Brittany Maynard’s ordeal is now over. On Nov. 1, the 29-year old with terminal brain cancer, who became the face of a movement to allow dying patients to choose when to end their lives, used the pills provided by her Oregon physician and died. Compassion and Choices, the nonprofit Maynard worked with, reported that “she died as she intended – peacefully in her bedroom, in the arms of her loved ones.” I would trade quite a few more days (especially days spent with searing pain or doped into semi-consciousness in an effort to manage symptoms) for the ability to say my goodbyes and die like that. We all know by now that the best death is not the one that can be postponed the longest.
The most striking thing about Maynard was the way she transformed herself so quickly, with this essay, from just another person into a warrior with a mission. But this is in keeping with the way many terminally ill people behave. They often spend their remaining days trying to improve the lot of those who will suffer similar illnesses in the future. Some, like Maynard, campaign for policy changes. Some offer themselves as subjects for medical experimentation, knowing full well that any findings will not help them. Some participate in support groups for those with similar medical prognoses.
“I didn’t launch this campaign because I wanted attention; in fact, it’s hard for me to process it all. I did this because I want to see a world where everyone has access to death with dignity, as I have had. My journey is easier because of this choice,” Maynard wrote on Oct. 9. In that way, she gave meaning to her final days in a way that a series of purely self-centered decisions never could have.
Discussions about physician-assisted suicide – and Maynard’s death – almost inevitably focus on what’s good for the terminally ill patient. But not every patient takes such a self-centered approach. A self-centered life, focused on personal gratification, aggrandizement and comfort, may or may not be good for the one living it. But a self-centered death is not. If all we care about is ourselves, everything we care about will perish in our death. That is unbearable.
Those who see themselves as connected to something bigger and more enduring than themselves, however, can die in a context of meaning and purpose. For some, religion provides this connection. But religion doesn’t always work. Many cannot summon the necessary theological convictions, especially on demand. And some kinds of religion fail at the end of life. A Christian oncologist told me that she deals with many patients who die filled with rage against God.
For others, a sense of connection comes from family, a deeply felt affinity with the natural world, or commitment to some ongoing endeavor such as art, science or efforts on behalf of disadvantaged kids. This approach clearly spoke to Maynard, who wrote that she worried she’d soon be unable to recognize her husband; her family moved with her to Oregon so she could die there.
For those who live a life of connection, when illness threatens to sever the connections, it is time to go. But the survivors go on, burdened or blessed with the memory of the death of their loved one. For them, the death is never the end of the story. And a death in the family – especially a long, drawn-out dying process – can be much worse for the survivors than it was for the deceased. This is part of the reason Maynard gave for opting against hospice care: “I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that. I did not want this nightmare scenario for my family.” She was looking outside herself.
The evaluation of Maynard’s death and of physician-assisted suicide more generally, must not be exclusively focused on the dying person. That would be to revert to the self-centered, unconnected perspective. Those of us with deep attachments to family and loved ones are all charged with carefully weighing what each of our alternatives probably would mean for our loved ones, with helping them to understand whatever choice we make, and with preparing them, as best we can, to go on to live happy, fulfilled lives without us.