Death in the balance


Always at her bedsideIn the aftermath of 29-year-old Brittany Maynard’s death on Nov. 1 and the release of a prerecorded video of Maynard expressing support for the “Death with Dignity” movement on Nov. 19, the date that would have been her 30th birthday, the nation’s attention has returned to an issue that has been a source of controversy in the United States for more than a century.

Less than a year ago, Maynard was diagnosed with terminal brain cancer. Doctors told her she had only six months to live, and the course of the illness, they explained, would be painful and debilitating. Maynard could expect to experience personality changes as well as the loss of verbal, cognitive and motor functions. After careful consideration, Maynard decided to take matters into her own hands. In the weeks before her death, she and her husband and family left their California home and relocated to Oregon, one of four states in the U.S. that allow some form of doctor-assisted suicide. Armed with a prescription for the medication that would end her life, Maynard chose to die when her suffering became too great.

Frank Kavanaugh, Ph.D., is a board member of the Final Exit Network, an organization that supports the rights of “mentally competent adults who suffer from a fatal or irreversible physical illness, intractable physical pain or chronic, progressive physical disabilities … to end their lives when they judge the quality of their lives to be unacceptable.”

Kavanaugh became an advocate as a result of his experiences as a professor of medical and public affairs at the George Washington University Medical Center.

“What I saw in my time at GW was that in those days, doctors weren’t taught to talk to patients about the end of life. They’re getting better at it,” he said. “Medical advances create longer lives, but ironically, the end of life can be more tortuous. Just ask people in the backrooms of nursing homes.

“Eighty percent of people hope to die in their own beds but most die in hospitals,” continued Kavanaugh. “Too many times at GW, I saw family standing around a bed arguing. At least now there are some options.”

Final Exit Network is not unique, he said. “There are 57 organizations in 26 countries working on this issue. I believe that the right to die will be the human-rights issue of the 21st century. I am 80 years old, and I think in my lifetime, we will probably see another 10 states pass death-with-dignity laws.”

One reason why Kavanaugh expects the movement to take center stage in the next decade or so has to do with the aging of the population and the increase in the incidence of Alzheimer’s disease.
In recent years, the chorus of American voices that supports assisted suicide or euthanasia has become louder. Oregon’s Death with Dignity Act was passed 17 years ago, and since then, New Mexico, Vermont and Washington have followed suit. Montana’s 2009 law falls short of legalizing physician-assisted suicide, but the state’s Supreme Court broadened the Rights of the Terminally Ill Act so that it provides immunity for physicians who assist patients in ending their lives if they have proof of the patient’s request in writing.

Campaigns to pass similar bills are now being waged in California, Colorado, New Jersey, Massachusetts and Connecticut. In New Jersey, the General Assembly passed a Death with Dignity Act, but Gov. Chris Christie said he would veto the bill if it won passage in the state Senate. In Maryland, supporters of a Death with Dignity Act took to the Lawyer’s Mall outside the legislature in Annapolis on Nov. 19. Had gubernatorial candidate Heather Mizeur won her bid for election, passing the act would likely have been one of her goals.

Statistics from a May 2014 Gallup Poll show that seven in 10 Americans answered in the affirmative when asked the following question: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” But when physician intervention was described as aiding “suicide,” only 51 percent responded positively.

In a finding particularly remarkable in today’s partisan culture, the same poll found that support for “death with dignity” was nearly the same whether those polled were Republicans or Democrats. When asked if they supported a law that would allow doctors to end the life of a terminally ill patient who requests it, 71 percent of Democrats and 68 percent of Republicans said they would support it in the May sampling. Again, when the word “suicide” was used, only 60 percent of Democrats and 41 percent of Republicans said they would support such a law.
In the Jewish community, views among some Orthodox, Conservative and Reform religious leaders are nuanced. While most support the withdrawal of life support in certain circumstances, they tend to proscribe active physician intervention to speed or bring about death.

Rabbi Yitzchak Breitowitz, a senior lecturer in Ohr Somayach, Jerusalem, is a former rabbi of the Woodside Synagogue in Silver Spring and was an associate professor of law at the University of Maryland.

“Jewish law regards life as sacred and inviolate regardless of its quality or potential duration,” explained Breitowitz, who earned his rabbinical ordination at Ner Israel Rabbinical College and his law degree at Harvard University. “We obviously have the deepest sympathy and compassion for those who are suffering, and society has a sacred duty to do what it can to alleviate pain, but as far as I know, no responsible contemporary halachic authority supports euthanasia or assisted suicide.”

