The normalization of suicide - the Brittany Maynard story

Much has been written and said - especially in the USA about the case of Brittany Maynard. 

Brittany Maynard is a 29 year old Californian woman who was diagnosed with a brain tumour - stage 4 glioblastoma - and told she had only six months to live. She has decided to commit suicide under the Oregon assisted suicide provisions on the 1st of November - days after her husband's birthday.

Brittany Maynard's circumstances are poignant and everyone expressing reservations about her intended actions and that she is being co-opted as the face of assisted suicide campaigns in the USA has acknowledged this. It is not as though those who oppose assisted suicide are not aware of what her prognosis may mean. What opponents of her decision have been clear about is that her public advocacy has serious negative implications for others in similar circumstances, for disabled people and for society's attitude to suicide generally.

One of America's best known palliative care physicians, Dr. Ira Byock, has been very public in his concerns about this case. In a recent statement on his website, Dr. Byock made the point that the real conversation should be about the parlous state of medical care in the USA today:

Giving doctors the authority to write lethal prescriptions does not fix any of the deep-seated deficiencies of medical education, perverse financial incentives, and woefully inadequate nursing home staffing that contribute to suffering for many thousands of people.

Physician-assisted suicide fixes none of these. Instead, it is a sad capitulation to our failures as a health care system and society.

Dr. Byock appeared on a number of US talk back programs in recent weeks in opposition to the head of the former Hemlock Society (now 'Compassion and Choices') Barbara Coombs Lee. Diane Coleman, CEO of Not Dead Yet USA and John Kelly, director of Second Thoughts rose to the defence of Dr Byock in a recent media release. This is worth reproducing here en block:

"'Dr. Byock urges attention to the crying need for high quality, patient-centered care that supports the value and dignity of dying people,' said Diane Coleman, president of Not Dead Yet. 'When I reach the terminal stages of my progressive neuromuscular disability, I hope that I will have a doctor like him.'

"What disabled people see is the likelihood that what is now offered to terminally ill people to prevent suffering will get extended to disabled people who may experience similar suffering. During the Diane Rehm Show, Byock raised one of the disability community's concerns as follows: 'And I actually would love to hear from Barbara what you say to somebody like Brittany who simply is suffering at that level but isn't terminally ill? Do you say to them, we can't help you because you don't -- you fall outside of the laws and the regulations of Oregon?'

"Coombs Lee usually says that her organization's goal is Oregon-style laws for people with a terminal diagnosis, but at a recent Connecticut forum, she affirmed a broader agenda as reported in CT News Junkie: Coombs Lee also said the legislation would exclude people with dementia and cognitive declines, since they could not make the choice for themselves. 'It is an issue for another day but is no less compelling,' she said.

"In addition, Coombs Lee's organization promotes VSED (voluntarily stopping eating and drinking) as a peaceful way to die that is legal in all states, whether or not the person is terminally ill. 'Their articles and materials urge doctors and families to cooperate with VSED,' said Coleman, 'which demonstrates a broader policy agenda than the current media focus.'

"However, disability concerns go beyond the strictly medical issues that affect old, ill and disabled people. 'Most people don't realize that people with disabilities are two to four times more likely to be abused than our nondisabled peers,' said John Kelly, director of Second Thoughts. 'And not enough people have heard about the rising rates of elder abuse, or know that the primary perpetrators are family and caregivers. That's the real world context for these ill-conceived laws.'

"Assisted suicide laws may appear to offer patient rights, but their actual provisions grant blanket legal immunity to physicians and other involved participants. Even when the law's criteria are not met, a simple claim of 'good faith' by the doctor or family member confers legal immunity. Once the drugs are obtained by the patient or family, the Oregon law takes no further interest. There is no requirement that an independent witness observe the death to ensure that the lethal dose is actually self-administered, or even that there is consent. Barbara Coombs Lee's claim of 'transparency' is completely false.

"Legalization of assisted suicide often looks acceptable when the focus is solely on an individual. However, not every terminal prognosis is correct, not everyone's doctors know how to deliver expert palliative care, and not everyone has a loving husband and family. A closer examination of the issue reveals the immense harm legalization poses to vulnerable people as well as society as a whole."

A blogger who posts under the name of 'Angry Black Woman' leaves us in no doubt about the effect the Maynard story has on people living with disability:

"What Brittany Maynard plans to do is tragic enough, but it is all the more tragic to the disability community because it is subtle coercion telling us that we not only have the right, but the duty to die. That's what it's all leading to - these physician assisted suicide laws and the belief that people with disabilities who take their own lives are heroes - it is leading us down the path to the day when we won't have a choice - we'll have laws on the books requiring us to die - unless we can stop this notion that us killing ourselves is an act of bravery, selflessness or heroism. To get to that, we have to abolish the world view that it's better to be dead than disabled."

Another disability advocate, Marilyn Golden, summed up the case against assisted suicide:

"Assisted suicide is a unique issue that breaks down ideological boundaries and requires us to consider those potentially most vulnerable in our society.

"All this means that we should, as a society, strive for better options to address the fear and uncertainty articulated by Brittany Maynard. But if assisted suicide is legal, some people's lives will be ended without their consent, through mistakes and abuse. No safeguards have ever been enacted or proposed that can properly prevent this outcome, one that can never be undone.

"Ultimately, when looking at the bigger picture, and not just individual cases, one thing becomes clear: Any benefits from assisted suicide are simply not worth the real and significant risks of this dangerous public policy."

As Canadian journalist Andrew Coyne recently observed; what we're really talking about here, in terms of public policy, is the normalization of suicide. The rest of the detail in the Maynard story is just another emotive wedge against existing prohibitions.

Further reading on this subject:

If Suicide a Right Must be Open to All
Assisted suicide cannot promise you a peaceful or painless death
Brittany Maynard - a sad story of vultures and manipulation