Published November 17, 2014
What causes terminally ill patients like 29-year-old Brittany Maynard to take their own lives instead of seeking palliative care?
“Ultimately, it is probably the subtle differences in perspective, personality and desire for control,” concludes Jack P. Freer, MD, clinical professor of medicine in the Division of Geriatrics and Palliative Medicine.
“Some will choose a more traditional path of hospice and palliative care to avoid the suffering of a medicalized death, while others feel the need to deliberately and directly dictate how that story ends.”
Maynard’s emotional story captured the public imagination and caused many to re-examine their positions about end-of-life choices.
After being diagnosed with incurable brain cancer, Maynard moved from California to Oregon so she could legally choose assisted suicide. While spending her final months with loved ones, she planned her death for Nov. 1, and she became an outspoken advocate for death-with-dignity laws.
“Her tragic and poignant case moved people who thought they had the issue of assisted suicide all worked out in their minds,” says Freer.
“Brittany’s youth and vitality, as well as her articulate and rational justifications, all seem to distinguish this from previous stories of medically assisted dying,” he says.
“Brittany’s story prompts partisans of various viewpoints to apply their worldviews to her situation,” Freer notes.
“Those who advocate a right to die found an enthusiastic and powerful spokesperson. On the other hand, a strong pro-life contingent urged Brittany to abandon her plans and pray for a miracle, based on comments on the YouTube and People Magazine websites.”
Both groups “simply see Brittany’s situation through the lens of their particular ideologies,” Freer adds.
Members of the hospice and palliative care community, however, have been particularly affected by this case and are the most conflicted about it, he says.
“This community has common ground with much of what Brittany has expressed — it is only the last chapter of her story that deviates from theirs.”
“These are people who have worked hard over the past few decades to change the way people die in this society,” he explains. “They have transformed the way we approach death, providing humane, medically competent care to dying patients in their homes, surrounded by family and loved ones.”
“They understand what motivates someone to take the path that Brittany Maynard did,” Freer notes. “Yet, they also know assisted suicide is a hot-button issue that could undercut public support for the kind of care they provide.”
In 1994, when the Oregon Death With Dignity Act was being debated, the Oregon Hospice Association opposed it, Freer recalls.
“Two decades later, the organization is working more closely with groups like Compassion & Choices, which supported Brittany Maynard’s decision.”
As a practicing physician, Freer cares for chronically ill and elderly patients.
His research and teaching focus on biomedical ethics — especially ethics related to incapacitated patients —as well as research ethics and palliative medicine.
He directs research ethics at the UB Clinical and Translational Research Center, where he founded and chairs monthly Clinical and Research Ethics Seminars.