Death with Dignity: Brittany Maynard Dies on Her Own Terms

Brittany Maynard, the terminally ill 29 year-old woman who bravely ignited the right-to-die debate with her public decision to end her life, died Saturday at her home in Portland, Oregon surrounded by her family. “Goodbye to all my dear friends and family that I love,” she wrote on Facebook. “Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me… but would have taken so much more.”

Before I tell you more, I am taking a moment to close my eyes and send my deepest sympathies and condolences to Brittany’s family.

In the spring, Brittany – a previously healthy, newly married young woman – was diagnosed with stage 4 glioblastoma, a particularly aggressive and especially nasty form of brain cancer. This type of cancer grows quickly and spreads shockingly fast. Glioblastomas grow so quickly because they create their own blood (i.e., “food”) supply. Though there are some treatments (e.g., surgery, chemotherapy and radiation) for the disease, there is no cure for it.  I remember standing in the bookstore reading her cover story in People magazine with tears pouring down my face, knowing what she was facing.

As a hospice nurse, I have cared for all too many people with glioblastoma. It is a a particularly gruesome way to die. People are plagued by seizures, changes in mood or personality, trouble speaking, loss of bodily functions, unrelenting & persistent headaches and difficulty speaking. I remember one woman for whom I cared who – whenever I entered her home – screamed (loud enough for neighbors to hear) the most shocking and stunning obscenities at me. While it was hard to take in (especially when she used my name in conjunction with the obscenities), I reminded myself  that her behavior was a direct result of her cancer. Additionally, her tirades were dispensed from her couch (because she was unable to walk), while wearing diapers (because she had lost control of her bladder and bowels).

Knowing that this was the likely end of her disease and after being told that six months to live, Brittany moved with her family from California to Oregon so that – when she was ready, on her own terms – she could take her life with a fatal dose of barbiturates under the state’s Death with Dignity Act.

Please allow me to explain this process because to have a logical discussion about it, I believe that we all need to understand the issues.

The Death with Dignity Act Law allows mentally competent (meaning that a person understands and can articulate the cause and effect of his or her actions), terminally-ill adult state residents to voluntarily request and receive a prescription medication to hasten their death. Right now, three states have legal physician-assisted suicide. Oregon and Washington have had it for a while. Vermont legalized it recently. New Mexico and Montana have court opinions that indicate that it wouldn’t be against the law to do physician-assisted suicide in those states, but they don’t have policies in place for doing it.

Several safeguards in Death with Dignity laws ensure all patients are protected, and if they wish to use the law, they’re in full control of the process. These safeguards and the request process ensure that there is no chance for patients to be coerced to hasten their deaths. Below are the specific eligibility requirements that must be met before a lethal dose of medication can be prescribed:

1. A person must be 18 years of age or older,
2. A person must be a resident of Oregon, Washington, or Vermont and provide the attending physician proof of residency according to the states’ laws. There isn’t a timetable associated with establishing residency. Proof can include a state issued ID such as a driver’s license, documents showing the patient rents or owns property in the state, state voter registration, or a recent state tax return. The attending physician must decide whether the patient has adequately established residency. There is no minimum residency requirement. A patient must simply be able to prove he or she is a current, bona fide resident of Oregon, Washington, or Vermont.
3. A person must be capable of making and communicating health care decisions for him/herself;
4. A person must be diagnosed with a terminal illness that will lead to death within six months.
5. Two physicians must determine whether these criteria have been met and follow this timeline:
   1. First oral request to your physician
   2. 15 day waiting period
   3. Second oral request to your physician
   4. Written request to your physician
   5. 48 hour waiting period before you can pick up your prescribed medications
   6. Patient may pick up prescribed medications from the pharmacy
6. A patient must be able to self-administer and ingest the prescribed medication.
7. Additionally, a person can rescind the verbal and written requests to the physicians at any time.

The law further requires…

• The attending physician must be licensed in the same state as the patient.
• The physician’s diagnosis must include a terminal illness, with six months or less to live.
• The diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally competent to make and communicate health care decisions.
• If either physician determines that the patient’s judgment is impaired, the patient must be referred for a psychological examination.
• The attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options.
• The attending physician must request that the patient notify their next-of-kin of the prescription request.
• Use of the law cannot affect the status of a patient’s health or life insurance policies.

The states’ departments of health enforce compliance with the law. Compliance requires physicians to report all prescriptions to the state. Physicians and patients who comply with the law are protected from criminal prosecution. Physicians and health care systems are not obligated to participate in the Death with Dignity laws.

Oregon has had their law in place for 14 years. According to public records, since the law was passed in 1997, a total of 1,173 people have had prescriptions written and 752 patients have died from ingesting medications prescribed under the law. To date, Oregon’s experience has been without abuses. The critics of Oregon tend to be outside of Oregon. They don’t tend to be from the state.

As a hospice nurse, I was asked on more than one occasion to hasten a person’s death. People asked for prescriptions – they told me – to have a sense of control, to give them the motivation to face whatever difficulty that laid for them at the end of life. In the face of unrelenting suffering (on behalf of the patient AND family), Did I think about it? Yes. Did I actually hasten a person’s death? Absolutely Not. I did, however, work with the patient’s health care team to do everything that could possibly be done to provide physical, emotional and spiritual comfort at the end of their lives. Our efforts were not always enough, though. Witnessing (let alone experiencing) such suffering is excruciating, beyond anything a healthy person can ever – in their wildest and most abhorrent dreams! – imagine.

At this point, I am unable to say where I stand because I don’t think that the issue is clear-cut or black and white.  What I believe without a doubt is that this dialogue needs to continue.  I am so very grateful to Brittany and her family for giving this topic such light.  I’m just so sad and sorry that it happened the way that it id.

Additional information on the Death with Dignity laws can be found here:

• Compassion & Choices of Oregon
• Compassion & Choices of Washington
• Vermont Ethics Network

As always, I would love to hear your thoughts!