Last month, following a decade of bitter political combat, Vermont Gov. Peter Shumlin signed the Patient Choice and Control at End of Life Act. Passage of the bill was a bittersweet triumph for the governor, who had made it part of his election platform and then encountered fierce opposition from a coalition of leaders from the Roman Catholic hierarchy and from representatives from the disability community and socially conservative organizations that also dispute the legitimacy of same-sex marriage, abortion, and contraception. Vermont is now the fourth state to make it legal for a physician to prescribe lethal medication to a terminally ill, mentally competent patient who wants to end his life and to offer immunity from criminal prosecution to doctors, family members, and friends who wish to participate. Vermont has also become the first state from New England to officially accept this treatment option, which has been available in Oregon, Washington, and Montana. The new law is an important step forward for the death with dignity movement.
When I mention this movement, people often look mystified. Explaining that it is the same phenomenon as “aid in dying” merely results in additional perplexity. It’s only when I say, “physician-assisted suicide” that the coin drops and they recall Jack Kevorkian—the original Dr. Death—or perhaps Derek Humphry, author of Final Exit and founder of the Hemlock Society. At this point in the conversation, many enthusiastically identify themselves as staunch advocates while others just as vociferously announce they are fervent opponents. And then there are the few individuals who suddenly break eye contact and start inching away. The latter are a reminder this is not only an extremely private and sensitive subject but that the act of hastening death is a cardinal sin if you’re Catholic and a potent taboo regardless of one’s religious affiliation or lack thereof.
What almost all of these people have in common is a lack of facts or experience upon which to base their opinions. Whether they love or hate the idea of physician-assisted suicide or are simply creeped out, it is unlikely that they have encountered anyone or even heard a narrative of someone who has resorted to using it as an option at the end of life; they are similarly unfamiliar with doctors or loved ones who have helped a patient to die. Because physician-assisted suicide has been illegal, complex, and intensely private, the stories have remained in the shadows. Even when they are recounted, the subject of suicide is so morbidly powerful that most people psychologically protect themselves by promptly forgetting the narrative or quickly switching the mental channel.
Last year, during the time of the Massachusetts Death with Dignity ballot initiative, I learned about Rear Adm. Chester W. Nimitz Jr. and his wife, Joan, from a brief article written by their daughter Betsy Nimitz Van Dorn that appeared in the Cape Cod Times. The couple died on Jan. 2, 2002, and after a fleeting spate of publicity, the story disappeared from public attention. I was able to speak with Van Dorn for a more intimate perspective of her parents and their decision.
Joan Nimitz was born in England, trained as a dentist, and came to America for specialty training in orthodontia. Like many women of her generation, after meeting and falling in love with her future husband, she had little opportunity to practice her profession and instead devoted herself to raising their three daughters and furthering her husband’s career. As a Navy wife, she led a peripatetic existence, moving the family every year to a new base in a strange city often located in a foreign country. She oversaw her children’s upbringing single-handedly during the extended periods in which her husband was at sea. By age 89, Nimitz suffered severe osteoporosis, bone fractures, and the constant pain of peripheral neuropathy. Although she and her husband loved golf, this pursuit was no longer possible, and because she was becoming blind with macular degeneration, she was unable to indulge her passion for reading.
Chester Nimitz Jr., at age 86, was a bonafide military hero and the son of the legendary World War II Pacific fleet admiral—Chester Nimitz Sr.—who was responsible for defeating the Japanese navy in the Battle of the Coral Sea, the critical Battle of Midway, and in the Solomon Islands campaign. Chester Nimitz Jr. graduated from the Naval Academy and served on a submarine, the USS Sturgeon, during World War II. He was awarded the Silver Star, which was presented by his father at Pearl Harbor. Nimitz was transferred to command of another submarine, the USS Haddo, and was awarded the Navy Cross and a Letter of Commendation with Ribbon. The Navy Cross citation reads in part, "For outstanding heroism in action during her Seventh War Patrol in restricted enemy waters off the West Coast of Luzon and Mindoro in the Philippines from 8 August to 3 October 1944.” The citation goes on to say, “Valiantly defiant of the enemy's over powering strength during this period just prior to our invasion of the Philippines, the USS Haddo skillfully pierced the strongest hostile escort screens and launched her devastating attacks to send two valuable freighters and a transport to the bottom. ... The Haddo out-maneuvered and out-fought the enemy at every turn launching her torpedoes with deadly accuracy despite the fury of battle and sending to the bottom two destroyers and a patrol vessel with another destroyer lying crippled in the water."
An interview recorded two months before his death was conducted at the Naval War College, and it reveals a man with no interest whatsoever in rehashing any brave exploits that took place in the war. When asked about his awards, he simply replied, “Yes, the patrols were all deemed successful. We got a combat star. In other words, we sank something all the time.”
Of greater concern to him in the interview was conveying his indignation over the penurious salary that he received during his time in the military that would not properly cover family expenses. After completing service in the Korean War and against Chester Nimitz Sr.’s express wishes, he left the Navy. He was recruited by Texas Instruments and later became the president of the Perkin-Elmer Corporation. According to his daughter, the first year he worked at Texas Instruments in Dallas he paid more in income taxes than he had cumulatively earned during 23 years in the Navy. Her parents did not lead especially lavish or self-indulgent lives but were extraordinarily generous to all of their progeny. Their mantra, Van Dorn says, was:
“We are not the kind of people that would ever want to leave any of our children a trust fund. We have given you decent educations, and you are fine on your own. We want the pleasure of watching our grandchildren go to great schools and summer camps and take trips and have adventures. That is the pleasure money can bring—not stockpiling it so some spoiled offspring can have it when he or she turns 21.”
