure. Then, as Chester and Joan Nimitz wrote, "consciously, rationally, deliberately," lights out.