Nurses, Brittany Maynard, Methods of Hastening Dying: No Easy Options

By Amanda Anderson, a critical care nurse and graduate student in New York City who is currently doing a graduate placement at AJN two days a week.

Last weekend, 29-year-old Brittany Maynard died, in her bed, in her bedroom, with her husband and immediate family beside her. I learned of her death on Twitter, along with millions of other readers. Several weeks earlier, Maynard had publicly announced, in a YouTube video, the way she planned to end her own life: using a lethal dose of medications prescribed to her for that purpose.

Maynard, while a compelling public advocate, is not the first to choose to die this way. Compassion and Choices, the organization that worked with Maynard to publicize her choice, lobbies for the drafting and passage of “death with dignity” laws, which currently exist in some form only in Oregon, Washington, Vermont, New Mexico, and Montana. Arizona.

In Oregon, where Maynard moved in order to be able to legally end her life before she was incapacitated by the effects of terminal brain cancer, approximately 71 other people made the same choice in 2013, the most recent year of reported data—the peak of a gradual increase from the law’s inaugural year of 1998, when 16 people did so.

Illustration by Denny Bond for AJN. All rights reserved.

Illustration by Denny Bond for AJN. All rights reserved.

Much social media discussion has arisen from Maynard’s case, often influenced by strongly held religious and ethical principles. For nurses, the issue can be further complicated by our own clinical experiences with death. Some have argued that legalized aid in dying opens a door to hasty, emotionally fraught, irreversible decision making.

Yet few commentators discuss other practices associated with hastening dying that are commonly practiced in our health care system, as described in a 2009 CE article in AJN by Judith Schwarz, “Stopping Drinking and Eating” (free until December 1). These practices include “foregoing or discontinuing life-sustaining treatment, including medically provided nutrition and hydration (such as tube feeding),” “using high doses of opioids to treat intractable pain,” and “initiating palliative sedation.”

Schwarz’s article focuses on the case of 100-year-old Gertrude, whose progressive loss of hearing and vision and her inability to complete activities of daily living had convinced her that she needed a plan to end her own life while she still could. Because she lived in a state where physician-assisted death was not a legal choice, Gertrude and her family enlisted the counsel of Compassion and Choices for knowledge of further options. Through a series of home visits and consultations, Schwarz assisted Gertrude and her family as they considered their legal options and arrived at the voluntary decision to stop eating and drinking.

What comes through in the article is that the process of deciding to initiate stopping eating and drinking is an arduous one that involves the entire family, medical providers, and even home help. In Gertrude’s case, she had to sacrifice her relationship with her long-time housekeeper on religious grounds, and her family had to make special arrangements with caregivers willing to respect her unique choice. In addition, Schwarz recommends that a nurse consult all other members of her health care team if asked by a patient about ways to hasten dying, and also suggests consulting mental health specialists to rule out clinical depression. It was also necessary to make sure Gertrude’s normal needs would be met in the course of the process.

On day four of her fast, Gertrude slept and “looked peaceful; her skin was luminous.” Her care continued as planned, including her beloved classical music, until day 10, when she died.

Brittany Maynard’s death differs in many details: she was young; her condition was acute; she hastened her death via a different mechanism, in a different legally approved way. But as with Gertrude, her decision to hasten her own death came with great thought and effort. Like Gertrude, she felt limited by her disease, speaking emotionally about the state of fear and pain her cancer placed her in, her autonomy stolen by her cancer’s “terrifying symptoms.”

After moving to Oregon, where physician aid in dying is legal under the state’s Death With Dignity Act, Maynard undertook the process of switching to a physician who would would provide care under the bill’s regulations. She also had to comply with Oregon’s rigorous criteria for the death with dignity program, including mandatory psychological screening for those with mental health diagnoses, multiple physician certifications, and a two-week waiting period before receipt of prescriptions.

And then, when she felt it was time to implement her choice, she had to do so voluntarily—in the environment she chose, facilitated by the support of her family, just as Gertrude did.

States where aid in dying is legal report that far fewer people make this choice than had been expected, with many of those who explore the option never filling prescriptions or, if they fill them, never choosing to use the drugs they’ve received. Maybe this has something to do with the healing power of knowing they are able to choose when it’s time to die.