Chester and Joan Nimitz were longtime members of the Hemlock Society, a national right-to-die organization that was organized in 1980. Hemlock’s philosophy—that people should be in charge of their deaths as well as their lives—appealed to them as meticulous managers. The Nimitzes freely discussed these beliefs with their children, and Van Dorn explained, “They always proclaimed that when they got sick and tired of feeling sick and tired, that they would do themselves in.”
This did not mean they wouldn’t take advantage of medical advances, and when the admiral developed coronary artery disease, he promptly underwent quadruple cardiac bypass surgery. However, after several years, his health began to noticeably deteriorate; he had frequent bouts of congestive heart failure, suffered gastrointestinal problems, lost 30 pounds, became incontinent, experienced chronic back pain, and began to fall at home. Like his wife, his vision became impaired, and he could no longer safely drive. Extensive evaluations and treatment at the best Boston teaching hospitals proved ineffective for this proud warrior.
Nurses were employed at their home to attend to Joan Nimitz’s worsening health problems, but the couple did not want to squander all of their money on such care. They were both appalled at the vast sums spent at the end of life to sustain people who were frail and sick and not likely to get better. They could clearly envision—and they rejected—the idea of spending their remaining years in a nursing facility.
The admiral particularly worried his heart condition might suddenly worsen and his wife would be unable to commit suicide by herself. Joan Nimitz confided to the children that she, too, feared that without her husband's help, she would not be in a position to ingest the barbiturate pills they had been stockpiling.
The admiral told his daughter, “That's the one last thing I have to do for your mother. ''
According to Van Dorn, her father had a large file box labeled with a 3-by-5 note card upon which he had written with a magic marker, “When C.W.N. [Chester Williams Nimitz] Dies.” In it were his insurance policies, documents concerning his Navy pension, and so forth. This was intended to save the family from the frustrating task of scrambling around in search of these papers. He was a commander, and he wanted his death and its aftermath to be conducted with the precision of a military operation.
Throughout the fall and winter, the Nimitz couple explicitly discussed with the children their plan. It followed the suggestions in the book Final Exit. When ready, they would begin with an anti-nausea suppository, followed by the sleeping pills, chased with a little of their beloved Mount Gay Rum with a squeeze of lime and soda, and maybe a little peanut butter to settle their stomachs. The last step involved securing a plastic bag over their heads as a precaution in case the medication was not sufficiently lethal. The admiral was going to let his wife take the pills first and make sure she was dead before he followed her example. Van Dorn concluded, “None of it was particularly pretty. But they were just so determined and upbeat about all of it.”
On New Year’s Day in 2002, the Nimitz clan, including some grandchildren, assembled for lunch. They discussed the football games, embraced, and quietly praised the patriarch and matriarch. Everyone was relatively subdued; the admiral and his wife were emotionally reserved individuals. The family members did not try to persuade them to change their minds, because they knew that this would be fruitless. They were confident that neither parent was depressed and their decision was entirely consistent with long-held beliefs.
The admiral had wanted one more chance to write tax-deductible checks for his children, their husbands, and grandchildren, and these were dated Jan. 2, 2002, and left in the apartment. He had seen a lot of deaths in World War II. Joan Nimitz had experienced the deaths of siblings, including one of her brothers, a British Royal Air Force pilot shot down in combat. Death was no stranger to this devoted couple and held no fear. After their family went home, Chester and Joan Nimitz wrote a suicide note that read in part, “Our decision was made over a considerable period of time and was not carried out in acute desperation. Nor is it the expression of a mental illness. We have consciously, rationally, deliberately, and of our own free will taken measures to end our lives today because of the physical limitations on our quality of life.”
After the police officially notified Van Dorn of the deaths, she brought out her father’s comprehensive list of people and telephone numbers. She divvied up the list with one of her sisters, and they called all of her parents’ closest friends to tell them what had happened before any word got into the newspapers. Almost universally the response was, “Yup, that’s your parents!”
In the spring when the ground thawed, the family convened in Cape Cod, Mass. It was a place filled with memories of summer barbecues and sailing expeditions. The ashes of the couple were interred; the younger children placed small keepsakes into the grave, such as a particular piece of Lego that reminded them of their grandparents; and family members spoke lovingly and respectfully of their progenitors.
In the ensuing years, Van Dorn has supported a number of nonprofit organizations, including Compassion & Choices, which along with the Death with Dignity National Center evolved from the original Hemlock Society. The efforts of these groups led to passage of the Vermont bill. Van Dorn appreciates that the law would not have directly helped her parents, as neither had a “terminal” disease. She understands that a civil rights movement, such as death with dignity, takes politically expedient and incremental steps. She anticipates that in the future the infirmities and suffering of advanced age may also qualify people to request this option (as is presently true in Belgium, Switzerland, and the Netherlands). Meanwhile, one more American state will allow its citizens further control at the end of life. And Van Dorn is looking forward to the day “when kids and their parents will regularly sit around the dining room table and talk about end-of-life issues the way you talk about college planning. Because, after all it is just another kind of planning.”