Dying Well - Part I
By Jerri Haaven
Certified Grief Recovery Specialist & Celebrant
The New York Times recently published an “Opinionator” written by Ira Byock, a well-known and respected palliative care physician, titled, “Dying Shouldn’t Be So Brutal.” The article reviews stories about people who are entering into the final stages of their lives and the care they receive.
Byock’s article reminded me of Brittany Maynard’s story. Maynard’s story is a journey into a young woman’s courageous battle with cancer, and the painstaking decisions she needed to make in advance of her death, which likely included whether to be buried or cremated.
The Courage to Die
29 year-old Brittany Maynard created a media firestorm by choosing to end her life through physician-assisted suicide. She had been diagnosed with stage-4 brain cancer, and was told she had six months to live. In an interview with People Magazine published on November 2, 2014, she said, "… there's not a single part of me that wants to die. But I am dying … So being able to choose to go with dignity is less terrifying.”
With the support of Compassion and Choices and the 1997 Death with Dignity Act, she chose to move to Oregon where, with the help of her physician, she was able to pick the date of her death, with her husband and mother at her bedside.
From reading Ira Byock’s recent article, it appears he believes that the medical community has failed these patients, especially those whose quality of life has significantly diminished. He thinks a system that was designed to care for patients over a period of months has often been prescribed only when a patient is at death’s door. The span of time endured by a patient who is terminally ill extends unnecessary pain, suffering and expenses. He advocates for requiring resident physicians to be trained and tested in palliative care before being awarded their medical license, among many other standards, to improve health care for the sick and dying.
In The Cost of Dying: End of Life Care, which aired on 60 Minutes on August 5, 2010, Byock takes us to the bedside of “Charlie,” a 68-year-old man hospitalized for liver and kidney failure. To improve his health, he sought to have a double transplant. When Byock asked if he were to go into cardiac arrest during surgery, would he want to be resuscitated, even if it meant going back into ICU, Charlie said, “yes,” without hesitation. Byock attempted to make him aware that it might be better to let nature take its course, but it didn’t sway Charlie. Charlie wanted to live. In the end, he was not well enough for the transplant, and died three months later.
What’s missing from Dr. Byock’s understanding, in my opinion, is the consideration of a particular situation that what would lead someone to decide to take his or her own life. In Maynard’s case, the brain cancer would cause her to experience crushing headaches, vomiting, seizures and the inability to speak. She could linger this way for months.
Yes, palliative care could ease some of her suffering, but her quality of life would significantly deteriorate as the disease progressed. Isn’t this a form of death in and of itself?
When a patient decides it’s time to cross to the other side, as in Brittany’s situation, most people including physicians are of the opinion that this is morally wrong. Why is it supported – as in Charlie’s case - when a physician suggests basically the same thing?
This appears hypocritical.
Byock discusses the controversy in a PBS Newshour segment, titled “Should terminally ill patients be able to choose when they die?” that aired on October 14, 2014. He asserts that 85 percent of people who use Oregon’s law to end their life do so because of their emotional suffering, the burden of their care and loss of ability to enjoy life. He believes that doctors are proscribed from patient-assisted suicide for the protection of vulnerable people and the public.
End of life
As a writer for OneWorld Memorials, I’m particularly aware of the critical decisions people face when a loved one dies. End-of-life care involves emotional check points as one might be faced with decision after critical decision – the least of which might be between cremation, traditional burial or a green burial. How to think beyond life to death and how to memorialize a loved one; whether to choose a keepsake urn that resides in our home, scatter the loved one’s ashes, or choose a traditional burial; these choices appear less significant in the context of Brittany Maynard’s story.
The choice to end a life in a dignified manner, as did Brittany Maynard, presents by far, the most difficult choice of all.
Jerri Haaven is a freelance writer, and a certified Grief Recovery Specialist and Celebrant. When caring for her dad, who suffered from dementia and COPD, Jerri struggled with the negative side effects of his illness. She developed positive outlets to express herself and recover from her loss. Today as a certified Grief Recovery Specialist and Celebrant, she uses her skills to help people who are in the midst of their own personal story of grief and loss.