Mark Bernstein suggests that terminally ill patients should have the option of assisted suicide.
Brittany Maynard was in the prime her life when she was diagnosed with glioblastoma multiforme, the most malignant and deadly form of brain cancer. The best available treatment consists of surgery, radiation, and chemotherapy (a pill, not intravenous) along with steroids to decrease brain swelling. Sometimes experimental treatments are undertaken. In spite of all this the vast majority of patients are dead within two years. Often patients suffer the side effects of the treatment, like hair loss, lethargy, depressed immunity causing infections, and facial bloating and weight gain from the prolonged use of steroids. Eventually they lose brain function like the ability to speak or move an arm or walk and ultimately they lose cognitive function. As a senior neurosurgeon who has dedicated his life to the care of patients with Ms. Maynard’s type of tumor and has treated thousands of such patients, I can attest to the poor quality of life many patients with glioblastoma endure.
And yes, there are a few happy stories of long-term and high-quality survival. In fact about 5% of patients survive at least 5 years (see here and here). So one could argue that Ms. Maynard may have been a little premature in her planned exit and may have had months or even years of happy life left, although we have no details of her specific case. But she was worried about missing the window of opportunity for when she was still able to make the decision about her future instead of having that decision falling to others.
If you were given the diagnosis and prognosis outlined above, would you think of changing things by taking control of your death into your own hands? Most people would not – they feel the need and desire to fight their disease as long as possible. But others, like Ms. Maynard might want to take control.
One reason that some people give for opposing assisted suicide is that they believe that “human life is worth preserving at all cost because it is sacred”. However if we examine this a little more closely, what constitutes “human life that is worth preserving”? Some people might argue that a life with almost certain death in the near future in which bodily functions and mental capacity would be progressively lost such that the patient loses control is not worth preserving, if the owner of that life makes that decision. Who does anyone think he/she is to dispute an individual person’s right to avoid such an undignified end and die on their terms?
Many also appeal to a “slippery slope” argument and suggest that if we allow assisted suicide to legally exist, then the inherent value of very ill people will decrease, and health care providers may not try as hard as they should to preserve their life. Again, as a doctor working in the trenches I reject this because we all know assisted suicide is clearly not for all and will never be forced upon anyone – it is only for those who wish to avail themselves of this service.
I find the fact that individual people and governments feel they can deny patients the option to determine if, how, and when they should die, to be arrogant, cruel, and misguided. This stance contravenes the fundamental bioethics principles of autonomy (independence to make one’s own choices), and beneficence (do good for the patient). Furthermore suicide has long been decriminalized in western society (United Kingdom 1961; Canada 1972; USA more recently) so the bioethics principle of justice as fairness is also contravened if those who are not capable to end their lives cannot enjoy the same rights as those who are able to end their lives.
Ms. Maynard’s case is at the same time tragic and inspiring. I am in awe of her incredible maturity, her unbelievable courage, and her unselfish conscious decision to turn her very bad luck into something positive for others by waving the right-to-die flag high. I also applaud her family and friends for their brave support of her decision. Finally, I congratulate jurisdictions like Oregon, Norway, Quebec, Switzerland, which have the collective progressiveness and humanity to legalize patients’ desire and need to end their lives on their own terms with some measure of dignity. If I was struck with a disease like Ms. Maynard’s, I would likely not have the courage to ask for assisted suicide, but it would be comforting to know that option was available to me. And as a neurosurgeon who fights every day to help brain tumour patients, I truly wish this therapeutic option was available for those who want it.
Mark Bernstein is a neurosurgeon at Toronto Western Hospital and Professor of Surgery at the University of Toronto.
