Dear Brittany Maynard, I Feel You, Cancer is Tough
Dear Brittany Maynard, I Feel You, Cancer is Tough
November 8, 2014
By Nancy Valko, RN ALNC (Advance Legal Nurse Consultant)
Spokesperson, National Association of Prolife Nurses (www.nursesforlife.org)
I recently wrote an article “I Lost My Daughter to Suicide: A Nurse’s Response to Brittany Maynard’s Campaign for Assisted Suicide” hoping that there was a small chance of convincing her or other vulnerable people that suicide (assisted or unassisted) is never the answer to any problem.
Now we know that Brittany did kill herself by assisted suicide on Nov. 1 with her family and new husband watching.
Was it worth trying to save Brittany and other suicidal people from suicide? Will legalizing assisted suicide lead to a better and more compassionate society?
WHY TRY TO SAVE A SUICIDAL PERSON?
In 2009, after my beautiful, 30 year old daughter Marie died by suicide using a technique she learned from visiting suicide/assisted suicide websites and reading the book “Final Exit”, a fellow medical colleague remarked to me that he even questioned why we tried so hard to save suicide attempters when they “were just going to do it again anyway.”
I ignored the massive insensitivity of that remark and told him that studies have shown that only 10% (or less in some studies) of suicidal people ever go on to complete a suicide.”
I also told him that I don’t regret one minute of the 16 years I spent trying to save my daughter Marie from substance abuse and despair. And although I was often frustrated, heartbroken and even angry at times during those years, I never stopped loving her unconditionally.
When Marie died, some people asked if I was relieved because Marie “was at peace and no longer suffering”. Of course not! The worst possible outcome for Marie and the rest of her family and friends was suicide. Although it was hard to watch Marie suffer with her demons, I would have spent the rest of my life trying to save her from suicide.
Personally and professionally as a nurse for 45 years, I have encountered many suicidal people. Some were terminally ill. But I found that even the few who were insistent about killing themselves revealed great fear and ambivalence. The will to live is so strong but these suicidal people were being overwhelmed with desperation, even when they were physically healthy.
I recall reading one woman’s story about how she attempted suicide multiple times but stopped when her brother said that he would stop her from suicide every time and any way he could. She said that his faith in the value of her life-even when she didn’t have it herself-convinced her to finally stop trying to kill herself. Obviously, “No” can be a life-saving word.
As Brittany Maynard admitted herself, she really didn’t want to die but, even though she still felt relatively well while planning her assisted suicide, she was afraid of possible future pain and debilitation.
The Oregon she moved to because of its’ law legalizing assisted suicide was the first state to pass such a law because it was sold to the public by groups like Compassion and Choices as a last resort to help terminally ill people end their lives because of intractable pain.
Ironically, the reality in Oregon now is that the three most frequently mentioned end-of-life concerns cited by people using the law are not about pain but rather “loss of autonomy”, “decreasing ability to participate in activities that made life enjoyable” and “loss of dignity”. There are lots of older people who could make the same complaints about their lives.
Where was Brittany’s assisting doctor when she died and was she even told about the so-called “safeguards” in Oregon’s law such as referrals for psychological or psychiatric counseling before she died? We will never know, especially because Oregon statistics and reporting on assisted suicide depend on secrecy and the assisting doctors’ willingness to self-report such cases.
ASSISTED SUICIDE IS STILL SUICIDE
The media coverage has been intense ever since Brittany Maynard announced her impending assisted suicide. The mainstream media fed the feeding frenzy by portraying Brittany’s situation as a tragic love story only relieved by Brittany’s stepping forward to act as a spokesperson for Compassion and Choices’ campaign to legalize assisted suicide throughout the US.
Criticism of assisted suicide itself was subdued in media outlets that rarely even reported the AMA’s, ANA’s and other professional organizations’ positions against physician assisted suicide. Some outlets even followed Compassion and Choices’ preference for using “death with dignity” terminology rather than the usual term “physician assisted suicide”. Suicide prevention websites and crisis help lines were never mentioned as a resource for any viewers who might be contemplating suicide themselves.
According to the World Health Organization’s publication “Preventing Suicide-A Resource for Media Professionals”, the media should “Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems” and “Provide information about where to seek help” among other recommendations. None of that was done in the weeks of reporting when Brittany Maynard was standing on a virtual window ledge while so many people shouted their support for her “right” to jump.
The Center for Disease Control (CDC) does not keep statistics on assisted suicide but according to Oregon’s annual reports on assisted suicide, there have been 688 assisted suicides since assisted suicide was legalized there in 1997.