But Breitowitz added this caveat: “Although Halacha does not support active termination of life,” he said, “it does recognize that there may be justification not to sustain life by artificial and invasive means and that various forms of life support may be withheld or even withdrawn in cases of terminal patients with intractable pain. The precise parameters of when and how it can or should be done is subject to considerable debate, but it is relatively clear that physical life need not be prolonged at all costs.”

Rabbi Avram Reisner, spiritual leader of Conservative congregation Chevrei Tzedek in Baltimore and an expert on biomedical ethics, said that physician-assisted suicide and euthanasia are incompatible with Jewish law.

“Judaism starts from the premise that God is the author and sole arbiter of life, that He formed human life at the outset in His image and calls it back when He chooses,” said Reisner. “He is as well the commander and ground of morality, who has commanded us to choose life.

“As such, the choice to hasten our deaths is not given to us. Our body is understood to be on loan to us with responsibility to guard and manage it, but that it is not ultimately ours to dispose of.”

With regard to Brittany Maynard’s decision to end her life, Reisner, who admitted he had not seen her videos, said, “Jewish thought would question the dignity of acting in disregard of God’s image and command. Likewise her concern for the suffering of her parents is laudable, but she cannot know if the choice to die sooner, though less impaired, is in fact the kinder choice for her parents, and even they may not know. We are encouraged to leave those calculations to God.”

Prior to moving to Oregon, where physician-assisted suicide has been legal since 1997, Reform Rabbi Michael Z. Cahana, senior rabbi at Congregation Beth Israel in Portland, served as chair of the Central Conference of American Rabbis’ Task Force on Physician Assisted Suicide. The committee’s purpose was to revisit the Reform Movement’s responsa on this issue, through the lens of “modern moral thinking,” he said.

“Our conclusion was that we didn’t differ from the responsa,” said Cahana. The task force concluded in its 2003 report that physician-assisted suicide was not compatible with Judaism and that proper palliative care could diminish a terminally ill patient’s desire to end his or her life.

The task force also raised the question if voluntary euthanasia could become involuntary in a public health environment conscious of cost-saving measures.

In language almost identical to that of Breitowitz’s, Cahana said, “Obviously, we have great compassion for those in pain, and we do everything we can to mitigate pain. But we don’t believe in suicide as a way of avoiding pain. Some of what we do to mitigate pain, [certain drugs, for example,] may lead to a lesser life span, but that is not the same thing as physician-assisted suicide.

“The Jewish perspective,” he continued, “is that life is valuable even if the person doesn’t believe it. We’re saying, ‘We still value you as a person even if the doctor says you have six months to live.’ ”

While Cahana’s congregation is located in Oregon, he maintained that his opposition to euthanasia does not present a conflict in his work with congregants. Cahana said that although he and others may not choose to take advantage of the law, he does not stand in judgment of those who do choose to exercise their legal rights.

“I have been in the position of helping people in this situation,” he said. “Mostly, I am not being asked my opinion. What is important is that the family agrees, that it is not causing guilt and pain. It is not my job to change their decision. My role at that time is to help people in pain.”

Kavanaugh contended that many of the concerns of religious leaders, like those of other critics of physician-assisted suicide, are unfounded, particularly the view that euthanasia will at some point in the future be mandated for the terminally ill.

The Final Exit Network does not “ever encourage people to take their lives, and we don’t provide the means or assist them,” Kavanaugh said. “If someone wants our help, they have to write to us, send their medical records, and then we have three doctors review it.

“We also send someone to determine that the person is mentally competent to make the decision. If the applicant meets all criteria, Final Exit Network will provide him or her with the information and compassionate support they need to hasten the end of their lives.”

Kavanaugh also pointed out that statistics tend to show that the provisions of the Death with Dignity Act are not frequently invoked.

“When Oregon passed its ‘Death with Dignity’ act, critics said, ‘Oh my God! People will be dropping like flies,” he said, but “as of Jan. 22, 2014, prescriptions for lethal medications were written for 122 people under the provisions of the DWDA, compared to 116 during 2012.”

Very often, said Kavanaugh, just having the prescription for a lethal dose of medication in hand is enough to provide some measure of relief.

“You can change your mind [about using the prescription] at any time,” he explained. “You never know what choice people will make. What’s most important is that people can decide for themselves.

“It’s about dignity, choice and control. They are not dependent on anyone else. They have control over their lives.”

Simone Ellin is senior features reporter at the Baltimore Jewish Times, WJW’s sister publication.

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