Brittany Maynard and SB 128 have shined the media’s spotlight once again on end-of-life issues in California and across the nation.
The 29-year-old Californian moved to Portland, Ore., from the San Francisco Bay area with her husband and mother to use the state’s “Death with Dignity” act. She had been diagnosed with grade four glioblastoma, and told she had no more than six months to live with the highly aggressive brain cancer. She reportedly suffered from seizures as well as severe head and neck pain at times.
After establishing residency and qualifying to take “aid-in-dying” medication prescribed by a doctor, she announced last year in a YouTube video that she would die on Nov. 1. Two days before, however, in a new video she said that she would delay killing herself until the time felt right. But the nonprofit end-of-life choice group Compassion & Choices confirmed that Maynard had, in fact, died by her own hand on the first of November.
On Jan. 21, at a Sacramento news conference, nine California lawmakers, along with Maynard’s relatives, announced plans to introduce legislation permitting physicians to write prescriptions ending the lives of terminally ill patients. A medical prognosis of death within six months would have to be made. And, independently, two doctors must agree that the dying person was mentally competent, didn’t need help in taking the medication and other criteria. Doctors would not be allowed to administer the drugs.
Backers of the bill said if it failed in the state legislature, like it has twice before, they’re prepared to make it a ballot initiative in 2016. Californians voted down a wider measure in 1992, which would have allowed doctors to kill their patients with lethal injections.
Currently, besides Oregon, Washington, New Mexico, Montana and Vermont allow adults to seek out medical help to die.
Mark Hoffman says he has sympathy for what Brittany Maynard, as well as her family, must have gone through in deciding to and then finally ending her life. But the retired 65-year-old clinical psychologist, who treated many suicidal patients over 35 years of practice, doesn’t understand her motivation.
“I think one of the most curious aspects of that case is that the day before, she announced to the world that she changed her mind about ending her life,” he told The Tidings. “I mean, she publically announced it.
“Now the question is, ‘One minute you said you changed your mind and you wanted to continue living for the time being. And the next day you’re dead. What or who got you to change your mind back again?’”
nSB 128’s fundamental flaws
Hoffman is the spokesman for California Seniors Against Legalizing Euthanasia. He points out that SB 128, which he’s reviewed in detail, follows practically word for word Oregon’s 20-year-old so-called “Death with Dignity” law. That statute allows terminally ill individuals to legally end their lives by taking drugs prescribed by a doctor. And while on the surface the bill looks like it takes great efforts to provide safeguards, analyzing it closely reveals grievous flaws.
Hoffman maintains that the measure as drafted “creates a lie.”
Why? Because the physician signing the death certificate is directed to give the cause of death as the underlying terminal disease or condition that motivated the suicide, rather than the death actually being caused by a self-administered lethal drug.
Another problem concerns how it purports to make sure that persons getting the lethal prescription are making an “informed” decision. They have to be counselled about potential risks. “And one of the potential risks is they might not, in fact, die in a timely manner as expected, which is specified as within three hours,” Hoffman pointed out. “There is no provision in the law that deals with the [possibility] that the drugs don’t work.”
Think of all the botched death penalty executions that have garnered national attention lately, he notes. (The U.S. Supreme Court recently agreed to hear a challenge by inmates to Oklahoma’s lethal-injection protocol.)
“So now that brings up a dilemma,” Hoffman said. “The person has not died as expected. You’re inviting either a physician to say, ‘Well, the person intended to die, so now I’m going to help them die,’ or ‘I’m going to violate their wish to die by resuscitating them.’”
nAbuse, conscious or not
And then Hoffman addresses what he says is the biggest issue: abuse.
The measure is fuzzy about the two witnesses who have to sign the request to die, attesting to the person’s sound mind, competence and having received other evaluations. “There are some provisions in the bill that no one involved can be, you know, using coercion or undue influence, especially for financial gain,” he acknowledged. “But how do you regulate that? Seriously?”
He talks about a letter he got from the wife of a terminally diagnosed older man. To her horror, she overheard his doctor’s sales pitch for suicide in an exam room. The physician was saying, “Think of what it will spare your wife. You need to think of her.”
The woman wrote, “I’m indignant that the doctor was not only trying to decide what was best for my husband, but also what was supposedly best for me. We got a different doctor. And David lived another five years or so.”
After an individual gets a terminal diagnosis — which like with the letter writer’s husband is often inaccurate — depression is a common consequnce. It’s precisely why thanatologist Elisabeth Kubler-Ross in her famous work “On Death and Dying” opposed euthanasia, the clinical psychologist says. She stressed that wanting to die is the number one sign of emotional depression. And it can last for weeks, months and even years if untreated with counseling and medication.
Also, weary around-the-clock caregivers may not even be aware that they’re giving off negative vibes to the terminally ill person. “I can certainly verify that,” said Hoffman. “It can be a very subconscious motivation. And the motivations for suicide are myriad. You know, there are certain common themes in different categories. But it’s such a broad question. I think it’s a mistake to try to overgeneralize.”
nHolding on to life
So what would the clinical psychologist say to people who have just gotten a medical death sentence? Should they hold on, knowing that their suffering and degeneration could get worse? Or should they opt out like Brittany Maynard?
He paused for a long beat before offering some personal musings.
“Well, that’s where’s spirituality comes in, I think,” he said, clearing his throat. “My own father was in his 90s and dealing with progressive incapacitation. And the last few years of his life, I would say he definitely struggled with depression because of his loss of physical and mental capacity. He was very aware of his deterioration.
“It was very sad for us to see that. But, you know, he bravely pushed on. It was just July last year, my wife and I went up to visit. And we had, I think, the best 4th of July celebration that I’ve had since I was a kid and fireworks were still legal,” he said, laughing. “He came out on the lawn and sat with us, and there was such a big grin on his face.
“We had a great time,” he added, “and he had a great time. It wasn’t very long after that he passed away.”
There was more silence.
“So we people who are facing that, you know, struggling through end-of-life issues, it’s very important for us to have empathy with them,” he observed. “And to help them bear whatever it is that they have to bear. Not encouraging them to prematurely end it all.
“Talk about ‘death with dignity,’” he remarked with more than a little distaste. “There’s no dignity in prematurely ending your life. There is no dignity in that.”
Editor’s note: During 2015, The Tidings will be featuring stories on end-of-life issues, assisted suicide and SB 128.
