Brittany Maynard died as she planned on Nov. 1. Her death brings new life to those campaigning in favor of the right to die with dignity. Maynard, age 29, and in the prime of her life, assessed her future after receiving the diagnosis of stage 4 glioblastoma. She knew that radiation or chemotherapy might buy her some time, but that time was at a cost. There was no guarantee the treatment would help her. It was likely to make her sick and worsen her quality of life. Maynard decided against treatment, as she wanted to make the most of the time she had left.
Maynard researched glioblastoma and how it would affect her as the disease progressed. She knew she would suffer and may not get adequate pain relief. She chose to take control of her body and decide when her life would end. Thankfully, she could do so in a legal way.
People against the right to die criticize Maynard’s choice to end her life. They argue that legalization of assisted suicide endangers the elderly, disabled and people with chronic illnesses. They assert that families and insurance companies will use assisted suicide to get rid of patients for their own financial gain. They argue that a legal right to die will evolve and eventually all unhappy people will be able to end their lives.
These arguments are without merit. Properly drafted laws and regulations will minimize the potential abuse of the right to die with dignity. No one opposed to the right to die with dignity offers objective evidence of widespread abuse of this right where it is legal.
Diane Coleman of Not Dead Yet offers palliative sedation as the legal alternative to the right to die with dignity. In an article for CNN, Coleman states, “advancements in palliative care have eliminated pain as an issue for patients who receive appropriate care.” She described palliative sedation as a legal solution that “does not raise the very serious difficulties that legalizing assisted suicide poses.”
Coleman’s characterization is incorrect. Palliative sedation is controversial and complicated. Numerous medical journal articles describe the difficult issues surrounding palliative sedation including:
- the principle of double effect
- lack of uniformity in guidelines for the use of palliative sedation across medical institutions
- deciding whether to withhold hydration and nutrition with palliative sedation
- whether palliative sedation is euthanasia
- obtaining informed consent
- insufficient proof that unconscious patients do not experience pain
The medical community is still debating these issues.
In addition to the practical and ethical problems raised by palliative sedation, there is the issue of choice. By the time palliative sedation is an option, patients are in great distress and near death. It is not their choice. Typically, family members decide, not the patients.
I wonder how many people, like Diane Coleman, who oppose the right to die have witnessed death. Not just any death, but a slow, degrading and painful deterioration of your body until you take your last breath.
To watch someone you love in uncontrollable pain is torture when you know their pain will only end with death. It is humiliating for people when their physical functioning deteriorates as they die and they become dependent on others for help with basic bodily functions. How sad it is for people who are dying to think that they are now just a burden to their families.
Medical advances mean a lot of pain is manageable, but not in every case. Who are we to decide that a person must endure days, weeks or months of unbearable pain and emotional turmoil? We do not have that right. That right, that choice, belongs to the patient.
Stanford University School of Medicine
Sedation in palliative care – a critical analysis of 7 years experience
Medication and Monitoring in Palliative Sedation Therapy: A Systematic Review and Quality Assessment of Published Guidelines.
Palliative sedation—still a complex clinical issue!