Dying with Dignity: Is it a choice or do we feel that we have no other choice?

In our most current blog post, rather than discuss an issue which Sharon Horn Consulting might be able to directly assist you with, we have decided to discuss a current topic that has stirred up much conversation, emotion, controversy and has in fact gone viral on social media.  This post is designed to provide information about this topic, and to create a platform for our readers to discuss and ask questions.

Recently, I am sure some of you have read or seen articles and videos chronicling 29 year old Brittany Maynard’s struggle with terminal brain cancer and her decision to end her own life with the help of an agency called Compassion and Choices.

Ms. Maynard, who took her life on Saturday November 1st 2014, seemed certain in her wishes. But what about other patients who may seem motivated by depression or hopelessness, and who some professionals might deem incapable of making such complex decisions under such duress?

Let’s discuss. Ms. Maynard transfixed online audiences when her story and videos went viral, reigniting the right-to-die debate, as she announced that she would be taking her own life rather than die the predicted painful death that her brain tumor would soon cause.  On new year’s day in January 2014, Brittany Maynard was diagnosed with glioblastoma multiforme. Initially, her doctors gave her a prognosis of several years, however, after further tests they revised the prognosis in April 2014, saying she had only about six months to live.

“After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left,” Ms. Maynard wrote in a post on CNN’s website.

Ms. Maynard came to the decision that when her condition became unbearable she would end her life with medication. She and her family moved from their home in Alamo, California to Oregon, one of five states with so-called “aid-in-dying” laws.

One of the more hotly debated topics surrounding Ms. Maynard’s decision and the days leading up to November 1st 2014, is how clear-eyed and calm she seemed in photos and videos released during this time leading up to her death. For organizations such as National Right to Life, which opposes physician-assisted suicide, this peaceful and poised vision seems like evidence of a young person in the prime of their life who might be ending life too abruptly. However, in reality, Maynard was suffering from crippling seizures and stroke-like symptoms, during which, in this heart-wrenching video, she describes a seizure where she eventually regains consciousness and is able to recognize that the man in front of her is her husband, however, she is unable to recall or speak his name. Perhaps, Maynard is very far from her “prime.”

According to Olga Khazan’s article in the Atlantic titled Brittany Maynard and the Challenge of Dying with Dignity, this issue raises an interesting catch-22 when discussing death-with-dignity laws. See, while Maynard might not have appeared, to some, like she was ready to die, most terminally ill who seek assisted suicide are depressed. Perhaps, Maynard sought this “answer” early enough in her dying process that she was able to find peace in knowing her outcome, however, for many the issue of depression makes physicians less likely to prescribe lethal medications that would allow terminally ill patients to die by their own hand. Thus, appearing well-adjusted like Maynard causes some organizations and individuals to feel that she wasn’t yet ready to die, while a more depressed, hopeless appearance might be viewed as not yet ready to choose the choice of the right to die.

Oregon has the longest-standing aid-in-dying laws in the U.S, however, since the law came into existence in 1997, 0.2 percent of all deaths in the state have been attributed to people taking their own lives under the law. For a patient to receive a lethal medication in Oregon the following criteria must be met:

  • He or she must have a terminal diagnosis confirmed by two doctors
  • Have only six months to live
  • He or she cannot have any underlying mental-health issue
  • His or her request must be verified by two witnesses
  • He or she must make one request for the medications in writing and one orally, and there’s a 15-day waiting period in between the two requests.

How many of these requests would you guess are approved or denied? According to Khazan’s article, Oregon physicians reject five out of six requests for lethal medication. The main reason being that physician-assisted suicide requests are less likely to be approved if the patient either a) views themselves as a burden to their loved ones or b) is depressed. Since both feeling unwanted and suicidal ideation can be symptoms of depression, many physicians feel that they cannot determine whether the patient would feel differently if their mental state improved. Essentially, does this individual want to die because they’re depressed, or because they’re terminally ill- or some combination?

In a study that compared 55 Oregonians who had requested physician-assisted suicide with 39 terminally ill people who did not request the medications, those seeking suicide were more likely to be depressed, hopeless, not spiritual, and self-reliant. A 2000 study of the Oregon law found that over a third of the patients who requested assistance with suicide, requested it because they perceived themselves as a burden to others, but only three of these patients actually received prescriptions for lethal medications which suggests physicians are reluctant to allow requests for assistance under these circumstances.

But how do we parse out melancholy, sadness, “the blues” or what some might call depression from a terminal diagnosis? Is it reasonable to expect an individual with terminal illness and a prognosis of 6 months or less to not experience feelings of depression? If an individual is experiencing depression surrounding this life trauma, does that mean they are incapable of making this decision on their own? These are difficult questions to answer. Some might say the doctors’ selectiveness is merited because according to Khazan’s article, 11 percent of patients who were either medicated for depression or evaluated by a mental health expert changed their minds about wanting to kill themselves. The article reflects that while that’s a small percentage, in terms of a clinical study, it’s a large percentage in terms of an irreversible, life-or-death decision.

The debate over whether mental illness can complicate a patient’s wish to die has already been explored in-depth in other parts of the world. In the Netherlands, voluntary euthanasia has been legal since 2001, however, more recently the country has attempted to explore offering physician-assisted suicide to psychiatric patients, rather than just terminally ill ones. There are so many questions that come to mind when we think or discuss Maynard’s death. Khazan closes the article, questioning the reader, “How do we know if someone, besides being ravaged by their body, is also tormented by their mind? And should it matter?”

Some individuals have described Maynard as highly poised and at peace in the days leading up to her death and they compare that with individuals who may seem as though they are suffering from depression and may be deemed as “less competent” to choose this choice. However, in this video of Maynard, although extremely poised, she is tearful throughout the video and clearly portrays overwhelming feelings of loss for what she will miss in the future and she even makes the statement that her wish or hope would be for some miracle that this brain tumor goes away and she does not die. These are not all peaceful feelings and thoughts, but death and dying is messy. On the CNN website, Maynard wrote “I would not tell anyone else that he or she should choose death with dignity. My question is: who has the right to tell me that I don’t deserve this choice?” Maynard went on further to assert that “being able to choose when to die has allowed me to live. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty, and pain.” Perhaps those individuals undergoing evaluation for approval of their request had already entered into a state of fear, pain and uncertainty. Are we deeming those individuals depressed and unfit to have the opportunity to make this choice? Or like Khazan pointed out, can physicians help individuals find a more mentally sound state from which to make decisions, in order to ensure they are acting from a place of sound mind and clarity? We invite you to share your thoughts.

Comment, please!