In the meantime, more than 38,000 suicides were reported in the US by the CDC in 2010, making suicide the 10th leading cause of death for Americans. The CDC also states that “Suicide costs society approximately $34.6 billion a year in combined medical and work loss costs” and “The average suicide costs $1,061,170”. According to the CDC, “More than 1 million people reported making a suicide attempt in the past year” with “More than 2 million adults reported thinking about suicide in the past year.”
It seems obvious that the health crisis here is the staggeringly large and increasing suicide rate, not the lack of enough legalized assisted suicide.
Assisted suicide has now been legalized in 5 states. Three states (Oregon, Vermont and Washington) by legislation and in New Mexico and Montana by court rulings still under dispute. Compassion and Choices has repeatedly fought to legalize assisted suicide in the other 46 states but has lost in public referendums and state legislatures.
Will Brittany Maynard’s tragic story be Compassion and Choices’ self-described “tipping point” in their decades-long quest to convince the public to demand that health care professionals supply lethal overdoses to people who think their lives are (or will be) too terrible and undignified?
As a society, we may think we deserve to decide when our own lives are not worth living and that we then have a right to be dispatched by a medical person. We may think that we deserve a life unencumbered by our own or anyone else’s disability or terminal illness.
But if we do embrace such attitudes, I fear will we soon learn that the damage done to ourselves, our vulnerable fellow human beings and our society is incalculable.
 “I Lost My Daughter to Suicide: A Nurse’s Response to Brittany Maynard’s Campaign for Assisted Suicide”. The Public Discourse. Oct 24, 2014. Online at: Click link here
 “Suicide and suicidal behavior”. Medline Plus. Online at: Click link here
 “Oregon’s Death with Dignity Act-2013”.Oregon Public Health. Online at: Click link here
 “Death with Dignity Act”. Oregon Public Health Division. Online at: Click link here
 “Preventing Suicide-A Resource for Media Professionals”. World Health Organization. Click link here
 “Death with Dignity Act”. Latest annual report. Oregon Public Health Division. Online at: Click link here
“Suicide: Consequences-Suicide and Suicide Attempts Take an Enormous Toll on Society”. CDC. Online at: Click link here
 “Facts and Figures”. American Foundation for Suicide Prevention. Online at: Click link here
Do assisted suicide supporters really expect doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on their ethics or their empathy? Do they realize that this reduces the second patient’s will to live to a mere personal whim—one that society may ultimately see as selfish and too costly?
Right now, twenty-nine-year-old Brittany Maynard is standing on a virtual window ledge, while the crowd below shouts its support for her “right” to jump. She says November 1 will probably be the day she kills herself.
Brittany is a beautiful young newlywed. Tragically, Brittany has a brain tumor that is expected to end her life in the near future. She and her family have moved to Oregon so she can legally take a doctor-prescribed lethal overdose, to avoid the suffering she expects as she approaches death.
Maynard has also joined with “Compassion and Choices” to promote their campaign to legalize physician-assisted suicide throughout the United States. In the last few weeks, C&C’s video telling her story has gone viral and been picked up by news organizations all over the world, including People magazine.
Groups supporting physician-assisted suicide now call the promotion of Ms. Maynard’s story “a tipping point” in their decades-long push to gain public support for changing laws.
I am a registered nurse with forty-five years of experience caring for many suicidal people, both personally and professionally. I also lost a beautiful, physically healthy thirty-year-old daughter five years ago to suicide. After a sixteen-year battle with substance abuse, my daughter committed suicide after visiting suicide websites and reading Final Exit by Derek Humphry, the founder of the Hemlock Society (the former name of Compassion and Choices). The medical examiner called my daughter’s suicide “textbook Final Exit.” It was not an easy death for her, or for those of us who loved her.
While I am sure Ms. Maynard is sincere and well-meaning, campaigns like hers can have a devastating impact on vulnerable people like my daughter, and be misused to promote a one-sided debate on legalizing assisted suicide.
Unlike most suicides, assisted suicide involves two parties. It’s worth looking at the impact of this agenda on both of them.
Groups promoting assisted suicide routinely dismiss suicide victims like my daughter as collateral damage, while some even provide how-to instructions that can be accessed by any depressed person. The central focus of the legal agenda is the frail elderly. Consistently, the median age of people taking their lives under Oregon’s assisted suicide law has been seventy-one. Less than 1 percent are under thirty-five years old. And there is a generation gap on this issue. As the Newark Star-Ledger has reported: “A recent poll showed that people over 65 oppose assisted suicide by a 12-point margin while those under 35 support it by 18 points.”
