On Oct. 12, Brittany Maynard, 29, who suffers from inoperable terminal brain cancer, announced plans to voluntarily end her life on Nov. 1. Maynard’s diagnosis means she will eventually lose all cognitive capabilities. Refusing aggressive chemotherapy treatment, Maynard decided to move to Oregon, where physician-assisted suicide is legal. Under Oregon’s Death With Dignity Act, mentally competent terminally ill patients with less than six months to live can elect when to die by taking lethal doses of prescribed drugs. With only a month left to live, Maynard has made her death into a campaign for terminally ill patients’ right to die.
However, her decision has been met with fervent opposition from disability rights advocates and religious conservatives. The freedom to live according to one’s beliefs and choices is duly recognized and celebrated in the United States. But terminally ill patients who wish to choose death with dignity versus a painful and prolonged end often face an enormous challenge even to obtain life-ending drugs. Denying mentally capable individuals the right to end their lives in a peaceful manner is a denial of their individual rights to self-determination and freedom of choice.
Oregon is one of only five U.S. states — along with Vermont, Washington, Montana and New Mexico — that allow medically assisted suicide. In the rest of the country, assisting people with suicide (even if they are terminally ill) is a crime. Maynard’s campaign highlights just how intrusive and unfair the laws criminalizing assisted suicide are for terminally ill patients and their families. For one, these patients must accept and live with their diagnosis. Second, asking a loved one to help end their suffering bears the cost of exposing them to the threat of prosecution and jail time.
The fear of prosecution for family members who help terminally ill patients is not theoretical. Last year Barbara Mancini, a 57-year-old nurse in Pennsylvania, was prosecuted for handing her father, John Yourshaw, a lethal dose of morphine. Yourshaw was a home hospice patient in failing health and had repeatedly expressed to family members his wish to die. Mancini was charged with a felony after an autopsy showed that her father died from a morphine overdose. The case was eventually dismissed but not before costing Mancini her job and more than $100,000 in legal fees.
Fear of prosecution is not the only hurdle facing advocates of death with dignity. Disability rights activists and religious conservatives have been very vocal about the ethics regarding assisted suicide laws. “There are hundreds — or thousands — more people who could be significantly harmed if assisted suicide is legal,” Marilyn Golden, a senior policy analyst at the Disability Rights Education and Defense Fund, wrote in response to Maynard’s announcement. Golden maintains that prognoses of terminal illness are often wrong and the disabled or terminally ill may be encouraged to choose assisted suicide for cost reasons. She adds that dying from illness is not necessarily painful because of “palliative sedation.”
Opposing physician-assisted suicide denies those disabled by terminal illness the right to control their deaths despite the fact that they suffer no cognitive impairment.
To be sure, there may be terminally ill patients who wish to cling to the possibility of incorrect diagnosis. But most people are convinced of their fatal prognosis, given the advances in medical technology. Besides, there is scant evidence of misuse and no local movements to repeal the laws in states that have death with dignity statutes.
Golden’s assertions regarding treatment costs as a factor in choosing assisted death, particularly for the poor, also do not hold up. A 2007 study published by The Journal of Medical Ethics found “no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses, including depression, or racial or ethnic minorities” from the death with dignity statutes in Oregon and the Netherlands.
The criticisms of disability rights advocates suffer from one central contradiction. They claim to protect the terminally ill (who are also often disabled) by insuring that they do not get steered into ending their lives. But that argument takes the crucial decision of choosing death with dignity away from the very people they purport to advocate for. Death with dignity statutes such as the one in Oregon allow cognitively capable patients to decide when and how to end their lives, regardless of their physical abilities. Hence, opposing physician-assisted suicide denies those disabled by terminal illness the right to control their deaths despite the fact that they suffer no cognitive impairment.
Support for the right-to-die
Religious conservatives oppose assisted death on the basis of their beliefs about the worth of life and the meaning of suffering. For example, Kara Tippetts, a devout Christian who is terminally ill, acknowledged in a letter to Maynard the pain of knowing one’s days are numbered. “But it was never intended for us to decide when that last breath is breathed,” wrote Tippetts. “Brittany, when we trust Jesus to be the carrier, protecter, redeemer of our hearts, death is no longer dying. My heart longs for you to know this truth, this love, this forever living.” As with most religious opponents of assisted suicide, Tippets applies her own definitions of the transcendent value of suffering and the existence of an afterlife on others, including those with differing views.
But none of these arguments are new. What is new, however, is the number of people who are engaged in the right-to-die debate because of Maynard’s decision. A recent Gallup survey shows that 7 out of 10 Americans polled supported some form of physician-assisted suicide. It’s a dramatic increase from just over 50 percent in 1970s. Legislatures in Hawaii, Kansas, Massachusetts, New Jersey and Pennsylvania have recently introduced death with dignity bills, with votes in New Jersey and Pennsylvania expected this year. Maynard’s campaign may serve as the catalyst for other states to consider similar laws.
A handful of European countries — the Netherlands, Belgium, Switzerland and Luxembourg — have legalized physician-assisted death. But the U.S. doesn’t have to look that far for examples. On Oct. 15 the Canadian Supreme Court heard oral arguments on reversing a two-decade-old precedent, which would decriminalize assisted death and even permit physician-assisted suicide.
As the representative from Quebec, which has already legalized the measure, rightly noted, death is part of life, and assistance in death is not suicide but should more accurately be described as end-of-life care. Unfortunately, that kind of thoughtful debate continues to be absent from our discourse in the United States, where death with dignity is often not an option for the terminally ill.