Brittany Maynard's suicide: A free choice or an expectation?

Denver, Colo., Nov 7, 2014 / 04:02 am

By now, the world recognizes Brittany Maynard as the media darling of right-to-die advocacy.  

After receiving a grim prognosis of six months to live due to an aggressive brain tumor, Maynard and her husband relocated to Oregon in order to take advantage of the Death with Dignity law, which legalized physician-assisted suicide in the state.

Compassion and Choices, an advocacy group for right-to-die causes, latched on to Maynard's youth and beauty after she approached them, asking how she could advocate for rights to assisted suicide for other people. They produced a video featuring Brittany and her family, complete with soothing music and beautiful photos, in which she calmly explains her situation and choice to die on Nov. 1.

She's been hailed as heroic, a brave woman who looked terminal illness in the face and ended her life on her own terms.

As writer Lisa Miller put it in a recent article for New York Magazine: "she has risen to the status of a martyr-saint."

"On my Facebook feed and on Twitter, in articles passed around friend-to-friend, I've watched Maynard be called courageous, inspirational, an angel; she is resting with the stars, her admirers say."

But the circumstances of her death have several experts and others questioning: exactly how free was Brittany in her decision, with a major advocacy group packaging her image and story for their own purposes?

"(Compassion and Choices) might have in some way encouraged her or helped her, to make it a much more public event, in order to pressure the society to have the laws change," said Rev. Dr. Joseph Tham, the Dean of Bioethics with the Pontifical Athenaeum Regina Apostolorum in Rome.

"I wouldn't say they exploited her, but in some way there must have been some kind of push in that direction," he said. "These groups are active in terms of finding people who are vulnerable in some way, and in making the case public to push an agenda."

Andrea Virdis, doctor of philosophy and doctor of research in bioethics at Catholic University of the Sacred Heart in Rome, said the first video released by Maynard seemed like a marketing ploy.

"The choice of Brittany was represented through a video which was tailored in a specific way. Watching this video, there was a notion of a sort of profound serenity, as if the choose to death had to be encouraged and praised," he observed.

"The video was almost a model for claiming this choice, in order to advance the request that these choices (of assisted suicide) may be carried forward also in States where the legislation still does not consent it."

A second video was released by Maynard as her Nov. 1st date drew closer. In the raw and heart-wrenching clip, Maynard reconsiders her decision, or at least the timing of it.

"I still feel good enough, and I still have enough joy, and I still laugh and smile with my friends and family enough that it doesn't seem like the right time," Maynard said. "But it will come, because I feel myself getting sicker. It's happening each week."

November 1st came and went, and the news came out Nov. 2nd – Maynard had ended her life as originally planned.

Dr. Julie Masters, who teaches a course called Death and Dying at the University of Nebraska-Lincoln, said in an interview before Maynard's death that when her class discusses physician-assisted suicide, she asks her students to consider whether it truly is a free choice.

"The question I posed to the students: is this a choice, or is it an expectation?" she said.

With names like "Death with Dignity," right-to-die laws often claim that they offer patients more dignity by giving them an out when it comes to intense and debilitating suffering. The idea of dignity, however, begs the question of what gives life value, Masters said.

"That's the challenge of the concept of a slippery slope, and when you move to the position of physician assisted suicide, to euthanasia, who do you expect to end their lives because they no longer seem to be worthy or of value?" she said. "Then I think we have a huge problem because then we fail to see the value of life, the value of that life."

Virdis echoed this concern saying that the meaning of dignity in society has become more and more about what people can have and can offer, rather than who they are.

"According to this idea, a life dignified to be lived is a life with given conditions (such) as feeling well, being happy, being sufficiently wealthy, being healthy, being healthy, being autonomous in choices, in daily life…" he said.

"(But) if we look into the real meaning of 'dignity,' we become aware that dignity is much more than something you can possess or not," he continued. "…everybody – whether he is healthy or sick, he is rich or poor, he is autonomous or dependent on others – has the value of life. And dignity is the value that characterize life itself, it is acknowledging that life is a value in itself, and it is not bound to other values."

In her column, Miller said that the idea of dignity without the ugliness and suffering that usually accompanies death, is a fairly new idea, sprung from Western society and detached from the all-too-often reality of most people's last moments.

"Jesus, bleeding, cried out in agony and loneliness on the cross, and the earliest Christians loved their martyrs burnt, starving, or torn apart and chewed," she wrote, "but in the secular West, dignity has come to mean a kind of existential modesty, a wish not to be seen at one's worst, at a moment when one might not have the wherewithal to retrieve an appropriate fig leaf for the indecent business that is death."

While Brittany's image and story – coupled with Compassion and Choice's publicity – have helped gained traction for right-to-die laws, society has not always been so receptive to the idea.

For years, the movement advocating for physician-assisted suicide went by the less-than pleasant sounding "Hemlock Society." In the 1960s, the first right-to-die bill was proposed, and shot down, in Florida. It wasn't until 1997 that Oregon became the first state to implement a Death with Dignity law, and so far only four other states have followed suit.

Miller speculates that this increasing acceptance of the idea of physician-assisted suicide stems from a desire to somehow "sanitize" death, which until recently had been understood to be a process naturally involving ugliness and suffering.

"Please don't think I have anything to say about Maynard's decision to end her life, because I don't," she wrote. "I'm talking about a nation's knee-jerk reverence for a young woman we never knew, a tidal wave of empathic grieving that allows us to dwell on the tragic injustice of untimely death while evading the grosser realities of death itself, which in the usual course of events involves shame, ugliness, and suffering."

Masters said that in her experience, people who choose assisted suicide are responding out of fear, which could be helped if hospice and palliative care were made to be more viable options, especially in the long-term.

"It's about fear. Be not afraid – 365 times we are told," she said, referring to the Biblical phrase. "But people are afraid because they have examples in their mind of other people who have died a hard death, and it is helping them to see that death can be a gift, and it can be approached in a comforting way."

When people who are not terminally ill consider suicide, it is typically because they see it as their only option, the only way out, she said.

"…what happens is people lose sight, they get this tunnel vision, and they only see one option that's suicide," she said. That's why it is so important for the terminally ill, who often can have suicidal thoughts, to be show that suicide does not have to be their only choice.

"And that is why we have these beautiful hospice and palliative care homes," she said. "There is more than one option. You have more options, you have more."

Miller said that while she doesn't believe that there is necessarily a right way to die, or that things were better in earlier times, she does think society has come to an unrealistic point of idealizing death as something peaceful, serene, and neatly squared away.

"I am saying that there's something overly sanitized in our devotion to Maynard now," she wrote. "'Look, she was so beautiful and, poof, now she's gone.'"

Masters said because Maynard's case has been made so public, religious leaders should take the opportunity to talk about end of life decisions with their flock, as that is who people most often turn to with questions regarding those choices.

"I hope for clergy, for rabbis, for ministers, for priests, for monsignors, to start the dialogue within a place of worship," she said. "Because people look to their religious leaders, their clergy, to guide them, and this is an opportunity to get that conversation going. What is the right thing to do?"

Jan Bentz and Ann Schneible contributed to this report