Choosing Death

Meet terminally ill cancer patient Brittany Maynard:

Gene Robinson defends Maynard’s decision to end her life on November 1:

Many people would call this suicide, pure and simple. But life is much more complex, and the human spirit much more creative, than such a judgment would suggest. Perhaps more than anything, what people fear most—aside from the pain of a terminal illness—is the loss of control. Call it pride and the desire for autonomy over one’s life if you will, but to those who advocate for the right to end one’s life, it is the right to “die with dignity.” That’s what Brittany wants. I think she deserves that right. And I think it is a thoroughly moral choice.

Brittany Maynard is not mentally ill. She is not suffering from depression. No amount of therapy—whether psychological or physical—will change the fact that without intervention, she will die a horrible death. She seems to have worked through the “stages of dying” made famous by Dr. Elizabeth Kubler-Ross, and reached the final stage of accepting the fact of her imminent death.

J.D. Tuccille supports the Oregon law that allows Maynard to make this choice:

Well-spoken and obviously thoughtful, Brittany Maynard has literally become the poster child—and video child (see [above])—of the movement dedicated to expanding options available to people otherwise facing an unpleasant end. Specifically, this works out as the ability to seek medical assistance free of legal penalties for those who offer help. In Oregon, the Death with Dignity Act, enacted in 1997, “allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.” Doctors participate only at their own choosing—they’re not compelled to help patients end their lives.

Which is to say, this is about the final choice that anybody can make, and freeing others to choose to offer assistance in achieving the chosen goal. That’s about as libertarian as it gets.

Ross Douthat reflects on why such laws haven’t become more widespread:

Many liberals seem considerably more uncomfortable with the idea of physician-assisted suicide than with other causes, from abortion to homosexuality, where claims about personal autonomy and liberty are at stake.

Conservatives oppose assisted suicide more fiercely, but it’s a persistent left-of-center discomfort, even among the most secular liberals, that’s really held the idea at bay. Indeed, on this issue you can find many liberal writers who sound like, well, social conservatives — who warn of the danger of a lives-not-worth-living mentality, acknowledge the ease with which ethical and legal slopes can slip, recognize the limits of “consent” alone as a standard for moral judgment.

Jazz Shaw appreciates the complexity, presenting views on both sides:

This is a subject which we’ve had to deal with in our family and one that I’ve personally debated for a long time. It’s not an easy question for many people, though the spiritual and social dilemmas surrounding it can lead to battles which come off as unseemly when dealing with a young person facing their own mortality. …

With or without government permission or medical help, many people are going to make this choice when faced with the ultimate question. They have to struggle with asking whether life is indeed so precious that a few more hours or days of it are worth the cost if that time is spent medicated beyond conscious activity while loved ones weep at their bedside. Those who determine that is is not and who can’t obtain competent medical advice will choose a gun in their mouth, a noose, a car “accident” or some cocktail of pills and alcohol which they cobble together themselves, often with disastrous results in failed attempts. So I’m not going to judge either Maynard or [fellow cancer patient Kara] Tippetts and can only hope that others will spare me such judgement should I wind up facing the same, awful decision point.

Harold Pollack finds that “the mass appeal of assisted suicide reflects an incredible failure of our health care system”:

We do not provide proper palliative care. As Atul Gawande relates in his beautiful new book Being Mortal, we do not reliably address people’s deepest needs when they face life-ending or life-altering illnesses of many kinds. We can do a better job of relieving people’s symptoms and protecting them from pain. We can protect families much more effectively against catastrophic medical expenses and hard caregiving burdens. We can work more effectively to ensure that every patient can make the most of their remaining days. We can more effectively promise that someone will die with dignity without the need to take precipitous measures while they still believe they can.

The Institute of Medicine’s recent report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, provides many practical suggestions of how these challenges might be more effectively addressed. For example, Aetna expanded its hospice and palliative care benefit by allowing people to still receive curative therapies while enrolled in hospice, and by slightly relaxing its eligibility standards for hospice services.  Such “concurrent care” models allowing people to receive improved attention to quality of life issues and symptom relief, even as they might choose fairly aggressive treatment of a life-threatening or life-ending condition.

Recent Dish on end-of-life concerns here and here. Update from a reader:

My mother died from glioblastoma, the same brain cancer that is killing Maynard. It is as horrific a disease as one can imagine. My mother seemed to lose another piece of herself each day. So I can understand Maynard’s decision to end her life before the worst of the disease affects her.

But, when I brought in home hospice the last week of my mother’s life (and I so regret not doing it sooner), they told me they would treat any symptom that could possibly cause her discomfort. And they did. That week she did not suffer. Witnessing her natural death and caring for her was one of the most profound experiences oft life. It was not a burden; it was a gift and I will always have the comfort of knowing I did this for her.

I respect and understand Maynard’s decision but I urge anyone else considering assisted suicide to speak with hospice first and learn what they can do for you.