The Ethics and Economics of the “Good Death”

Brittany Maynard and Death with Dignity

Brittany Maynard, a 29 year old woman who was diagnosed with terminal brain cancer, has recently pushed the question of physician-assisted suicide back into the national consciousness. Her decision to end her life using Oregon’s Death with Dignity law has been the subject of intense scrutiny over the last few weeks. Compassion and Choices (an advocacy group that supports the legalization of death with dignity) has been working with Maynard to document her experiences, People magazine profiled her, and the Daily Mail published a lengthy write-up after Maynard visited the Grand Canyon with her family. Salon published not one, but two stories on October 30th when Maynard announced a decision to delay her death.

Her case has also been subject to intense criticisms: Organizations opposed to physician-assisted suicide, such as the Catholic Church, have criticized her decision. Wesley Smith, writing for the National Review Online, lambasted Maynard and claimed she used a tragic situation to push a political agenda. Religious leaders have written open pleas begging her to not cut short the life God gave her.

 The Unattended Move

Moving Boxes

Photo courtesy of Guardian Removals http://www.guardianremovals.co.uk/

Every article about Maynard mentions a fact in passing: She and her family moved from California to Oregon specifically for the protections and allowances for physician-assisted suicide under Oregon’s Death with Dignity Law, which is only available to state residents. By glossing over this question of access—which I believe undergirds every mention of Maynard’s move to Oregon—the otherwise extensive media coverage has ignored her vital concern: Except for the few states where physician-assisted suicide is legal, Death with Dignity is an option only for those who can afford the financial and emotional costs of moving.

Someone who wanted access to Death with Dignity, but currently didn’t live in a state where it was legal, would have to be financially capable of covering the high costs of moving to another state. Therefore, the option to relocate is only available to those who can afford it. Additionally, even if someone could afford to move, the idea of moving away from your chosen home is antithetical to the basic ethical premises of Death with Dignity: To allow patients to end their lives peacefully in a manner and place of their choosing.  These concerns are consistent with what Maynard herself wrote, “I didn’t launch this campaign because I wanted attention…I did this because I want to see a world where everyone has access to death with dignity, as I have had.”

The Economics of “Dying Well”

That Death with Dignity laws cannot be accessed by all citizens equally calls us to confront America’s unequal and biased healthcare system, and to question what it means to “die well.” If the option to spend one’s last days in a place of one’s choosing is an affirmation of human dignity, can we accept that such an option is only available to those who are able to finance complicated move, and to those who are willing to leave their homes behind in their last days?

Can we truly say that the denial of Death with Dignity measures to those who want them is a just and fair treatment? For some patients, simply having the knowledge that they have the medication should they choose to take provides immense psychological comfort, even if they never take the prescription. Can we accept that it is good practice to deny an option that would bring people psychological comfort even if they choose not to use it? These questions press upon a nerve that runs through the entire American healthcare system: Socioeconomic status is not only tied to how well you can live, but also to how well you can die.

Stranger in a Strange Land

SpoonDeath with Dignity laws are supposed to allow patients some amount of control over their deaths. Culturally, we retain ideals of what a “good death” is: Dying peacefully at home, surrounded by friends and family, and surrounded by the artifacts that made a life your life. Yet, moving from one’s home to a state that has a Death with Dignity measure but requires residency disrupts this purpose.

Having to move from a place you have intentionally chosen to be home, losing a view of a favorite park, a familiar sunset, the sounds of a beloved neighborhood, and proximity to the community in which memories are rooted and remain in order to minimize your suffering at the end of life seems both heartbreaking and cruel. It isn’t just that moving is only an option for those who can afford to. It’s also that moving removes someone from the place and community in which she would choose to end her life.

ConclusionStrange Land

In her essay “Race, Religion, & Commodification of a Good Death,” Ann Neumann writes “we think death will gracefully crawl into bed with us,” and “embrace us into that good night.” Maynard’s story has not only brought us to confront the ideals of the “good death,” but also to question their attainability. And by invoking the idea of the “good death,” I do not mean that physician-assisted suicide is the only avenue to it. I mean to invoke the ideals of comfort, care, and human dignity, which should be available to all facing the end of life. If currently the “good death,” however we conceive of it, is only available to those who can afford it, then we have to work tirelessly to ensure that in the future, it is available to all.

 

Meghan Guidry (Harvard University)
MeghanMeghan is a Masters of Divinity candidate at Harvard Divinity School, where she studies bioethics, humanist philosophy, end-of-life care, and health policy. Her research focuses on the disconnection between ethics and technologies, assisted suicide, and other cheery subjects. Her interests include creative writing, swimming, language philosophy, medical sociology, and coffee. You can check out her books at Empty City Press, find her on Facebook, and follow her on Twitter @monocrescent.

One response to “The Ethics and Economics of the “Good Death”

  1. Excellent post. It reminds me that I think society’s concept of the death process has been too Hollywood stylized. Like birth, death is usually painful & messy, but unlike birth, death is rarely portrayed as such in TV & in film. Until society adapts its Disney-like view & recognizes death as a gritty, natural process of life, how can we have truly meaningful dialogue on the subject of what a “good death” is or isn’t?

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