“No medical saying is better known than ‘first do no harm,’” observed medical ethicist Daniel Sokol in the British Medical Journal. But he noted: “Clinicians inflict harm all the time, whether it is by inserting a cannula, administering chemotherapy, performing a tracheotomy, opening an abdomen, or drilling into the skull…The clinician’s hope is that the benefits will outweigh the harms.”
My wife, Brittany Maynard, and I had several conversations about this very topic. In March 2014, Brittany was told that she had a massive incurable brain tumor and was given a terminal prognosis of most likely only six months to live. She was then faced with considering the application of the principle of “first do no harm” to her own situation.
Some might be tempted to equate death as the ultimate form of harm. I would caution against that conclusion. If asked, “Which is worse, being tortured to death or having a peaceful passing?” most would likely agree that being tortured to death is significantly worse than passing peacefully.
Everyone knows that death is simply a part of living. We all have a beginning, middle, and end—a birth, a life, and a death. As a society we need to get away from seeing death as failure, particularly when it is being applied to adults who are terminally ill.
For my wife, death came all too soon. She was young, beautiful, strong, and determined to live an adventurous, long life. Unfortunately, brain cancer drastically changed that timeline, and she died at age 29.
To be clear, Brittany wanted to live. She underwent an eight-hour brain surgery in January 2014. We then pursued and researched all of the treatments and clinical trials that were available. We looked into options domestically and internationally. We sent her packet of medical records to facilities that appeared to have promise. Unfortunately, the first routine follow-up MRI 70 days after her surgery showed an aggressive change in the tumor, which led Brittany to receive a six-month prognosis.
As is common, the principal treatment options available to Brittany—chemotherapy and radiation—produce painful and debilitating side effects that would have robbed her of living the last few months of her life as she wanted. So, applying the “first do no harm” principle in her case was simple. Brittany decided to live life, enjoy life, and not undergo treatments that would have filled her last few months on this earth with pain, discomfort, nausea, and the inability to sleep. The eventual outcome, even with those treatments, would have been the same: death.
The next application of “first do no harm” related to the unfortunate reality of how the brain tumor would end Brittany’s life.
Left to run its course, it would have produced horrific symptoms: worsening seizures, risk of losing the ability to communicate, pain that cannot be treated with morphine, going blind, aggressive/violent behavior, inability to sleep, paralysis. In a word, torture.
The decision of how one would prefer to die is one that only the terminally ill adult can make for herself. After a lengthy and protective process, terminally ill adults who are finally granted a prescription for aid-in-dying medication are in complete control of when they decide to take the medication, if at all. In Oregon, there are hundreds of cases over the past 17 years in which the terminally ill adult never ingested the medication and died without needing to consume it; the prescription was simply a back-up if their suffering became unbearable.
Faced with a terminal prognosis, how does a physician, or anyone, apply the principle of “first do no harm?” In Brittany’s case, it came down to her deciding that a peaceful death was actually the least harmful option for her as a patient.
There will be critics quick to point out that Brittany may have lived another 30 days or even another 60 days. I—as did she—concede that point. Brittany very well could have been alive for that many days. However, she would not have been “living;” she would only have been suffering. Brittany’s symptoms were getting particularly bad. The tumor’s “torture” had begun weeks before her death on November 1, 2014.
As a result of Brittany’s experience, I had to ask myself: “When my time comes, how do I want to go?” When I have asked other people this question, typically their response is the same as mine: “I would just want to die in my sleep.”
Well, that’s exactly what Brittany was able to achieve. She fell asleep within five minutes after drinking four ounces of her aid-in-dying medication. Consuming this medication does not produce any pain or discomfort. It does not induce fear. If anything, it relieves anxiety for dying people, knowing that they get to pass away while asleep. That’s what it did for Brittany. Seeing her passing first hand, I can assure you it was the most peaceful event one could hope for.
Doctors prescribe medicines to benefit patients all the time. They prescribe medicine to reduce swelling, lower blood pressure, regulate blood sugar, control seizures, and reduce pain. I want to thank Oregon residents for having the wisdom to pass a ballot initiative two decades ago to authorize physicians to prescribe medication that allowed my wife to avoid being tortured. By allowing Brittany to decide for herself when it was the right time for her to die, they absolutely lived up to the principle of “first do no harm.”
Now my mission is to fulfill my promise to Brittany to continue our family’s partnership with Compassion & Choices to change the laws in California and other states to give dying people nationwide the same end-of-life option that enabled my wife to pass away as gently as possible.