Public opinion scholars often complain that interest groups short-circuit the deliberation process by framing complex issues in overly simplistic, emotionally appealing ways. These kinds of framing effects are generally frowned upon in academic literature, because they can distract busy citizens from the most important issues related to a topic. By substituting flash for substance, savvy consultants can manipulate public opinion to win important changes in public policy.
From an issue-framing perspective, Brittany Maynard’s sudden emergence as the face and voice of the campaign to legalize assisted suicide could be considered a textbook example.
Unless she changes her mind, Maynard intends to commit suicide by ingesting a lethal dose of prescription drugs she obtained from her doctor. Maynard, a twenty-nine-year-old newlywed suffering from terminal brain cancer, is using her recent celebrity to promote the legalization of assisted suicide in the forty-five states that currently ban it.
Maynard’s story resonates. In a culture that idolizes youth and beauty, her terminal diagnosis is an act of injustice in search of a solution. Those who support assisted suicide frame the problem as one of law instead of medicine: we already have the necessary medicine to “help” those who want to commit suicide. Helping Maynard doesn’t mean taking an ice bucket challenge to fund a cure. It requires changing the law so she and others can beat a disease to death’s door.
It’s a clever framing tactic. Gone are any considerations about the impact legalizing assisted suicide would have on vulnerable populations such as the poor and the disabled. Not a word is mentioned of how normalizing assisted suicide would alter personal, familial, and professional expectations about when someone should choose death. The issue is boiled down to this: I’m dying of cancer. I want to die now. You have no right to refuse me.
In a society dominated by individualism and relativism, who needs to deliberate? No one wishes to endure a long and painful death, and if modern medicine can’t come to the rescue, then surely the law should permit a competent adult to end her life early—even if it means enlisting the aid of a doctor.
And yet, decriminalizing a doctor’s liability for helping a patient kill herself is not a top priority for the vast majority of Americans. That’s why a young, telegenic presence such as Maynard is needed to force assisted suicide onto the agenda. Her story is both tragic and attractive, making it an ideal frame of reference for groups pushing to expand the so-called “right to die.”
Attracting Attention, Money, and Momentum
A look at the organization behind Brittany Maynard’s sudden popularity indicates how her story is being used as a campaign tool.
A resident of California, Maynard moved to Oregon with her husband to take advantage of the state’s “Death with Dignity” law, which is the first of its kind in the United States. Since her October 14 op-ed for CNN went viral, Maynard has shared her name and life history on a slick website designed to attract one million signatures to a petition praising Maynard for having the “courage” to kill herself. Tellingly, a small notice at the bottom says that by signing the card the signatory agrees to receive emails from the most active right-to-die organization in the United States.
Maynard’s website is actually “An initiative of Compassion & Choices,” according to the landing page’s banner. Further down, Compassion & Choices is described as “the oldest and largest organization working to improve care and expand choice at the end of life,” operating “many programs and services.”
True, Compassion & Choices is the oldest and largest organization pushing to legalize assisted suicide. Its current form is the most recent iteration of Derek Humphry’s (now disbanded) Hemlock Society. In the interim, the organization briefly did business as Compassion in Dying. Its programs and services primarily include counseling people on how to commit assisted suicide.
As can be seen from its advocacy work, Compassion & Choices does not exist to improve care. It exists to help people avoid getting the care they need by killing themselves.
Under its various guises, Compassion & Choices failed to persuade the United States Supreme Court to find a right to die in the US Constitution. It then targeted the states. In Montana and New Mexico, the group secured piecemeal judicial victories that keep the door open for further expansion. Though at least 140 attempts have been made to get state legislatures to approve assisted suicide laws, only Vermont in 2013 agreed. In the last year alone, legislative bodies in Massachusetts, Connecticut, New Hampshire, and New Jersey have all refused to go along.
From a wins and losses standpoint, Compassion & Choices has had its greatest success in statewide ballot campaigns. However, success is relative here, since only Oregon (1994, 1997) and Washington (2008) decided to legalize assisted suicide. States voting “no” include California (1992), Michigan (1998), Maine (2000), and Massachusetts (2012).
In none of these campaigns, though, did Compassion & Choices have a spokesperson as young, healthy, and attractive as Brittany Maynard. The chance to frame support for assisted suicide around such a sympathetic figure is an opportunity too good to pass up.
