"Death with Dignity" and Brittany Maynard's Legacy
The real issues surrounding physician-assisted suicide and end-of-life care.
Posted Nov 04, 2014
On November 1, a young woman named Brittany Maynard ended her life with a fatal dose of medication, legally prescribed by her doctor. It was her way of wresting control from a terrible disease that had taken over her life and made her dying a slow, debilitating, painful, and excruciating journey.
For most of us, committing suicide is difficult to contemplate and might seem impossible to carry out. You might question the wisdom of her decision and the morality of her actions. You may have religious objections and believe that no one should have the right to choose when or how they die.
Or you might wonder if, given similar circumstances, you too would end up taking that fatal dose.
In an effort to make meaning out of her suffering and create a legacy, Brittany decided to go public with her disease, her dying, and her decision, posting a video that went viral. As a result of her candor, she has spurred greater awareness and ignited public discussions on this topic.
Death with Dignity
Along with Oregon, Washington & Vermont also have passed Death with Dignity laws, making physician-assisted suicide legal. In New Mexico, a recent court ruling upheld the right of terminally ill patients to end life on their own terms. And advocates in Montana defeated a bill that would’ve imprisoned physicians for honoring patients’ wishes for death with dignity. Many other states are wrestling with this issue in their courts and legislatures.
The Limits of Modern Medical Technology
We got in this pickle because life-saving modern medical technology advanced so much during the 20th century that it suddenly became possible to keep people alive past their expiration dates. In fact, ever since the 1950’s, it has been all too common for dying patients to be hospitalized and put on life support, even against their wishes, largely because physicians and society-at-large felt compelled to use this miraculous “life-saving” technology to prolong life at any cost. After all, prolonging life had been a focus of medical care for centuries. And not fully understanding the consequences, many patients and families insisted that doctors indeed “do everything” even when it was against best medical judgment.
Hospice Care to the Rescue
By the early 1960’s, health care practitioners, patients, and family members alike started questioning the futility, suffering, and expense of aggressive medical intervention for the terminally ill. People observed that intensive care units merely prolonged dying, but not living. Furthermore, many people found that intensive care did not allow them to close out their lives in a way that felt meaningful to them. And compared to simply allowing death to happen, intervening with intensive care often causes more pain and discomfort-- physical, emotional, and spiritual. Surely, there had to be a better way to provide end-of-life care.
Hospice care focuses on increasing the quality of life rather than the quantity. It encourages and allows patients to live fully until they die. Invoking another centuries-long tradition, hospice makes it possible for people to die at home, with comfort and dignity, surrounded by their loved ones.
Still, for the next few decades, there was no consensus on where to draw the line between hoping for a cure and "giving in" to death. Indeed, hospice is still commonly seen as “giving up the fight”.
In addition, physicians were unsure about and reluctant to address the intractable pain caused by some diseases (like cancer), even at the end of life. One problem was that repeated doses of morphine and other opiates could turn patients into “drug addicts,” which was considered an extremely pitiful and shameful way to go. Another problem was that sometimes, so much morphine was required, patients would be rendered unconscious-- and sometimes respiration was hindered, hastening death.
But medical ethicists and clergy began pointing out that writhing in agony was dehumanizing and unnecessary. And key is the intent behind administering high doses of morphine. If the sole intent is to hasten death, a potentially lethal dose should not be prescribed by a physician. But if the intent is to control pain, prescribing a potentially lethal dose is justified, and the informed, consenting patient is willing to take the risk.
A Cultural Shift in How We View Death and Dying
Over the past few decades, with growing public awareness and education, there has been a cultural shift toward understanding that modern medicine cannot cure what’s incurable, and suffering through failed attempts at aggressive intervention is a terrible way to die. We consider the fact that there are fates worse than death. And thanks to pioneers like Elisabeth Kubler-Ross, we've reframed dying as an important phase of human development and an opportunity for personal growth-- for the terminally ill and the bereaved alike. Hospice is increasingly seen as a valued alternative where hope doesn’t disappear--it merely changes direction. With the support of hospice, we can go from hoping for a cure and long life to hoping to live fully during the remaining time and hoping for a peaceful death.
A Cultural Shift in Patient Self-Determination
In the olden days, doctors were considered to be in charge of their patients’ medical care, making important decisions for patients. It was even considered a kindness to not talk about death and dying with patients, and even keeping secret a terminal diagnosis.
Now, no matter where you live, you can take charge of your destiny by filling out a legally binding advance directive, which outlines your medical treatment preferences and end-of-life wishes. By refusing such interventions as cardiac resuscitation, mechanical ventilation, feeding tubes, or hydrating IV’s near the end of your life, you’re aligning yourself with the medical research showing that these interventions painfully and unnecessarily prolong the dying process. When the body is shutting down, it is a physical burden to be resuscitated, ventilated, fed, and watered. Refusing intensive care and receiving comfort care is a way to let nature take its course and allow death to mercifully come when it calls.
Still, even with hospice care widely accepted, it is all too common for physicians to recommend intensive care, and for folks to request that maximum interventions be carried out for themselves or their loved ones. And in the absence of an advance directive, far too many dying patients are still admitted to intensive care only to endure the suffering of fending off imminent death.
The Role of Physician-Assisted Suicide for the Terminally Ill
When the Death with Dignity Act was passed in Oregon, naysayers predicted that euthanasia would become rampant. They worried that physicians would be required to offer fatal prescriptions, that family members would have shady ulterior motives and push suicide on dying relatives, and suicidal people would see this a permission to get a lethal dose in the absence of terminal illness. However, research shows that none of this came to fruition, and in fact, in 16 years, of the 1173 patients who received a prescription, 36% never used it. And yet, having that option can be therapeutic in itself, offering peace of mind should the day come when death is most merciful and welcome.
If you presume to know that you would never choose physician-assisted suicide, entertain the possibility that you truly have no idea what you would choose if you should face a situation that entailed unbearable and intractable suffering. You can only imagine what you might do if you had to walk that journey.
For those who consider suffering as divine discipline, be careful what you wish for.
For those who are religious and believe God gave us intensive care to fend off death, remember that God doesn’t need an ICU to keep you alive. And perhaps God also gave us hospice care, so we could die with more comfort and dignity. So if you want to put God in charge of when you die, get medical technology out of the way and choose hospice. And by all means, don’t choose physician-assisted suicide if it goes against your values and beliefs.
For those who question Brittany Maynard’s action, know that you have the right to self-determination, not the right to other-determination. Then imagine what it would be like if others had the right to determine your end-of-life decisions.
With death inevitable, Brittany wanted to have a hand in writing her last chapter, rather than having all of it written for her.
Whatever your beliefs, thoughts, and feelings about physician-assisted suicide, consider this perspective: Brittany was able to finish her life with a sense of self and purpose, with loved ones empathizing with her subjective experience and trusting her decisions. She refused to be a victim, and steadfastly remained the hero of her own journey.