Brittany Maynard: death with dignity or exploitation?

A California newlywed, Brittany Maynard, 29, diagnosed with a swift and fatal brain cancer, has moved with her husband to Oregon so she can have control at the end of her life under Oregon's pioneering death-with-dignity law.

She has legally obtained a lethal prescription and intends to use it, possibly as early as Saturday (or may hold off for a later date, according to a video she posted on YouTube Thursday morning). And she has partnered with Compassion & Choices, an advocacy group pushing for more laws like Oregon's, to use her death to raise awareness and support for physician-assisted suicide, now available in only five states.

Her story and video went viral on the Web in the last three weeks. Since Oct. 6, nearly nine million people have viewed her six-minute video on YouTube - and a new video will be released today. More than three million have visited the Compassion & Choices websites.

"This chick is a hero," said Martha Frye Kienzle, who graduated from Jefferson Medical College in May and is now a  pediatric resident  in St. Louis, in a post on Facebook.

Asked to elaborate, Kienzle e-mailed: "She's setting an example. People die terrible deaths in this country. And the issue of physician-assisted suicide has really dropped off the radar in recent years. It should be everyone's right to do what she's doing."

Many disagree.

Ira Byock, a hospice and palliative-care physician and author of Dying Well, is a longtime opponent of assisted suicide. He says the exploitation of Maynard's case "borders on pornographic. No light here and a lot of heat."

Maynard, of San Francisco, was diagnosed in January. By April, she had been given six months.

"There is not a cell in my body that is suicidal or that wants to die," Maynard told People.com. "I want to live. I wish there was a cure for my disease, but there's not.

"My glioblastoma is going to kill me," she added. "I've discussed with many experts how I would die from it, and it's a terrible, terrible way to die. Being able to choose to go with dignity is less terrifying."

The Oregon Death with Dignity Act was extremely controversial when enacted in 1997. Oregon voters twice had to pass a statewide referendum to authorize it.  Ultimately, the law was upheld by the U.S. Supreme Court, which has ruled that assisted suicide is not a constitutional right but that the issue should be left to the "laboratory" of the states.

Washington and Vermont have passed laws almost identical to Oregon's, and courts in New Mexico and Montana have granted citizens in those states similar rights.

The Oregon law states that if a person is found by two doctors to be terminally ill with six months or less to live and deemed mentally competent, the patient can obtain a lethal dose of drugs. The dying must ingest the drugs themselves without any assistance from doctors or loved ones.

Versions of the Oregon law are awaiting legislative action locally. John Burzichelli, an assemblyman from Gloucester County, predicts what he calls aid-in-dying legislation will be passed by the New Jersey Assembly by the end of 2014.

"I think it could get out of the Senate," said Burzichelli, a sponsor. "I don't know if this governor signs it. But things change."

Prospects are dim in Pennsylvania. "Lying in quiet repose in committee" is how Daylin Leach, a state senator from Montgomery County, described his bill's status.

In 14 years, 1,173 Oregonians have had prescriptions written under the law; 752 have used them to die, on average 53 a year.

Many who obtain the drugs choose not to take them. Maynard has said that she feels no pressure to take the drugs but is glad to have them.

"I can't tell you the amount of relief it provides me," she said. "I know it's there when I need it."

Bioethicist Arthur Caplan at New York University strongly opposed the Oregon law at first but now has no objection. Time has shown him the law is rarely used and is not abused.

He says Maynard's impact could be huge politically.

"She is a newlywed, attractive, passionate, and committed," he said. "This shifts the issue of physician-assisted suicide from baby boomers to millennials. Critics of legalization know this and are especially worried. They have seen what can happen when young people are mobilized - Obama's election, gay marriage, and marijuana legalization."

Byock, who retired last year as head of palliative medicine at the Dartmouth Hitchcock Medical Center in Lebanon, N.H., said America knows how to provide compassionate care at the end of life but does not do so, calling that a national disgrace.  Too often, American doctors are not trained in end-of-life care. Patients are impoverished trying to pay for medical and long-term care. Nursing homes are poorly staffed and people are left feeling unwanted and undignified.

"I and the teams with whom I've worked have cared for hundreds of people as tragic as Brittany Maynard," he said. "We didn't let any of them die suffering. They died as gently and peacefully as I hope Brittany Maynard dies. This is possible today with really good medical care, including palliative care and hospice."

Barbara Coombs Lee, architect of Oregon's law and head of Compassion & Choices, debated Byock on public television.

"Hospice and palliative care is the gold standard," she told Byock. "It's wonderful. But it's not a miracle. And it cannot prevent the kind of relentless, dehumanizing, horrific decline that Brittany faces, where her disease will cause unending seizures and headaches and nausea and vomiting and pressure in her brain, and the loss of every bodily function, including thinking and moving.

"No palliative care, terminal sedation, or promise of effective palliative care can give Maynard the thing she treasures now," Coombs Lee said - "the hope of gaining control over her disease before it takes her life."

Maynard has objected to Byock's characterization that she was being exploited. She and her husband made the decision to move to Oregon long before she got involved with Compassion & Choices. And the amazing public respone has given the end of her life meaning. As she wrote on a Compassion & Choices website last week, "something monumental has started to happen."

On Friday, Maynard also posted photos of a trip to the Grand Canyon, and expressed "thanks to the kindness of Americans around the country who came forward to make my 'bucket list' dream come true."

Unfortunately, she added, the following morning she had her worst seizure so far and was unable to speak for hours.

She has said the date she ends her life is not set in stone but would depend on how she's feeling.

Her original plan was to celebrate her husband's birthday on Friday, and then on Saturday, surround herself with the people she loves, play her favorite music, and die peacefully in her own bed, her husband beside her.

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