Is Medical Greed Leading to D.I.Y. Deaths?

My PJ colleague Walter Hudson published a compelling argument regarding physician-assisted suicide in response to the ongoing dialogue surrounding terminal cancer patient Brittany Maynard. His is a well-reasoned argument regarding the intersection of theology and politics, written in response to Matt Walsh’s Blaze piece titled “There is Nothing Brave About Suicide.” Both pieces are a reminder that, in the ongoing debate over whether or not Maynard has the right to schedule her own death, little has been said regarding the role the medical profession plays in the battle to “Die with Dignity.” Walsh argues:

None of us get to die on our own terms, because if we did then I’m sure our terms would be a perfect, happy, and healthy life, where pain and death never enter into the picture at all.

It’s a simplistic comment that ignores a very real medical fact: Death can come on your own terms. And that doesn’t have to mean suicide.

My mother was a nurse for 20 years. During that time she worked in a variety of settings, from hospitals, to private practice, to nursing homes. Much like Jennifer Worth, the nurse and author of the Call the Midwife series, my mother practiced at the end of Victorian bedside nursing and the dawn of Medicare. As a result, the abuses she witnessed in the name of insurance claims were grotesque. For instance, if a patient required one teaspoon of medication, an entire bottle would be poured into the sink and charged to that patient’s insurance company. This was just the tip of the iceberg of unethical practices that would become priority in the name of the almighty “billing schedule.”

Some of the most abusive practices she witnessed during her time in nursing revolved around end-of-life care. Patients on their deathbeds would lay there in dying bodies being kept alive by machines, drugs, anything that could be listed as a line item on an insurance claim. “We have the best medical care in the world,” she would observe, “and one day soon, no one will be able to pay for it.” The problem with our system has nothing to do with a lack of socialization and everything to do with simple human greed.

A passionate advocate of end-of-life care, Jennifer Worth wrote an entire volume on her own experience as a nurse for the dying in her fourth volume In the Midst of Life. She writes extensively about Brompton Cocktails, a particular concoction of morphine, alcohol, thorazine, and at times cocaine used to ease the pain of dying patients. My mother recalls similar cocktails being administered to her own end-of-life patients to make them comfortable as their souls transitioned from one life to the next. Dr. Ben Carson explained how this would work in Maynard’s case, commenting, “We should never be too quick to judge others without spending some time in their shoes.”

When we have these debates they often evolve into aggravated conversations about euthanasia. In a political sense, legalizing voluntary physician-assisted suicide could open the door to the kind of political and medical abuses that may very well lead to involuntary euthanasia. At the same time, who is willing to control the abuse on the other end of the spectrum, where the dying are forced to submit to life-sustaining measures taken by medical professionals for legal and financial reasons? In a CNN op-ed, Maynard wrote of her decision:

After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left.

I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.

Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

Maynard also wrote:

I’ve had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms.

…Now that I’ve had the prescription filled and it’s in my possession, I have experienced a tremendous sense of relief. And if I decide to change my mind about taking the medication, I will not take it.

This is the spiritual fly in the ointment. What Brittany Maynard is confronting is what we will all face at some point: the fear of death. To simplify her choice as “suicide” is to be ignorant of the unique circumstances she faces as a 29-year-old woman who thought she’d be bringing life into this world instead of preparing to depart from it. Moreover, to depict her as a spokeswoman for a “Culture of Death” is to be blind to the intrinsic fear motivating her actions. Jennifer Worth was right, there is no dignity in dying. But to understand that, you must first understand that there is no fear in death.

Were we still allowing patients to die naturally, instead of pumping them full of drugs, hooking them up to machines, and spending tens of thousands of dollars demanding that they live another day, would we be so afraid of death?

Speaking of Maynard’s case, surgeon Atul Gawande observed:

What I think it indicates is that our health system has failed Brittany Maynard. She can’t count on the idea that, as her symptoms progress, that she would be prevented from having suffering, that she could count on clinicians and others… that her priorities will be met.

Would Matt Walsh think a Brompton Cocktail as suicidal in nature as Maynard’s medication? Sadly, it would seem that in her case, the only difference is in who administers the drug. “Nursing is self-service these days,” my mother and her fellow nursing school friend agreed. Years of neglect on the part of Medicare and Medicaid administrators prove that socialized medicine isn’t the cure. “Patients will have to be their own advocates,” one insurance broker recently informed me. “Obamacare won’t pay what doctors will charge, so the cost will fall to the patients. Once they see those bills, they’re going to start calling the shots.”

Perhaps that is why Maynard’s case is so controversial. Not because she is advocating for “dying with dignity,” but because her desire to die without grotesque medical intervention is an acknowledgement of the inevitable. In cases like Maynard’s, “Dying with Dignity” is nothing more than prescribing a do-it-yourself Brompton Cocktail to those who don’t wish to drain their bank accounts in pursuit of a painful, prolonged death. Which means that, in a world where medicine is governed by greed, compassionate and respectful end-of-life care is now being left to the realm of D.I.Y.