The Right To Die: A Healthy Choice?

Brittany Maynard chose assisted suicide

The plight of Brittany Maynard and her articulate YouTube video have focused a great deal of attention on the question of the "right to die." This well educated, happily married and attractive 29 year old raised public awareness by using modern media to communicate her wishes and to advocate for her position that she had a right to choose how and when she would die after being given a terminal diagnosis for her inoperable brain tumor.

She was told by her doctors that she had only about six months to live and that the course of the disease would become painful and difficult. Although they offered no hope for a recovery, this decision was not made from a state of depression. Many individuals and families face this choice. Few face it at such a young age and that is part of the reason Brittany's situation attracted so much attention.

Oregon's right to die

Oregon is one of four ( Washington, Oregon, Vermont and Montana) states where laws have been passed giving patients the right to seek a physician to assist them in their own death when diagnosed with a terminal disease.

Oregon's law requires the patient to meet these criteria:

The patient must be:

• 18 years of age or older
• A resident of Oregon
• Capable of making and communicating health care decisions for him/herself 
• Diagnosed with a terminal illness that will lead to death within six (6) months.

It is up to the attending physician to determine whether these criteria have been met.

If the patient qualifies the following steps must be taken:

1. The patient must make two oral requests to the attending physician, separated by at least 15 days;
2. The patient must provide a written request to the attending physician, signed in the presence of two witnesses, at least one of whom is not related to the patient.
3. The attending physician and a consulting physician must confirm the patient's diagnosis and prognosis. 
4. The attending physician and a consulting physician must determine whether the patient is capable of making and communicating health care decisions for him/herself.
5. If either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination. 
6. The attending physician must inform the patient of feasible alternatives to the Act including comfort care, hospice care, and pain control. 
7. The attending physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. A patient can rescind a request at any time and in any manner. The attending physician will also offer the patient an opportunity to rescind his/her request at the end of the 15 day waiting period.

Brittany and her husband relocated to Oregon from California to be able to meet the state's residency requirement.

Bravery or Cowardice?

Most of us have a fear of dying. We don't want pain or suffering. We don't want extreme disability and most of us do not want to burden our loved ones. Is it fear of pain or a realistic assessment that the suffering will benefit no one? If you followed the story in the media there were interviews with families of people who had died of a terminal disease who felt the last months were precious. For some, that time might be of great value, but who are we to make those decisions for others?

For some, their religious faith makes this act impossible but should they have the right to impose their beliefs on others? And none of us really knows what our wishes will be until they face this terrible dilemma, however certain we may feel at another time.

Then why isn't all suicide ok?

I see a very large difference between suicide for terminal disease and suicide because of depression. There is great pain and suffering in both cases, but for most people with severe depression there is a chance of improvement with help. Even those who continue to struggle despite help experience periods of remission when their symptoms improve and they are able to enjoy life. Assisted suicide requires a short time frame (six months in Oregon's law) and a terminal disease with no realistic hope of improvement. We cannot yet make those predictions for mental suffering.

What about the family?

Brittany had the support of her loved ones. We don't know the discussions that came before her public announcement, but she was able to persuade her family of the need to make this difficult choice. I suspect few go ahead with this decision without that type of support. Not only the individual, but those who love the person share in this choice.

I have had the experience of working with terminally ill patients and their families. Hospice, which specializes in end of life care, feels that patients hang on until their relatives accept their death and give them "permission" to let go of life. They have watched many families go through this difficult passage together. They witness many times when a spouse or a child says, "it's okay" that death comes more swiftly and peacefully.

An individual choice

The passage of Brittany Maynard is opportunity for all of us to think about and discuss our feelings about the circumstances of our death with those closest to us. None of us likes to face this inevitable eventuality but greater peace of mind can come from exploring the issue before it is a crisis.