I cannot manage to die

Pitt health law pioneer Nathan Hershey explains why he wishes to die and how the law will not allow it

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This article was written by Nathan Hershey with the help of his friend and memoir assistant, Alicia Ni’Tracy.

I would prefer to bring my life to an end at a time of my choosing, but it appears that I am unable to do so without help. I do not want to do it in a way that will bring possible penalty to anyone who would choose to cooperate with me in accomplishing this goal, in response to an expression of my desire to end my life.

Due to both the progression of my Alzheimer’s and the permanent effects of a stroke, my capacity to plan and accomplish is severely inhibited. I rely on the help of my daughters to organize my economic and living situations as well as the hiring of daily helpers I need to maintain a relatively safe, active and comfortable life. I rely on these helpers so I can communicate with people I still know, by reading and sending emails and by making phone calls.

I need this help around the clock, to know when and how to reach the dining room in my memory-care assisted-living building, to shower safely, to organize my transportation and support for cultural and political events, to locate possessions I rely on such as my shaver and shaving cream beside my bathroom sink and the cups in my kitchen, to take my medication and to continue writing — including this essay.

This feeling of dependence is an experience I dodged in my youth, during my service in the military and throughout my career as a professor of health law. My intelligence and autonomy have been of utmost importance to me for almost all my life. I had a fairly good memory and an independent personality during my earlier life. To exist in such extreme dependence today is agonizing for me.

Recently, I apparently had a very enjoyable day at a party and a performance. I awakened the next morning with no recollection of experiencing any pleasure the day before and no knowledge of what had occurred. When I woke, the confusion, frustration and dependence of the day felt as if they had gone on forever, and would continue forever. I am no longer able to hold onto a sense of fulfillment.

I thought about end-of-life issues for many years prior to the onset of my Alzheimer’s and the occurrence of my stroke. Decades before my condition became evident, I held the belief that the choice of if and when to have one’s life end should be left to the individual as an exercise of freedom. I told my daughters about my conviction in this matter long before it became an issue for me.

Accordingly, with the help of my daughter, who holds a power of attorney for me, my medical directive has been constructed to allow for comfort measures only. This was put into place well before anyone could question my memory or brain function.

Looking ahead to concluding my life also involves looking back on my life as a whole, taking stock of my experiences.

I enjoyed a well-supported childhood with two loving parents, a full academic experience at both New York University and Harvard Law School, service in the U.S. Army, a successful career in health law, 50 years as a professor at the University of Pittsburgh’s Graduate School of Public Health and many other professional achievements. I met a beautiful woman named Carol to whom I was married for 50 years, had two wonderful children and many friends and athletic adventures along the way.

As I assess my life, I feel fulfilled. I am prepared to conclude my life now.

This essay is the result of many gathered notes and drafts over the course of several months, and it draws on ideas I’ve discussed with my memoir assistant for more than four years. I am certain that my decision that I am ready to pass on is thoroughly considered, permanent and final.

Although my cognitive health is poor and in progressive decline, my physical health is relatively stable for a man of 84 years. Currently, only three U.S. states permit aid in dying: Oregon, Washington and Vermont. Three of their requirements are cognitive competence, a likelihood of dying in the next six months anyway and residency in that state. Residency is relatively easy to establish. However, the other requirements are impossible for me.

A hospice nurse evaluated my physical health within the last few weeks and determined that I am unlikely to die in the next six months. (I do not remember that evaluation.)

The cognitive health requirement is that the individual seeking aid in dying must be 100 percent undoubtedly sound of mind in order to get his or her wishes met, attempting to ensure the highest possible legitimacy of consent. Even if my physical health declines to the extent that I become likely to die in the following six months, due to my brain injuries and disease, I will never pass the cognitive requirements to qualify for aid in dying in any state.

Live too long, lose your right to make a decision that will be honored.

If I terminated my life by my own actions, I fear that those close to me might be accused of assisting me in doing so. They have assured me that they do not care if others do not approve of my position on end-of-life decision-making, and they are confident that if they do not aid me in dying, they can’t be proven to have done so and therefore will not be punished by the law. However, the obstacle still remains that I am not able, without help, to plan and implement an effective and comfortable method to end my life.

I don’t have the answers. I do have a certainty that I face an ultimate dilemma. I am not capable of planning or implementing my own death, but I believe I am capable of knowing that I want to die. The very fact that I need assistance in order to terminate my life is the same requirement that disqualifies me from receiving that help. I wonder for how many people this is a common experience. I wonder what can be done.

Nathan Hershey is emeritus professor of health law at the University of Pittsburgh (hershey@pitt.edu). He joined Pitt as a research associate in 1956 and played an integral role in creating the field of health law, which regulates what is now the nation’s largest industry.

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