Brittany Maynard’s ‘Death with Dignity’ Poses Challenge to Hippocratic Oath

The unfortunate case of 29-year-old Brittany Maynard has captured the attention of the nation on an unprecedented scale.

Maynard, a resident of California, was diagnosed with low-grade astrocytoma on New Year’s Day 2014.² Despite undergoing a partial craniotomy and a partial resection of her temporal lobe, the cancer returned in April 2014 as grade IV astrocytoma, also known as glioblastoma. 

Given just six months to live, in which she would experience accelerated decline in logical function including speech, cognition, and motor power, Maynard recognized that her treatment options were in fact very limited with respect to survivability.

Following her grim prognosis, Maynard chose to move her family to Oregon, one of three states in the U.S. with “death with dignity” laws so that she could end her life “when the time seemed right,” before the disease claimed much of her quality of life, according to her website.¹

Maynard ultimately ended her life on Nov. 1, 2014 with the aid of a prescription from her physician. Her decision and resulting actions have in turn reignited the ethical debate around physician-assisted suicide among medical professionals, a topic that challenges the core of medical training in the United States.

As physicians, our primary goal is to treat illness in an objective manner without prejudice on any level. Neurologists are frequently consulted in the hospital and at times in the office setting by other medical disciplines to assess the potential to salvage compromised neurologic function from various medical causes ranging from cardiac arrest to advanced dementia. The role of the physician is to prolong life by whatever means possible in terms of medical treatment options.

The possibility of physician-assisted suicide is not in keeping with the standards of medical practice. Although there are times in medicine where after exhaustive treatment, the patient continues to worsen despite the best efforts of all physicians and nursing staff, we as healthcare providers continue to offer our best efforts.

Neurologists and all physicians have an obligation to their patients to identify and maximize all treatment options. Prescribing a medication to a terminal patient in order to promote death is clearly not in the realm of physician practice.

The role of the neurologist does not extend to advising a patient to take medications that would result in their demise. Beyond the ethical challenges, there are also many legal issues associated with the process of assisted physician-assisted suicide, and physicians should be recognizant of the long-term consequences of the “death with dignity” process.

Albert S. Favate, MD, is an assistant professor of neurology at New York University School of Medicine, and the division chief of the vascular neurology department and Stroke Care Center at NYU Langone Medical Center in New York City. He is a member of the Neurology Advisor Editorial Board. 

References

1. The Brittany Maynard Fund. http://www.brittanymaynardfund.org. 
2. Maynard B. CNN. My Right to Death with Dignity at 29. Available at: http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/. Accessed November 10, 2014.