Monday, October 27, 2014

Facing Death with Dignity

On New Year’s Day, at the age of 29 and married for only a year, Brittany Maynard was diagnosed with brain cancer and given only a few years to live. By April, she learned she had the worst and most aggressive form of brain cancer, and this time doctors gave her six months. No treatment could save her, and it wouldn’t be an easy end. “I’ve discussed with many experts how I would die from it,” she says, “and it’s a terrible, terrible way to die.”

Facing this, as well as the pain of putting her family through her decay, Maynard chose “death with dignity,” an end-of-life option for terminally ill patients. A physician has prescribed a medication she can self-ingest to end her suffering at her discretion, and in fact, she has settled on a date to do so: this November 1, just beyond her husband’s birthday.

She and her family moved from California to Oregon, one of only five states where death with dignity is authorized, and she is living her remaining days to the fullest. When she recently explained her decision in an essay called “My Right to Death with Dignity at 29,” it went viral. In it, Maynard defended herself against accusations that she was committing suicide:

I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms… Who has the right to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?

This power to choose how and when to end her life has given her a sense of control and peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain. “Being able to choose to go with dignity is less terrifying,” Maynard explains. Less terrifying for her family too, who have an unusual opportunity to work through the grieving process on their own terms as well. “I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully,” says Maynard. “I can't imagine trying to rob anyone else of that choice.”

Her poignant story raises difficult and uncomfortable questions about an issue most of us prefer not to think about at all – our own passing. We naturally wonder, “What would I do?” and it’s hard not to agree with her decision. Facing a certain, torturous end, the thought of being able to control how and when one passes from this world has undeniable appeal. Who wouldn’t want that power and that right, to ease oneself gently into that good night?

Then along came Maggie Karner, who answered Maynard with her own essay at The Federalist entitled “Brain Cancer Will Likely Kill Me, But There’s No Way I’ll Kill Myself.” Karner was diagnosed this spring, at age 51, with the same stage-4 glioblastoma tumor as Maynard. As her title suggests, Karner is critical of Maynard’s choice. She embraces Thomas Aquinas’ determination that “it belongs to God alone to pronounce the sentence of death and life”:

God wants me to be comfortable in my dependence on Him and others, to live with Him in peace and comfort no matter what comes my way. As for my cancer journey, circumstances out of my control are not the worst thing that can happen to me. The worst thing would be losing faith, refusing to trust in God’s purpose in my life and trying to grab that control myself.

Ever since St. Augustine in the 6th century, Christianity has viewed suicide as a sinful loss of faith and a usurpation of God’s judgment. It irks Karner that “assisted suicide” has been given the more palatable euphemism, “death with dignity,” which she considers less about dignity than it is about seizing a power which should be God’s alone.

I am a Christian too, but I don’t subscribe to a blanket condemnation of suicide. I remember once when I was a boy, there was news of a local teen’s suicide. My mother, a Sunday School teacher, chided a fellow Christian who disapproved of the boy’s lack of faith. “No one knows what passed between that boy and God in his final moments,” my mother said, and her compassion stuck with me.

Enter Heather Knies. In 2005, at the age of 24, Knies too was given six months to live. She battled not one, but two brain tumors – one of them the same kind as Maynard and Karner. But,

I wanted to defy [the doctor] and the medical world and show that no one is a statistic. I was immediately defiant. I never once thought it would be the death of me… The mind is so much more powerful than anyone can imagine. People believe that when they get cancer, it will kill them. But I never once thought that.

And she was right. Today, at 33, she is married, a mother, and cancer-free – and her doctors at the Barrow Neurological Institute in Phoenix cannot explain why. Her surgeon states that in his 35 years in practice he has never seen anything like this. “It’s one of the most malignant tumors there is,” he said. “It’s not unheard of that a few survive – it’s a bell curve and there are outliers. But in her case, not only has she survived, but she is perfectly normal and there is absolutely no evidence of a tumor on her MRI scan.” He isn’t comfortable thinking of it as a “cure,” but “her survival is remarkable.”

Knies attributes the miraculous healing not only to “a great team of doctors and wonderful family and friends with a positive attitude,” but also to her certainty that “God had a plan for me… As my dad said, so many angels must be sitting on my shoulders.”

Divine intervention or not, in light of the fact that a few grade 4 glioblastoma sufferers have beaten the odds, does Brittany Maynard’s willing surrender now seem premature? Should she cling to hope?

Not facing a terminal prognosis, it’s impossible for me to truly put myself in Maynard’s shoes and answer for her. But I can’t help thinking that I would rage against the dying of the light and hold fast to any thread of hope that I might be among those few “outliers” who survive, like Heather Knies – not so much for myself, but for my wife and children. After all, even if the possibility of a miracle is infinitesimally slim, it’s not impossible.

But that is my choice. Like Maynard, I would not want to deny anyone else in similar circumstances the right to take control of their passing. Philosophers and physicians have debated the complex ethical dilemmas of assisted death for many centuries; but those philosophers and physicians won’t be taking Maynard’s journey (or Maggie Karner’s) with her. Her choice should be respected because when Death comes for Brittany Maynard, the carriage will hold just themselves and Immortality, as Emily Dickinson put it. That will be true for each of us as well, so that moment – perhaps more so than any other in our lives – belongs to us.

(This article originally appeared here on Acculturated, 10/23/14)