Roosevelt Institute | Cornell University

An End to Suffering: Who Makes the Final Call in End-of-Life Decisions?

By Frank SunPublished November 9, 2014

29-year-old Brittany Maynard's decision to end her life at such a young age has made a significant impact on the American public. This controversial subject has tugged at the heartstrings of millions of people and has been discussed by policymakers all over the country. What implications does her decision have for the ongoing debate and what factors must be considered to thoroughly understand the issue of physician-assisted suicide?

By Frank Sun, 11/9/2014

                  Throughout the past few weeks, one woman's choice to end her life has caused a major stir around the country. Brittany Maynard, a woman sick with an aggressive brain tumor, ended her life in Oregon under Oregon's Death with Dignity Act. Prior to her decision, she was the focus of two videos filmed for Compassion and Choices that garnered more than 13 million views in October and early November. It is evident that Ms. Maynard's decision is going to influence the argument (political and personal) on patients' end-of-life decisions. Ms. Maynard also drew a lot of attention to Compassion and Choices' website indicating that the issue of physician-assisted suicide has been a newsworthy topic of late.

                  This is an extremely controversial subject because of the various ethical factors that go into making the decision to end one's own life. Many people believe physician-assisted suicide is morally indefensible. Very religious individuals and communities believe that life is a gift from God. When states such as Massachusetts tried to pass a referendum supporting physician-assisted suicide, certain Roman Catholic organizations spent millions of dollars to oppose the referendum. Conceptually, many people cannot grasp the idea of destruction of self. It is important to consider human autonomy in the debate, but suicide is an act that undermines the very existence of self. Destruction of self removes a human being's autonomy because that person would cease to exist. Others opposing the process believe the issue cannot be thought of in terms of politics and must be thought of in terms of the family — sympathy and empathy are powerful ethical and moral motivations.

                  Another important point from the opposition includes the fact that the phrase "physician-assisted suicide" contradicts and is completely incompatible with the doctor's role. There are concerns about the competency of the patient in a terminally ill state and her ability to make a well-informed decision. People are concerned about the ethics of coercion and pressure coming from the physician — they believe physicians should be providing alternatives to care and trying their best to actually cure the disease. Physician-assisted suicide can also be viewed as the physician giving up which does not align with their role as a healthcare provider.

                  An important point to keep in mind when considering positive effects of physician-assisted suicide is the fact that as an autonomous human being, one has the right to relief from intense suffering. It is difficult for people who have never been in the shoes of the terminally ill to fully understand and grasp those feelings and points of view. Ms. Maynard had many supporters but much opposition came from individuals who were more concerned about her family and the idea of suicide rather than her well-being and struggle. Also, physician-assisted suicide can help families save money and cut healthcare costs overall. According to a 1998 study done by Emmanuel and Battin in the Netherlands, after calculating American savings based on the Dutch experience, the U.S. could have saved on average $10,118 ($15,000 today) per patient in medical spending if assisted suicide had been legalized everywhere. This would have amounted to approximately $627 million in savings. These could have then been allocated to preventative care, which could have decreased the need for debate over physician-assisted suicide if the malignant diseases were prevented.

                  It is clear that physician-assisted suicide is an extremely difficult issue, dividing the general public. However, Ms. Maynard's decision at this time really sent this ongoing issue onto the national spotlight because she was so young. The public was not used to someone like her choosing to end her life. As a young person, she caught the attention of the most tech savvy, socially connected, and passionate generation currently alive. The young people of today are more connected to the world and in tune with national and world issues than ever. Controversial news spreads like wildfire across the Internet, through texting, and word-of-mouth.

                  The policy implications from this generation are strong. Because these people are now of voting age, politicians had to take into account the opinions of the youth when campaigning during the midterm elections. People running for office actually put Ms. Maynard's story on their campaign or Facebook pages. It is rare that such a specific medical ethics issue makes such an impact on campaigns. However, our government was created to respond to the people so it is only natural that politicians are monitoring shifts in public opinions and trending topics when campaigning. Legislators need to pay attention to issues that galvanize the public.

                  This issue also brought back the debate on the separation of church and state when making political decisions. Is that even possible with an issue so ingrained in many people's religious beliefs or will religious views play a huge part in decisions?  

                  Could this change the future for medical ethics legislation? As more and more groups begin lobbying for physician-assisted suicide to be legal everywhere, are legislators going to be more responsive to the issue? Is physician-assisted suicide going to be the next big political debate? The answers to these questions are uncertain. It will be interesting to see where the issue goes in terms of state and national government and the courts. However, one fact can be stated with confidence: Brittany Maynard left her legacy to the public, to young people everywhere, and impacted the political system.