Right now, twenty-nine-year-old Brittany Maynard is standing on a virtual window ledge, while the crowd below shouts its support for her “right” to jump. She says November 1 will probably be the day she kills herself.
Brittany is a beautiful young newlywed. Tragically, Brittany has a brain tumor that is expected to end her life in the near future. She and her family have moved to Oregon so she can legally take a doctor-prescribed lethal overdose, to avoid the suffering she expects as she approaches death.
Maynard has also joined with “Compassion and Choices” to promote their campaign to legalize physician-assisted suicide throughout the United States. In the last few weeks, C&C’s video telling her story has gone viral and been picked up by news organizations all over the world, including People magazine.
Groups supporting physician-assisted suicide now call the promotion of Ms. Maynard’s story “a tipping point” in their decades-long push to gain public support for changing laws.
A Different Point of View
I am a registered nurse with forty-five years of experience caring for many suicidal people, both personally and professionally. I also lost a beautiful, physically healthy thirty-year-old daughter five years ago to suicide. After a sixteen-year battle with substance abuse, my daughter committed suicide after visiting suicide websites and reading Final Exit by Derek Humphry, the founder of the Hemlock Society (the former name of Compassion and Choices). The medical examiner called my daughter’s suicide “textbook Final Exit.” It was not an easy death for her, or for those of us who loved her.
While I am sure Ms. Maynard is sincere and well-meaning, campaigns like hers can have a devastating impact on vulnerable people like my daughter, and be misused to promote a one-sided debate on legalizing assisted suicide.
Unlike most suicides, assisted suicide involves two parties. It’s worth looking at the impact of this agenda on both of them.
Groups promoting assisted suicide routinely dismiss suicide victims like my daughter as collateral damage, while some even provide how-to instructions that can be accessed by any depressed person. The central focus of the legal agenda is the frail elderly. Consistently, the median age of people taking their lives under Oregon’s assisted suicide law has been seventy-one. Less than 1 percent are under thirty-five years old. And there is a generation gap on this issue. As the Newark Star-Ledger has reported: “A recent poll showed that people over 65 oppose assisted suicide by a 12-point margin while those under 35 support it by 18 points.”
Brittany Maynard’s position is consistent with that of others in her age group. Yet the elderly—the people overwhelmingly affected by these laws—say “No.” They know how hard it can be to convince younger generations that they still have lives worth living and worth respecting. Others who strongly disagree with C&C are the people with disabilities who belong to groups such as Not Dead Yet. Those with disabilities face a great deal of bias from able-bodied people who seem to think people with their conditions are “better off dead.”
Ironies abound in this debate. For example, when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is often considered as a sign of stress or mental disorder, while a sick person's wish to die is considered an understandable and even courageous decision. How do we reconcile the two views that a lethal overdose is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent terminally ill or disabled person?
Healing or Harming: What about Those Who “Assist”?
Then there are the medical professionals being called on to “assist.” Few people would seriously consider legalizing friend- or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. So the goal is to lend this act professional respectability by promoting physician-assisted suicide—or, more accurately, medically assisted suicide, since nurses also are necessarily involved when the assisted suicide occurs in a health facility or home-health situation. Many people are not aware that groups such as C&C oppose conscience rights for medical professionals like me, as well as for hospitals that believe that helping to terminate a life is unethical.
Medical groups such as the American Medical Association, the American College of Physicians, and the American Nurses Association oppose legalization of physician-assisted suicide. The AMA has said that allowing physicians to participate “would cause more harm than good,” observing that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
When I worked as a hospice nurse years ago, our guiding principle was that we neither prolong nor hasten dying. I felt great satisfaction helping my patients and their families live as fully and meaningfully as possible until natural death. We nurses not only made sure that our patients were physically comfortable—we also helped with spiritual, emotional, and practical concerns.
Unfortunately, with the help of the media, assisted-suicide groups have had some success trying to convince both medical personnel and the public that natural death is agony and that medically assisted suicide should be a civil right. Yet this drive for totally controlling death profoundly changes the medical system, even for people who may recover or who may live with disabilities—and for patients who would never consider suicide.
The Ethical Impact
Society has long insisted that healthcare professionals adhere to the highest standards of ethics, as a protection for society. Without that clear moral compass, it has been said, the physician is the most dangerous man in society. The vulnerability of a sick person, and the inability of society to monitor every healthcare decision or action, are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Erasing the bright line doctors and nurses have drawn for themselves—which separates killing from caring—is a decision fraught with peril, especially for those who are most vulnerable.
As a nurse, I am willing to do anything for my patients—but I will not kill them nor help them kill themselves. In my work with the terminally ill, I have been struck by how rarely such people say anything like, “I want to end my life.” I have seen the few who do express such thoughts become visibly relieved when their concerns and fears are addressed, instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.
This should not be surprising. Many of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or a relative, who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate, or desperately discouraging? The terminally ill or disabled person is no less vulnerable than the rest of us in this respect. And to think that an entire society, through its laws, can give such a response—to you, and to anyone with a similar health condition—may be the ultimate form of suffering.
Do assisted suicide supporters really expect us doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on our ethics or our empathy? Do they realize that this reduces the second patient’s will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves?
Stories like Brittany Maynard’s can feed into a society that is fascinated by tragic love stories, but does not understand how such stories are used as propaganda to promote a dangerous political agenda that can affect us all—and our loved ones.
Personally, I will continue to care for people contemplating suicide or who have made an attempt regardless of their age, condition, or socio-economic status. I reject discrimination when it comes to suicide prevention and care. I hope our nation will do so as well.
Nancy Valko, RN, ALNC, is a longtime writer and speaker on medical ethics issues who recently retired from critical care nursing to devote more time to consulting and volunteer work. She is also a spokesperson for the National Association of Pro Life Nurses.