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Death heeds an invitation

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After suffering from debilitating headaches for years, Brittany Maynard went to the doctor several months ago to see what was wrong with her. It turned out she had a brain tumor that required immediate removal. After surgery, she underwent a follow-up visit, only to find that the tumor had grown much larger than before, and was now considered a Stage 4 glioblastoma. It was just about the worst form of brain cancer one could be diagnosed with.

Prior to surgery, doctors had given Maynard a prognosis of several years more to live. After discovery of the tumor’s growth, however, they shortened Maynard’s life expectancy to only a few more months. Brain tumors of this type are, essentially, a death sentence for those who have them, and even aggressive treatment typically does no more than extend life expectancy from three months to 15 months. Even then, such treatment tends to bring with it potentially debilitating side effects and expose the patient to prolonged suffering.

Faced with this prognosis, Maynard decided that on Nov. 1, the day after her husband’s birthday, she would take a prescription medication and end her life, rather than endure acute suffering. To do this, she moved from California to Oregon, which has a Death with Dignity law that allows for physician-assisted suicide for patients such as Brittany, who seek to terminate their own life when faced with terminal illness. Washington, Montana, New Mexico and Vermont all have similar laws allowing for physician-assisted suicide.

On Nov. 1, Maynard made good on her plan and ended her life in her home, surrounded by a close circle of family and friends, one of whom was a physician.

In the months before she died, Maynard did two things. One was to travel extensively with her family and check off a number of items on her “bucket list,” including seeing the Grand Canyon. The other was to lend her story to the right-to-die movement, for which she became a highly visible proponent. Since the final passage of Oregon’s right-to-die law in 2013, more than 750 people have opted to end their lives when their death appeared to be inevitable and imminent. The average age of these suicides is 71.

The nature of Maynard’s terminal illness and her decision to end her life was not particularly unusual. That she was so young and photogenic, however, was, and she used that to promote the cause of letting people die on their own terms when their death appears inevitable and imminent.

Before she died, she issued a final statement through Facebook: 

“Goodbye to all my dear friends and family that I love. Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more. The world is a beautiful place, travel has been my greatest teacher, my close friends and folks are the greatest givers. I even have a ring of support around my bed as I type … Goodbye world. Spread good energy. Pay it forward!” 

The right to die, and physician-assisted suicide, is nothing, if not controversial. Oregon’s own right-to-die law has experienced numerous attempts to block or repeal the law. Physicians have sharply criticized members of their trade doing anything that would not prolong life. And while Maynard was given a terminal prognosis, there are those rare cases when patients with similar medical conditions have somehow defied the odds and survived, which calls into question whether Maynard’s decision was as logical as she professed.

Maynard did not consider her own actions to be suicide. At length, in interviews in various media outlets, she said that she did not actually want to die, nor was she depressed. She merely accepted that because of her disease that she would die, she would die soon, and that she would suffer extensively before she did. And even then, hers was a decision, she said, she spent no small amount of time making. 

Already the debate over her final action and the moral nature of it have begun the clamor that will echo around Maynard’s name for some time. This will be her legacy; how she spent her all-too-brief life and more importantly, how she decided to end it. How she died was meant to question our most fundamental assumptions about life, death and the decisions we make in between. In particular, Maynard has raised, once again, one of the most persistently difficult medical questions of our age: which is more important, the length of one’s life or the quality of it?

And yet, for all of that discussion, for all of the reasons Maynard gave for why her death is so much more different than what we might typically think of when we think of suicide…suicide remains precisely what she committed. And with that comes a very complicated conversation with everyone left behind once the suicide’s life is over.

There are those who will see Maynard’s suicide just like they would any other suicide, and decry the act as selfish, or one of weakness. Maynard should have fought to her last breath, so the thinking goes. Others will say that it was Maynard’s life to live, and that she was merely opting out of extraordinary suffering she could not avoid otherwise. This is the kind of discussion where there may be little middle ground, and what middle ground there is proves to be a most uncomfortable place to stand.

To say that those who commit suicide are cowards, or weak, is to ignore what drove the individual to that final, desperate measure. Those of us who witness a suicide or are left to make sense of its aftermath rarely are equipped to do so. In such a vacuum of certainty, passing judgement on the departed feels easy and natural. But it does little to make sense of the loss, or ease the pain it has left behind. Far better to try to understand why people like Brittany Maynard did what they did, even while knowing that we probably never will.

We pass judgement on those who choose to end their own lives because it is such an inversion of that most fundamental drive — to live. Every day, when we awake, we ask ourselves silently if we wish to live or die, and our answer is so automatically, “to live,” that we almost don’t even know that we are asking ourselves a question. But there are those for whom life has become something where that question becomes more and more difficult to answer, and so the answer “to live” becomes more and more a doubtful one. Sometimes, we can help those in need to find a desire to live. Sometimes, we cannot. Suicide does many things to those who witness it. Among other things, it displays in stark terms that ultimately, we only have so much control over the things around us. And that is a tough thing to face.

Ultimately, if there is a single truth that unites everyone touched by Maynard’s actions, it is that all life must end. And in all life, there must be suffering. Somewhere within all of that, there lies an endless diversity of thresholds for how suffering is too much to expect to bear, and how much right one has to invite one’s own demise.

Brittany Maynard’s death shines a light on all of that, and yet, simplifies none of it. She is gone, but leaves behind no smaller the moral quandary of a society at odds over how best to face our own mortality. Maynard’s disease only strikes three or four people out of every 100,000. The rest of us should consider ourselves lucky that however we face our final moments, we do not do it under the shadow of a choice that nobody ever comes into this world prepared to make.


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