Brittany Maynard knows exactly when she plans to die.
Earlier this year, when the 29-year-old UC Irvine graduate found out she had terminal brain cancer and six months to live, she set a death date – Nov. 1.
On that day, a Saturday, she plans to be upstairs, in her own bed, listening to soft music. She’ll be with her husband, mother, stepfather and best friends. At some point, she will drink a cup of water infused with a physician-prescribed drug and drift into a deep sleep from which she does not plan to wake.
But before she could feel secure in those plans, Maynard and her family had to move from Northern California to Oregon – one of three states in the nation to pass the Death with Dignity Law, which gives terminally ill individuals the choice of assisted death.
Maynard is part of a tiny group. In the 20 years since Oregon made assisted death legal, only a handful of people have moved to the state specifically to end their lives, say people who track assisted death in Oregon.
Maynard has made a video about her situation. In it, she talks about her diagnosis, her decision to relocate to Oregon and her impending death. The video has gone viral, and as of Wednesday it had more than 7.5 million views.
The elementary school teacher is proud to have become, in her last days, one of the most powerful proponents of the Death with Dignity law.
She has, really, just one regret.
“I don’t want to die. There is not a single suicidal cell in my body.”
DIFFICULT YEAR
Maynard got married two years ago. At the same time, she began having headaches, initially diagnosed by a neurologist as migraines.
But during the last New Year’s holiday, a severe headache sent Maynard to the hospital. Brain scans revealed a tumor. It was diagnosed as brain cancer, and she was told she had about 10 years to live.
In the spring, about three months after her diagnosis, doctors saw that the tumor had grown. She had stage 4 glioblastoma and a new prognosis – about six months to live.
Maynard faced a decision. She could opt for hospice care, which offers treatment for pain but no significant attempt to beat back the disease, or she could accept palliative care, which focuses on providing patients with relief from the pain and stress of a serious illness while allowing them to pursue treatment options.
She chose a third option. She and her husband would move to Oregon, the first of three states (Washington and Vermont are the others) where physician-assisted death is legal.
To qualify in Oregon, patients must be 18 or older, capable of making health care decisions and suffering from a terminal illness that will lead to death within six months. Under the law, two physicians must determine whether these criteria have been met.
You also have to be a resident of the state of Oregon.
Maynard, if she moved from her most recent home, San Francisco, could die in the time and manner of her choosing.
“I extensively researched how my disease would take me,” she said, responding via email this week because of her frail condition.
“I knew it was going to be very painful and potentially prolonged, since my body is young and healthy.”
Still, Maynard said, leaving for Portland was challenging. Her husband had to take a leave of absence from his job. Her parents had to relocate from their home in Southern California.
“Nothing about this journey has been easy,” she wrote. “But, we were prepared to make these sacrifices.
“We would’ve done it for anyone in our family,” she added.
“To limit the suffering of a loved one.”
TOO EASY?
The Death with Dignity Act was approved by voters in Oregon in 1994. The law went into effect in 1997. A similar law was passed in Washington in 2008 and in Vermont in 2013. Medical aid and dying is authorized through judicial action or court cases in Montana and New Mexico.
In California, voters rejected a ballot initiative to legalize assisted death. And from 1995 to 2008, lawmakers unsuccessfully tried four times to pass bills relating to the issue.
Opponents of the Death with Dignity law say assisted dying raises a number of serious and potentially dangerous issues.
“When you combine assisted suicide with a profit-driven health system, that’s a deadly mix,” said Marilyn Golden, a senior policy analyst at the Berkeley-based Disability Rights Education and Defense Fund.
Golden gives the example of Oregon cancer patient Barbara Wagner, who she says was refused costly doctor-prescribed chemotherapy by her insurance company. But Golden said insurance did cover the $300 cost of the lethal drug.
“Insurers are under pressure to deny life-sustaining treatments that could cost thousands of dollars when they have this much cheaper option,” Golden said.
Golden believes the Oregon law lacks accountability because it doesn’t prevent abusive family members or heirs from steering patients to assisted death.
“Once the drug is prescribed, there are absolutely no controls,” she said. “There is no accountability, no monitoring of abuse and no oversight.”
The law also does not require that patients be evaluated for serious issues such as depression, a practice that Golden describes as dangerous.
A CHOICE
For proponents, such as the Rev. Ignacio Castuera, a United Methodist minister in Claremont, assisted dying can be viewed as an expression of love – to help an individual end pain and suffering.
He said it is important to distinguish between suicide and assisted dying.
“In suicide, there may be anger, emotional pain or even vindictiveness involved,” said Castuera, a board member for Denver-based Compassion & Choices, an organization that advocates for the Death with Dignity law.
“But in Brittany’s case, and in the case of others who are terminally ill, it’s about an unwillingness to confront the pain and make their exit on their own terms. The loving thing to do is be supportive.”
George Eighmey, a board member of the Death with Dignity National Center in Oregon, said the decision always rests in the hands of the patient.
“When they get the prescription, all it means is they have the choice,” he said. “Whether they follow through with it or not is their decision alone.”
Eighmey said he has been present during patients’ last moments at their request for support. He said he gets a number of last-minute questions: How will I die? Can I swallow it with alcohol? How fast should I drink it?
Once the drug is consumed, the patient falls asleep in about five minutes. Death typically comes 20-60 minutes later.
Eighmey believes people who take the drugs always know when they are ready to go.
“They know because their suffering has become unacceptable. They’ve become detached from the world. Nothing interests them any more – trips, the news, nothing.”
Maynard picked Nov. 1 so she could celebrate her husband’s birthday at the end of October.
“Unless my condition improves dramatically, I will look to pass soon thereafter,” she said. “When my suffering becomes too great, I can say to all those I love, ‘I love you; come be by my side, and come say goodbye as I pass into whatever’s next.’
“I can’t imagine trying to rob anyone else of that choice.”
Contact the writer: 714-796-7909 or dbharath@ocregister.com