Brittany Maynard’s position is consistent with that of others in her age group. Yet the elderly—the people overwhelmingly affected by these laws—say “No.” They know how hard it can be to convince younger generations that they still have lives worth living and worth respecting. Others who strongly disagree with C&C are the people with disabilities who belong to groups such as Not Dead Yet. Those with disabilities face a great deal of bias from able-bodied people who seem to think people with their conditions are “better off dead.”
Ironies abound in this debate. For example, when a convicted murderer tries to discourage efforts by lawyers to stop his or her execution, this is often considered as a sign of stress or mental disorder, while a sick person’s wish to die is considered an understandable and even courageous decision. How do we reconcile the two views that a lethal overdose is the ultimate punishment for a convicted murderer and, at the same time, the ultimate blessing for an innocent terminally ill or disabled person?
Then there are the medical professionals being called on to “assist.” Few people would seriously consider legalizing friend- or family-assisted suicide. The inherent dangers of this type of private killing are much too obvious. So the goal is to lend this act professional respectability by promoting physician-assisted suicide—or, more accurately, medically assisted suicide, since nurses also are necessarily involved when the assisted suicide occurs in a health facility or home-health situation. Many people are not aware that groups such as C&C oppose conscience rights for medical professionals like me, as well as for hospitals that believe that helping to terminate a life is unethical.
Medical groups such as the American Medical Association, the American College of Physicians, and the American Nurses Association oppose legalization of physician-assisted suicide. The AMA has said that allowing physicians to participate “would cause more harm than good,” observing that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”
When I worked as a hospice nurse years ago, our guiding principle was that we neither prolong nor hasten dying. I felt great satisfaction helping my patients and their families live as fully and meaningfully as possible until natural death. We nurses not only made sure that our patients were physically comfortable—we also helped with spiritual, emotional, and practical concerns.
Unfortunately, with the help of the media, assisted-suicide groups have had some success trying to convince both medical personnel and the public that natural death is agony and that medically assisted suicide should be a civil right. Yet this drive for totally controlling death profoundly changes the medical system, even for people who may recover or who may live with disabilities—and for patients who would never consider suicide.
Society has long insisted that healthcare professionals adhere to the highest standards of ethics, as a protection for society. Without that clear moral compass, it has been said, the physician is the most dangerous man in society. The vulnerability of a sick person, and the inability of society to monitor every healthcare decision or action, are powerful motivators to enforce such standards. For thousands of years doctors (and nurses) have embraced the Hippocratic standard that “I will give no deadly medicine to any one, nor suggest any such counsel.” Erasing the bright line doctors and nurses have drawn for themselves—which separates killing from caring—is a decision fraught with peril, especially for those who are most vulnerable.
As a nurse, I am willing to do anything for my patients—but I will not kill them nor help them kill themselves. In my work with the terminally ill, I have been struck by how rarely such people say anything like, “I want to end my life.” I have seen the few who do express such thoughts become visibly relieved when their concerns and fears are addressed, instead of finding support for the suicide option. I have yet to see such a patient go on to commit suicide.
This should not be surprising. Many of us have had at least fleeting thoughts of suicide in a time of crisis. Imagine how we would feel if we confided this to a close friend or a relative, who replied, “You’re right. I can’t see any other way out either.” Would we consider this reply as compassionate, or desperately discouraging? The terminally ill or disabled person is no less vulnerable than the rest of us in this respect. And to think that an entire society, through its laws, can give such a response—to you, and to anyone with a similar health condition—may be the ultimate form of suffering.
Do assisted suicide supporters really expect us doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on our ethics or our empathy? Do they realize that this reduces the second patient’s will-to-live request to a mere personal whim—perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that we helped other human beings kill themselves?
Stories like Brittany Maynard’s can feed into a society that is fascinated by tragic love stories, but does not understand how such stories are used as propaganda to promote a dangerous political agenda that can affect us all—and our loved ones.
Personally, I will continue to care for people contemplating suicide or who have made an attempt regardless of their age, condition, or socio-economic status. I reject discrimination when it comes to suicide prevention and care. I hope our nation will do so as well.
Nancy Valko, RN, ALNC, is a longtime writer and speaker on medical ethics issues who recently retired from critical care nursing to devote more time to consulting and volunteer work. She is also a spokesperson for the National Association of Pro Life Nurses.
Reprinted with permission of the author.