Brittany Maynard and the Ethics of Assisted Suicide

Introduction

The case of Brittany Maynard is a fairly textbook one when it comes to discussions centering on doctor-assisted suicide and euthanasia in general. There are indeed cases where the death of a patient is a certainty. However, the devil is in the details: some people believe they must suffer through their final days, while others — such as Brittany Maynard — feel they should have at least some control over their own destiny. These people feel that they should be able to die "with dignity" and on their own terms, rather than having to wait for death to come and for suffering to mount as that date approaches.

However, there are medical, legal, and ethical considerations that must be taken seriously when it comes to someone choosing suicide and involving one or more other people in the process. While "death with dignity" sounds legitimate to many, there are many layers to the issue when it comes to both the person wishing to die and the people involved in the process.

Medical and Legal Dimensions of Assisted Suicide

Suicide can be a very difficult and messy affair. Quite often, people use guns or other extreme means to ensure a quick death. While facilitating death for most people seeking relief is widely seen as improper, many who carve out any exception tend to do so for people who provably have terminal disorders that will end their lives painfully and, quite often, within a fairly short period of time. Such was the case with 29-year-old Brittany Maynard. Diagnosed with a stage four brain cancer known as glioblastoma, her doctors told her she had less than six months to live, and that those months would involve extreme pain. She moved to Oregon to take advantage of that state's law allowing physician-assisted suicide through the use of a lethal dose of painkillers. Prior to her pre-planned death, she was experiencing increasingly frequent and severe seizures, as well as headaches, neck pain, and stroke-like symptoms. She was quick to say that even though she planned to end her life, it was the cancer that was killing her (Scott, 2014).

Even given the fairly clear-cut nature of this case, many suggest that the situation is fraught with complications, and that those who participated in helping Ms. Maynard die committed medical, ethical, or legal lapses. When it comes to medical lapses, the most commonly cited concern stems from the general credo followed by all medical professionals: "do no harm." However, one must define harm in this context. Some suggest that forcing Brittany Maynard to suffer with her cancer until it killed her would itself constitute harm, while others argue that deliberately ending a patient's life — for any reason — is, in most situations, tantamount to murder (Bahan, 1997).

The United States has maintained a general aversion to one person intentionally killing another. In almost all instances, such an act is considered murder. If a death occurs due to an intent-laden act but the death itself was not provably intended, it is typically treated as manslaughter. This creates legal issues for doctors or other professionals involved in assisted suicide, even in states like Oregon where laws allow participation without fear of prosecution. While withdrawing life support from a patient with no brain function has not generated much legal controversy in general, the case of Terri Schiavo demonstrates that significant gray areas exist. The only real options in Schiavo's situation — euthanasia aside — were to withdraw the feeding tube (which did eventually happen) or allow her to remain in a vegetative state indefinitely. Ms. Maynard, by contrast, was lucid and made a conscious choice to end her life (Printz, 2015).

Ethical Considerations and Professional Standards

When it comes to the ethical implications of assisted suicide, a number of dimensions must be considered. Ethics in this context falls into two basic types: personal ethics and professional or medical ethics. Generally speaking, the two are not supposed to intersect, as doing so can create serious problems. However, some overlap is unavoidable. For example, Oregon's law allows doctors to participate in a patient's assisted suicide but does not require it. A doctor who is unwilling to assist may refuse and defer to a colleague who is prepared to help under the law. Much the same principle applies to abortion: following the precedent of Roe v. Wade, women were permitted to obtain abortions if they chose, but doctors were not universally required to perform the procedure — only certain physicians were trained for it, making it a specialty in its own right (Huxtable, 2014).

The law in Oregon and other jurisdictions with assisted suicide statutes permits doctors to assist in a patient's death. However, this does not dissolve the ethical tensions that exist within the medical community and the broader public. Some hold that suicide — assisted or not — is always a sin, a crime, or both, and that the same moral weight applies to anyone who assists. Even if doctors who legally participate in assisted suicide feel their consciences are clear, many others — both physicians and laypeople — argue that doctors should not have the option at all, and that assisting in death should remain illegal regardless of circumstances.

That said, there is no universal federal standard in the United States, and the federal government has largely deferred to the states on this matter — not unlike the approach taken with medical and recreational marijuana laws in states such as Washington and Colorado. Across the board, ethical judgments — both personal and professional — vary widely, though the overall trend appears to be moving toward allowing individuals to make their own choices, including through the ballot box. Oregon remains one of the few places in the country where physician-assisted suicide is legally permitted (Huxtable, 2014).

Conclusion

In the end, the broader lesson from the Maynard case is that people should have advance directives and make their intentions unambiguously clear through wills and other legal documents. The Terri Schiavo case could have been far less contentious had she possessed an advance directive; the absence of one is precisely what allowed her husband and her family to become locked in a prolonged legal and emotional battle over her fate. Concurrently, people need to respect the boundaries of others when it comes to assisted suicide. Even if someone believes the practice is morally repugnant, there is no genuine wrong being committed when all parties involved are consenting adults acting within the law.

References

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Campbell, C. S., & Black, M. A. (2014). Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. Journal of Pain and Symptom Management, 47(1), 137–153. doi:10.1016/j.jpainsymman.2013.02.024

Caplan, A. (2014). Bioethicist: Brittany Maynard's death was an ethical choice. NBC News. Retrieved June 10, 2016, from http://www.nbcnews.com/health/health-news/bioethicist-brittany-maynards-death-was-ethical-choice-n239966

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Printz, C. (2015). Death with dignity: Young patient with brain tumor puts a face on the right-to-die movement. Cancer, 121(5), 641–643. doi:10.1002/cncr.29283

Scott, A. (2014). Should terminally ill patients have a right to die? U.S. News & World Report. Retrieved June 10, 2016, from http://www.usnews.com/opinion/articles/2014/11/04/should-brittany-maynard-have-had-the-right-to-doctor-assisted-suicide

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