Human life is a gift. Death, too, can be a gift. Is it ever appropriate for us to choose the timing of our death?
Brittany Maynard, 29, was diagnosed with a stage 4 glioblastoma, an aggressive and uniformly fatal brain tumor. With the blessing of her family and millions of supporters around the world, she ended her life in Portland, Oregon, with a fatal dose of barbiturates prescribed by a physician. Oregon is one of five states, in addition to Washington, Montana, Vermont, and New Mexico, that allow physician-assisted death (PAD), and its Death with Dignity Act of 1994 was the first of its kind.
PAD is a complex topic. In 2013, the Pew Research Center showed a divided country on this topic: 47 percent approve and 49 percent disapprove. The numbers remain unchanged since 2005. A Medscape poll recently asked readers worldwide, “Do you approve or disapprove of physician-assisted suicide for terminally ill patients?” 54 percent said they strongly approved, 17 percent somewhat approved and 24 percent strongly disapproved.
Columbia University professor of clinical psychology Andrew Solomon has written about his mother’s PAD in 1991. She had suffered a years-long battle with ovarian cancer. He calls Maynard “little short of heroic” for devoting her final moments to brining light to this important topic. Maynard’s age has given a new face to PAD and speaks to a new generation of Americans. Given major shifts in attitude toward topics such as gay marriage and medical marijuana use, lawmakers foresee wide legislation that will likely support PAD.
The slippery slope argument has been a major objection to the legalization of PAD. Yet, many physicians believe that the burden of performing PAD forces them to reconsider participation in such programs. Physicians practicing in states where PAD is legal have found regulations and guidelines that provide grounds for refusing PAD.
Currently, the law requires that a patient be diagnosed with a terminal illness to have access to PAD. Solomon supports strict guidelines on who is an appropriate candidate with precautionary evaluation placed in effect for those who suffer from reversible conditions.
Traditional medical education is entirely focused on preserving life at all cost. The training of doctors and health care workers to participate in PAD can be traumatic, both in the loss of a patient with whom they have built a relationship, and in the acknowledgment of the limitations of medicine. Meanwhile, doctors routinely administer morphine to terminal patients in pain, in order to relieve pain, even when there is risk of hastening the patient’s death. Palliative programs have flourished across the country and are backed by insurers. This practice is also well accepted both by the ethics committees as well as by clergy.
Most religions believe that life comes from God, and its end remains up to God, that human beings should not intervene. However, religious leaders see no value in suffering from chronic pain or at the end of life and encourage physicians to relieve suffering, short of terminating life. The Biblical story of King Saul, who commits suicide while wounded in battle while fearing torture, has been frequently cited. Clergy have argued to justify Saul’s action, while labeling it an exception and not the rule. The Talmud says, “One who is in a dying condition is regarded as a living person in all respects.”
Unless faced with the difficult issue of chronic and terminal painful suffering, for a loved one, or for ourselves, the decision to be for or against PAD can be very difficult. Like most difficult societal choices, we must draw on multiple sources, from science to religion, from philosophy to law, and we must listen well to dying patients.
Life is a gift. Watching my patients in their 90s fight for one more day of life is encouraging. But I have also been witness to extraordinary and unnecessary suffering where I, as a physician, have felt powerless. Maynard’s decision was the right one for her, and she should be honored. We don’t live on an isolated island and must respect the ill and the suffering regardless of our own religious views.
And still, each moment of life remains so precious, mystical, and truly magical that no individual suffering should diminish its infinite communal value.