Many people die as my patients sometimes do—in hospital beds, surrounded by their family members, as the intensive care team turns off their life support and nurses give ordered comfort care. Others die within moments of aggressive intervention, or while receiving advanced life support and CPR as specifically outlined by their advanced directives.

No health care provider or patient or family member takes dying lightly. There’s usually a lot of effort and thought and care involved for all concerned. Brittany Maynard’s case reminds nurses like myself that we should educate ourselves on every option so that we can speak to patients with compassion, regardless of their choices and our beliefs—in ways that are unbiased, informed, and protective of their rights, and within our scope of practice.

Bookmark and Share

2016-11-21T13:03:35+00:00 November 5th, 2014|Nursing, nursing perspective, patient engagement|8 Comments

About the Author:

I'm a nurse with a critical care background who works in administration in Manhattan. My blog is This Nurse Wonders. I also blog for Off the Charts and Healthcetera, and tweet as @ajandersonrn.

8 Comments

  1. mamaantis November 10, 2014 at 1:23 pm

    Within the past year I watched a documentary entitled, “How to Die in Oregon” (2011), and it addresses this matter in a direct way, following several people using PAD. While I know where I stand on the matter, this documentary makes one think even beyond what one may already know. Death has many legal, ethical, and spiritual considerations, but until we are in the place of the individual who must ultimately make the choice, we cannot know. It has made me more upfront with my own family in regard to their wishes, and more sensitive to the patients that I serve. Julie A., RN

  2. amygetter November 7, 2014 at 1:44 am

    I have cared for many hospice patients in Washington and Oregon who have chosen to use PAD to end their lives, A number of my patients who wished to use it (even in states where PAD is legal) had so many obstacles placed in their way that they “ran out of time”. And some have obtained the drugs, only to leave them sitting in a cabinet. Too many people do not understand the many safeguards present in the laws and are afraid to even have the conversation, so Thank You for this post that clarifies some commen misconceptions.
    Amy Getter, RN, MS

  3. Keith E Gardner November 5, 2014 at 11:34 pm

    Every one of us without exception will die. Each of us should be able to exercise the option of deciding when and how their own life will end. Certainly, one must be cognizant of the many factors involved in the decision to end or continue living until the last breath. Perhaps a panel of professionals in psychiatry, medicine, clergy and lay people could provide the individual council regarding the pros/cons of ending their life. This assumes the individual is conscious, aware and is able to express and understand the finality of their choices. I believe each self aware human has the right to make life and death decisions regarding his own life.
    Keith E Gardner RN, BSN, Psychiatric Nurse Specialist

  4. Mary November 5, 2014 at 11:23 pm

    I would not hesitate to do the same. If possible, I will never put my family through all the life prolonging nonsense in the hospital and watching me suffer. No way. I will find a way. I have a living will and have done all I can in that way, but wish that in every state we had that right to decide,,,,,,,enough.

  5. L Jane Acree November 5, 2014 at 9:18 pm

    We never know what we would want in Brittany’s situation. But talking about it openly will certainly help many to sort out how they truly feel about it. Appreciate your post.

  6. JaLyn November 5, 2014 at 7:50 pm

    I believe that all Americans should have the option to choose for themselves, while they are of sound mind, the means in which to die if facing a terminal illness. I am glad that Brittany re initiated this conversation. As nurses, we try not to force our beliefs on others. As Americans, we need to support patients in these choices as well. I do hope that State legislatures will reopen this discussion, and people will refrain from bringing their own belief systems into the conversation.

  7. Laura Olson November 5, 2014 at 6:56 pm

    I don’t consider her a hero but I am very glad she had the choice as everybody should to determine her fate on her terms.

  8. Jennifer Reynolds November 5, 2014 at 5:08 pm

    Brittany was a hero and should be remembered in a positive light. Thank you for this. I was inspired to blog about her the second i heard she made the choice…
    http://dnpreynolds.org/2014/11/03/heroes-come-in-many-forms/

Comments are moderated before approval, but always welcome.