BIEN. MUY BIEN. QUE BUENO QUE EN CANADÁ SE ESTÉ BUSCANDO SOLUCIONES A QUIENES POR UN EJERCICIO DE VOLUNTAD, EJERCEN SU LIBERTAD DE VIVIR HASTA SUS ÚLTIMAS CONSECUENCIAS. PORQUE, AUNQUE NO LO SEPAN, MORIR ES UN ACTO DE VIDA, Y EN TANTO ESA VIDA SEA NUESTRA, HA DE SER UN ACTO DE VOLUNTAD, PUES EN ÚLTIMA INSTANCIA LA MUERTE HUMANA (ES DECIR DERIVADO DE LA CONSCIENCIA Y NO DE LA BIOLOGÍA), HABRÍA DE SER UN A DECISIÓN, TODA VEZ QUE ADEMÁS, SE CUENTA CON LA CONDICIÓN DEL ESTADO TERMINAL, QUE SE SABE DE LA MUERTE PRÓXIMA Y SE UTILIZA EL TIEMPO PARA “HACER LA MALETA Y VIAJAR LIGEROS” COMO DIJO MI PAPÁ. ES DECIR, QUE SE APROVECHA PARA TERMINAR ESA VIDA QUE HA DE SER VIVIDA EN CONSCIENCIA Y CON CONSCIENCIA PARA DARLE EL ACABADO (HUMANO), DENTRO DEL PRINCIPIO PRIMERO Y ÚLTIMO QUE HABRÁ DE MOVERNOS, LA LIBERTAD.
ACA EN MÉXICO AHÍ LA LLEVAMOS. YA ESTA LA NORMA OFICIAL MEXICANA PARA LOS CUIDADOS PALIATIVOS DESDE EL AÑO 2010, AUNQUE LA INMENSA MAYORÍA DE LOS PROFESIONALES LO IGNORAN PORQUE LA INMENSA MAYORÍA DE LAS UNIVERSIDADES NO CUENTAN CON PROGRAMAS QUE INCLUYAN ESTA CAPACITACIÓN Y LAS INSTITUCIONES ESTÁN TAN OCUPADAS EN BUSCAR SOLUCIONES PARA LOS “VIVIBUNDOS, QUE NO LES ALCANZA PARA LOS MORIBUNDOS NI LA MÁS MÍNIMA CONSIDERACIÓN, NO OBSTANTE, DESPUÉS DE 35 AÑOS DE ESTAR EN ELLO, AHORA ME SIENTO TRANQUILO DE QUE YA SOMOS MÁS DE DOS LOS QUE ESTAMOS EN ESTO.
I went to school with Dr Bernstein ( U of O, Meds ’76) and have heard him lecture and have read some of his written work. I have been involved in promoting assisted dying for a few years, hearing the “call” probably from my palliative patients over the years. I have been so encouraged to see the recent support from vocal physicians and the CMA’s recognition of the debate. I just read Dr Bernstein’s excellent article and to hear a physician of his stature and moral standing supporting this cause makes me so proud of him and of this cause. Indeed we did discover many precious principles during our medical training together. Though he reached great heights in his career as a neurosurgeon, the great equalizers are compassion and empathy. Well done Mark!!
I agree that Ms. Maynard’s case is a very tragic one and that her decision to end her life asks us to consider the meaning and place of suffering at the end of a life and whether such suffering should be relieved and shortened by assisted death. I do not deny that this is an important conversation we need to have. However, watching Ms. Maynard’s video where she told us of her plans to travel the world, and indeed how she made the best of her last months by fulfilling some of her wishes, made me realize how the conversation has remained in the hands of the privileged.
Finding meaning in life and fulfilling one’s final wishes are crucial human endeavours and these may include avoiding a lot of pain. Unfortunately, the focus on the possibility of ending one’s life makes it appear as if the dying patient’s primary concern is orchestrating his or her death. However, as the recent innovations in palliative care have shown us, the dying person does not need to be understood as a one-dimensional individual who just has to decide (or not) now is the time.
It is not that I am against the recent discussions on assisted death; rather, my worry is that we are leaving out important components of the process of dying. Death is not merely an end point, but a process that can be made a good one and where the end can also be a good one. We should also take into consideration the fact that not everyone has equitable access to the possibility of a good death. If we only focus on the legality of assisted death, we are missing a crucial opportunity to discuss how to improve dying and not just speed it up.