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This Woman Will Take Her Own Life November 1. Our Healthcare System Let Her Down.

The Brittany Maynard Fund/Compassion & Choices

The story is getting a lot of attention online, and it’s not hard to see why. It’s about Brittany Maynard, a young Oregon woman with stage 4 glioblastoma, a malignant brain tumor. There is apparently no cure for this awful disease. Her expected lifespan is measured in months rather than years at this point.

Maynard has decided to end her life this November 1, two days after her husband’s birthday. She is a vivacious woman who seems to love her life, and has achingly so much to live for at the age of 29. She wants to avoid a terrible death, and to control the manner of her own passing. She is packing as much joy as she can into this final period of her life. She is not suicidal in any way. She has now made a series of affecting videos and interviews on behalf of Compassion and Choices, an organization that supports expanded access to assisted suicide for patients with life-ending illnesses. She and her family moved to Oregon to gain access to the state’s Death and Dignity Act, “which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.”

It would be presumptuous of me to question this very personal decision in a tragic situation. Like everyone else, I can only wish Brittany Maynard the best, however she conducts her final days.

I have no firm policy opinion about death-and-dignity laws, either. Speaking with wonderful people who face serious cancers, and speaking with people who have actually provided end-of-life care—including my wife Veronica who has worked with desperately-ill children as a clinical nurse specialist—I constantly hear the same refrain: the mass appeal of assisted suicide reflects an incredible failure of our health care system.

We do not provide proper palliative care. As Atul Gawande relates in his beautiful new book Being Mortal, we do not reliably address people's deepest needs when they face life-ending or life-altering illnesses of many kinds. We can do a better job of relieving people's symptoms and protecting them from pain. We can protect families much more effectively against catastrophic medical expenses and hard caregiving burdens. We can work more effectively to ensure that every patient can make the most of their remaining days. We can more effectively promise that someone will die with dignity without the need to take precipitous measures while they still believe they can.

The Institute of Medicine’s recent report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, provides many practical suggestions of how these challenges might be more effectively addressed. For example, Aetna expanded its hospice and palliative care benefit by allowing people to still receive curative therapies while enrolled in hospice, and by slightly relaxing its eligibility standards for hospice services.  Such “concurrent care” models allowing people to receive improved attention to quality of life issues and symptom relief, even as they might choose fairly aggressive treatment of a life-threatening or life-ending condition.

If we did these things, we would still face the inherent tragedy of a unique human life reaching its end. Yet we would do so more humanely, with less fear about what will actually happen when we become disabled or seriously ill, let alone what will happen in our actual final days. Assisted suicide will always pose difficult ethical and policy issues. Yet the issue would be less pressing, even as we confront the heartbreak of losing wonderful people such as Brittany Maynard when she has so much left to give, so long before her time. We spend $2.9 trillion on American medical care. We can do this better.