Brittany Maynard’s death with dignity campaign puts US laws back in focus

A campaign by Brittany Maynard, a terminally ill cancer patient, to bring doctor-assisted suicide laws to states across the U.S. has spotlighted the existing patchwork of laws regarding the right to end one’s life.

The 29-year-old moved from California to Oregon so that she could be in a state with a death with dignity law. On posts on her website and in an article for CNN, she has written about her plans to take her life when her “suffering becomes too great.”

In the process, she has galvanized debate over an individual’s right to die, especially among America’s youth.

How does death with dignity differ from euthanasia?

Euthanasia is illegal everywhere in the U.S. and is unrelated to the “carefully written and regulated death with dignity laws,” according to the Death with Dignity National Center's website.

Melissa Barber, the director of digital communications at the center, explained that euthanasia is when one person hastens the death of another to ease suffering. But under death with dignity (DWD) laws, the patient self-administers lethal medication prescribed by a physician. The choice of when to take the prescription drugs or whether to take them at all is entirely up to the patient.

Which U.S. states have passed DWD laws?

Oregon, Washington and Vermont­­ are the only states to have passed doctor-assisted suicide laws.

Since Oregon’s Death With Dignity Act was enacted in 1997, over a thousand people have had DWD prescriptions written, according to the state’s health department. Not all those given a prescription chose to end their lives. In Oregon, 752 people have died by taking the prescribed medications.

In 2013, doctors in Washington wrote terminally ill patients 173 prescriptions for lethal medications, according to the state’s health department. This number is almost triple that of 2009, when the law was first implemented. The underlying illness in most cases was cancer, followed by neuro-degenerative diseases like amyotrophic lateral sclerosis, known as ALS.

The Vermont legislature passed the Patient Choice and Control at End of Life Act, similar to Oregon and Washington's DWD acts, in 2013. So far, there have been no reports of patients taking prescribed lethal medications under the law.

In Montana and New Mexico, courts found that there is “nothing illegal” if a physician decides to assist terminally ill patients who choose to end their lives, said Melissa Barber. This effectively legalizes doctor-assisted suicide in these states.

But Marilyn Golden, senior policy analyst at the Disability Rights Education and Defense Fund, said there is legal ambiguity in New Mexico and Montana. Doctor-assisted suicide, she said, is a “loophole in the court’s decision.”

What are the criteria for exercising DWD rights?

All three of the states with doctor-assisted suicide laws have similar safeguarding measures, Barber explained. The patient has to be an adult, terminally ill and diagnosed with fewer than six months to live. The patient then submits two verbal requests, 15 days apart, indicating that it is not a snap decision. Two physicians then evaluate the patient to ensure the person is mentally competent to make their own medical care decisions. If approved, the patient submits a written request signed by witnesses. If not, they are sent for psychological evaluation.

Once the procedure is complete, the prescription can be filled after a 48-hour waiting period, Barber said.

To exercise DWD rights in a state, the patient must also be a resident of that state.

What is the main opposition to DWD laws in states that don't have them?

A number of groups against doctor-assisted suicide — Not Dead Yet, Second Thoughts and Disability Rights Education & Defense Fund — released a statement Thursday, responding to Maynard's campaign and argued that “Not every terminal prognosis is correct, not everyone’s doctors know how to deliver expert palliative care, and not everyone has a loving husband and family.”

While sympathizing with Maynard, the press release said, “Legalization of assisted suicide often looks acceptable when the focus is solely on an individual.”

Golden said it’s important to not just look at one individual situation but to consider all the people who could be harmed by “bad medicine.”

Given the significant possibility of misdiagnosis, she explained, patients “can lose years of their lives and give up on treatment out of fear of what’s coming in the future."

Plus, once the prescription is written, she said there is no control over it. When the medication is self-administered, no witness is required to be present. This, she said, could lead to elder abuse.

But Barber from the Death with Dignity National Center said the real resistance to DWD laws comes down to faith.

“The opposition is founded in religion,” she said, “and it doesn’t quite work in a country where the state and church are separated.”

Why has Maynard’s story drawn such a huge response from young adults on social media?

"This is happening to one of their own," said Dianne Gray, president of The Elisabeth Kubler-Ross Foundation that deals with end-of-life care, among other issues. "They realize this could be them.”

Given her age, Maynard's story is particularly resonant. Shortly after marrying, doctors diagnosed the 29-year-old, who was trying to start a family, with terminal cancer.

Thousands of people tweeted out the hashtag #brittanymaynard since the campaign started last week.

The social media outpour is not surprising, said Pamela Rutledge, director of the Media Psychology Research Center in California.

“[It is a] change in social perspective of a generation,” she said.

Technology has created a sense of an “empowered generation,” she said, adding that engaging with someone emotionally on a social media platform has become increasingly common.