A young woman named Brittany has engaged people in a national conversation about dying in America. She was diagnosed with glioblastoma, which is a type of brain cancer, and had no options for cure. She anticipated a long and horrible death, and chose instead to move to Oregon where she had access to physician-assisted death. She ended her life on November 2, 2014.
There has been much debate about this topic over the past several weeks, with strong voices from both sides making passionate arguments. Rather than focus on the legality and legislation of physician-assisted death, I think it is more important to look into how we support individuals with serious and terminal disease through the use of palliative care and hospice.
Hospice workers take care of people who are seriously ill every day. Embedded within the hospice philosophy is the belief that death is an integral part of the life cycle. We help patients and families through what can be a very difficult period in their lives, but what can also be a time of transcendence, of reconciliation and growth for the individual and his or her family. It is common for terminally-ill patients with advanced disease to think about dying, and some may express a wish for death to come sooner. These requests often occur during times of physical or spiritual distress. These requests may also come from a strong fear of becoming a burden on loved ones or from a fear of losing control. Intensive palliative care which addresses the physical, spiritual and psychological aspects of suffering -- as well as provides caregiver support and resources -- can relieve this distress in the majority of individuals. Dignity can be preserved in more ways than by simply taking a pill to speed up the dying process.
Given that there is already confusion and suspicion by many patients and families that morphine is used to speed up death at the end of life, I feel the need to explicitly state that hospice philosophy does not endorse or practice the intentional hastening of one’s death through physician-assisted death.
Most people, like Brittany, don’t want to die. Some pursue every avenue to try to avoid death despite having a terminal disease. This leads to more hospitalizations, more testing, more treatments, and less time to focus on what matters. Doctors are often guilty of encouraging this path, sometimes not recognizing that there is another way, and sometimes just afraid of having the conversation with the patient. It is tragic that Brittany had this terrible disease. But because her doctors were honest with her about her prognosis, and she was able to hear it, she had the time to do what was important to her. She shifted her focus from the medicalized world of cancer treatments, to traveling and spending time with loved ones in the time she had left. Hospice supports this philosophy, and can often be instrumental in helping people reach important life goals in the last weeks or months of their lives.
I think what is more thought-provoking than Brittany’s decision about how her life would end are her words of how to live:
“The reason to consider life and what’s of value, is to make sure you’re not missing out. Seize the day. What’s important to you? What do you care about? What matters? Pursue that. Forget the rest.”
by Dr. Laura Patel, Medical Director
More about Brittany Maynard:
My right to death with dignity at 29 by Brittany Maynard, October 14, 2014 (CNN Opinion)
Terminally Ill Brittany Maynard: Why I'm Ending My Life in Less Than Three Weeks by Nicole Weisensee Egan, October 27, 2014 (PEOPLE)
Brittany Maynard, right-to-die advocate, ends her life by Jessica Durando, November 3, 2014 (USA Today)