Indeed, the website Compassion & Choices maintains for Maynard is actually a vehicle to solicit donations for “legal strategies, ballot measures and legislative efforts to make death with dignity accessible state-by-state.” As a volunteer advocate for Compassion & Choices, Maynard says her ability to raise money for this purpose is a defining part of her legacy.
Since Maynard’s op-ed was published, Compassion & Choices claims that a video describing her decision to commit suicide has been viewed over five million times. “That’s 5 million people who now know the importance of access to death with dignity,” gushes the site, before it asks readers to share the video on their social networks. All of this is accompanied by egocentric slogans such as, “My life. My death. My choice. I support Brittany Maynard and all Americans’ right to choose #DeathwithDignity.”
In sum, Brittany Maynard is helping Compassion & Choices use her tragic experience as a recruitment tool to make assisted suicide more available. The issue is presented as a choice, not a duty.
But what about the people left out of Maynard’s frame?
Hastening Death via Medicaid Policy
Disability rights organizations are acutely aware of the danger assisted suicide poses to their community. Not Dead Yet and other disability organizations argue that legalizing assisted suicide will enshrine in law the notion that those with disabilities are justified in hastening their deaths because their lives are substandard. Moreover, once a legal definition of substandard life is established, it matters little whether the final decision to die is made by the individual, a family member, a medical professional, or even an actuary employed by an insurance company or a government agency.
This is especially true when one of the main arguments behind assisted suicide is the idea that costly patients are a burden to their families and society. Thus, the implication goes, terminally ill patients have a duty to commit suicide in order to avoid burdening others.
Back in May, Not Dead Yet flagged a little-noticed grant announcement in a New York State Medicaid brochure. (Medicaid is a joint federal-state program that funds medical care for the poor and the disabled.) The purpose of the grant is to entice hospitals serving large numbers of Medicaid patients to test ways of reducing “unnecessary hospitalizations,” and thus expenditures. Participating hospitals are required to select from third-party vendors preselected by New York.
One of the vendors is “The Conversation Project.” Its primary mission is to certify hospitals and other healthcare providers as “Conversation Ready,” which means training personnel to initiate conversations about end-of-life treatment with people who are currently healthy. The stated objective is to get people talking about which medical procedures they do and do not want, and making those wishes known to family members in a legal document.
The part that troubles Not Dead Yet, however, is the way The Conversation Project stacks the deck in favor of refusing care. In its training materials, The Conversation Project includes this eye-opening line:
You’ll see that this isn’t really about dying – it’s about figuring out how you want to live, till the very end.
According to Not Dead Yet, “The Conversation Project goes even further in specifically eliciting fears of long-term disability and translating them into decisions to forgo life-saving treatment.” As proof, Not Dead Yet highlights this set of questions from the group:
What to talk about:
Are there circumstances that you would consider worse than death? (Long-term need of a breathing machine or feeding tube, not being able to recognize your loved ones)
What kinds of aggressive treatment would you want (or not want)? (Resuscitation if your heart stops, breathing machine, feeding tube)
When would it be okay to shift from a focus on curative care to a focus on comfort care alone?
As Not Dead Yet explains, “There is no indication that the need for such interventions could be either short term or permanent. There is no information on the tens of thousands of disabled individuals who are currently living a fulfilling life while permanently using these devices.”
Instead, once again the average person is exposed to a strategically crafted frame that points to only one logical conclusion: I’d rather be dead.
Assisted Suicide Deserves Deliberation, Not Catch Phrases
Brittany Maynard may not be aware that New York State is trying to reduce its Medicaid spending by convincing people they are better off dead than disabled.
But by associating with Compassion & Choices, she has become the most visible spokesperson for a movement that markets death in many different arenas. It’s a movement with members intending to force a conversation about end-of-life decisions that always seem to terminate in a premature death.
But simply having a conversation about a delicate subject such as dignity at the end of life does not, by itself, ensure that the right principles will be discussed. And, as right-to-die advocates have shown repeatedly, they are willing to employ all kinds of euphemisms to distract well-meaning people from what assisted suicide really is: the intentional killing of a vulnerable person.
What’s needed as we deliberate about assisted suicide is not a razor-thin focus on the exceptionally rare case of a beautiful young woman diagnosed with a particularly aggressive type of cancer. Instead, we need a full and robust discussion about whether it is possible, in principle, to stop one person’s right to die from becoming another’s duty to die.
Ashton Ellis is a doctoral student in political science at Claremont Graduate University. Previously, he taught at Pepperdine University’s School of Public Policy.