Ms. Maynard’s Request

On New Years Day, after months of suffering from debilitating headaches, Brittany Maynard learned that she had brain cancer. She was 29 years old, recently married, and hoping to soon start a family. One week after she learned of her diagnosis, she underwent a partial craniotomy and a partial resection of her temporal lobe in an effort to stop the growth of her tumor. Over the next four months she spent the majority of her time in and out of hospitals in hopes that all the medical consultations and research would result in a cure for her devastating illness.

In April Dr. Patel informs Ms. Maynard that not only has her tumor returned, but it is now even more aggressive. Ms. Maynard is given a prognosis of only a few months left to live, and Dr. Patel recommends full brain radiation as a final attempt to shrink the tumor. She explains that given the advanced stage of Ms. Maynard’s cancer, successfully shrinking the tumor would not cure her condition, but it could potentially extend her life by several months. However, no treatments can fully cure her cancer in order to save her life, and the side effects of radiation often include hair loss, first-degree burns to the scalp, nausea, vomiting, headaches, extreme fatigue, hearing loss, and difficulty with speech and memory.

After carefully considering the possibility of full brain radiation, Ms. Maynard determines that the side effects would likely diminish her quality of life while offering little hope of meaningfully extending her life. Not wanting her final months or weeks to be full of painful side-effects, Ms. Maynard resigns herself to the knowledge that she is terminally ill and there is no treatment available that can save her life.

Dr. Patel then offers hospice care and palliative services as a way for Ms. Maynard to die more comfortably. While Ms. Maynard appreciates that palliative care would provide pain medication to ease her symptoms, she expresses concern over developing morphine-resistant pain, suffering personality changes due to the tumor, and experiencing significant verbal, cognitive, and motor loss as her cancer progresses. Because she is otherwise young and healthy, it is very likely that Ms. Maynard’s body will continue to sustain her while the cancer eats through her brain and wreaks havoc on her mind, given the increasing frequency and magnitude of the seizures she’s been experiencing. Tearfully, Ms. Maynard explains that the idea of experiencing this type of cognitive decline, and having her family witness her progressive decline, is more devastating to her than the initial cancer diagnosis.

With no hope of a cure and not wanting to experience a significant cognitive decline prior to her death, Ms. Maynard requests her physician’s assistance in dying. This would involve Dr. Patel writing her a prescription for a lethal medication, such as a large quantity of barbiturates, that she could take at home to end her own life. This would allow Ms. Maynard to be in control of the time and manner of her death when she decides that the time is right. Ms. Maynard explains her choice to Dr. Patel, saying that “having this choice at the end of my life would be incredibly important. It would give me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty, and pain. I want the opportunity to seek joy and love and to spend time traveling to outdoor wonders of nature with those I love in my final days, and to know that I have a safety net when my illness becomes too much.”

However, Ms. Maynard is also concerned about what her family’s reaction might be to her decision. While she intends to speak with her family before making a final decision, she hasn’t told them yet because she wanted to discuss the idea with just her physician first. Her husband has understandably urged her to try every medical option that might extend her life, and her family’s religious beliefs could also cut against her wishes to hasten her death. This is because some people view physician-assisted death as “giving up hope” while others suggest that terminally ill patients should wait longer because there could be “a miracle in the form of a cure.” Many religious communities also believe that only God can determine when a life is over and that it is wrong to take one’s death into their own hands.

On the other hand, proponents of physician-assisted death often ask important questions about the right of a patient to self-determine, such as “why should others have the right to tell me that I don’t deserve a choice? That I must suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone else have the right to make that choice for me, or to take that choice away from me?”

One final consideration is while physician-assisted death is legal where Dr. Patel practices, and she knows other physicians who have gone through the proper channels to assist terminally ill patients in dying, she is personally concerned about her conflicting duties as a healthcare professional. As a physician, Dr. Patel sees her professional and moral aim as promoting patient health and healing, and this aim appears at odds with helping a patient to die. Although Dr. Patel recognizes that part of her job is to abide by patient wishes and promote patient well-being, even by allowing them to refuse life-saving treatments, she is unsure of whether she believes this extends to assisting patients in hastening their deaths. Additionally, Dr. Patel is concerned about the perception this could create for her other patients, worrying that they may lose trust in her commitment to promoting their own health.