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How Brittany Maynard may change the right-to-die debate

In the weeks leading up to her death, Brittany Maynard became the face of the nation’s right-to-die debate. Critics called her case exploitation. Advocates argued she was making her mark. Maynard said she just wanted to leave a worthy legacy. And now that she’s gone, the trail she left behind may bring the physician-assisted suicide movement — and the deep divide about it — to a younger generation.

Maynard, 29, died Saturday at her home in Portland, Ore., after taking lethal drugs prescribed by her physician. It was a decision she made earlier this year after being diagnosed with terminal brain cancer and given six months to live.

Arthur Caplan, of New York University’s Division of Medical Ethics, wrote that because Maynard was “young, vivacious, attractive … and a very different kind of person” from the average patient seeking physician-assisted suicide, she “changes the optics of the debate.” In Oregon, the median age of someone who uses the state’s law to die is 71. Only six people younger than 34, like Maynard, have used it.

“Now we have a young woman getting people in her generation interested in the issue,” Caplan wrote in article published on Medscape. “Critics are worried about her partly because she’s speaking to that new audience, and they know that the younger generation of America has shifted attitudes about gay marriage and the use of marijuana, and maybe they are going to have that same impact in pushing physician-assisted suicide forward.

“She may change politics right here.”

Her story commanded national attention. Before she died, she launched her own campaign with Compassion & Choices, an advocacy group for the terminally ill. She drew support from lawmakers in Connecticut and New Jersey.

“I think [legislation] could get out of the Senate,” New Jersey Assemblyman John Burzichelli (D-Gloucester County) told the Philadelphia Inquirer. Burzichelli, the bill’s sponsor, thinks it will pass New Jersey’s state legislature this year.

Even the women on “The View” debated her right to die. Big names like Rosie O’Donnell said to have “control over your own death, when you’ve had no control for so long over your illness, I think is the human thing to do.”

But “assisted suicide” summons up deep religious and ethical concerns among some critics, including many Catholics and those associated with the Right to Life movement. While organizations have avoided criticizing Maynard, many have come out against the media and advocacy groups for what they consider exploitation of her story to gain a political edge. National Right to Life called Compassion & Choices “ghoulish” in its representation of Maynard’s tragedy.

“While we would never criticize Maynard,” National Right to Life said on it Web site, “we are angry that Compassion & Choices would exploit her tragedy for its own malevolent purposes. Maynard’s case is what groups like Compassion & Choices live for, a beautiful young woman about to be cut down in the prime of her life. It matters not that such cases — authentically terminal illnesses — are always the opening wedge after which, once the principal is established, the ‘right’ to be ‘assisted’ expands to a whole panoply of reasons none of which are about terminal illnesses. Compassion & Choice’s agenda extends far beyond terminally ill 29-year-old women.”

And even though Maynard’s story, which was documented in TV interviews and popular magazines, inspired a community of supporters, there were also social media efforts devoted to persuading her to choose a different course.

Ira Byock, chief medical officer of the Institute for Human Caring of Providence Health and Services, spoke loudly against the practice.

“When doctor-induced death becomes an accepted response to the suffering of dying people, logical extensions grease the slippery slope,” he wrote in a New York Times op-ed. He cited statistics in Holland, where the practice is permitted, that claim more than 40 people sought and received doctor-assisted death for depression and other mental disorders. “Even the psychiatrist who began this practice in the 90’s recently declared the situation had gone ‘off the rails.'”

Byock added: “Moral outrage is appropriate and needed to fix the sorry state of dying in America. Legalizing assisted suicide fixes nothing. The principle that doctors must not kill patients stands.”

In a poll conducted by the New England Journal of Medicine last year, 67 percent of more than 1,700 medical experts surveyed in the United States were against the physician-assisted suicide. That same year, a Pew Research survey showed public opinion was split, with 47 percent of U.S. adults supporting the practice and 49 percent opposing it. Then a Gallup poll that year suggested results varied according to how the question was presented: Some 70 percent of Americans were in favor of allowing physicians to “end the patient’s life by some painless means,” but only 51 percent were in support of allowing doctors to help a patient “commit suicide.”

Compassion & Choices President Barbara Coombs Lee, who drafted Oregon’s Death With Dignity Act, argued with Byock on public television.

“Hospice and palliative care is the gold standard,” she told Byock last month. “It’s wonderful. But it’s not a miracle. And it cannot prevent the kind of relentless, dehumanizing, horrific decline that Brittany faces, where her disease will cause unending seizures and headaches and nausea and vomiting and pressure in her brain, and the loss of every bodily function, including thinking and moving.”

Coombs Lee added: “No palliative care, terminal sedation, or promise of effective palliative care can give Maynard the thing she treasures now … the hope of gaining control over her disease before it takes her life.”

Late last month, Maynard took to her blog to address critics.

“I made my decisions based on my wishes, clinical research, choices, discussions with physicians, and logic,” she wrote. “I am not depressed or suicidal or on a ‘slippery slope.’ I have been in charge of this choice, gaining control of a terrifying terminal disease through the application of my own humane logic.” Throughout the past month, she said that was the reason for her campaign — to fight for other terminally-ill patients in states without protections.

Oregon, Vermont and Washington are currently the only three states that have death-with-dignity laws. Two other states, Montana and New Mexico, have court rulings that protect physicians who help patients die. Bills have been introduced in seven other states.

But Caplan believes this is just the beginning.

“Brittany Maynard may change this debate,” he wrote. “My forecast is that we are going to see more push to put these laws in the front of state legislatures and to get them on state ballots. We are going to see more states move in this direction. That intimately may be her legacy to the physician-assisted suicide debate.”

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