Magazine article Newsweek

In A Peaceful Frame of Mind: Patients Demanding Control over Their Medical Care May Not Relinquish It in Their Final Days

Magazine article Newsweek

In A Peaceful Frame of Mind: Patients Demanding Control over Their Medical Care May Not Relinquish It in Their Final Days

Article excerpt

Byline: Anna Quindlen

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'd 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. …

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