Dr. Arnold Relman, the former New England Journal of Medicine editor-in-chief who died of cancer in June, sought the same type of physician aid in dying that Brittany Maynard received in Oregon last Saturday. But the famed physician's doctors in Massachusetts turned him down, said his widow, Dr. Marcia Angell, also a former NEJM editor-in-chief.
“He wanted to bring about death in a peaceful and fast way, and he couldn't have that,” said Angell, who campaigned for passage of a “death with dignity” ballot initiative in Massachusetts that was narrowly defeated in 2012, in an interview with Modern Healthcare.
Last week, Angell published an op-ed article in the Washington Post arguing that the widely publicized decision of the 29-year-old Maynard to move from California to Oregon after she received her terminal cancer diagnosis and take advantage of that state's Death with Dignity Act could help shift the national debate over physician-assisted suicide.
Maynard took a fatal dose of barbiturates prescribed by a doctor and died Saturday, surrounded by family members.
“She was quite clear she saw this as a matter of autonomy and self-determination, and I think that appeals to young people who put a high premium on personal choice,” said Angell, a senior lecturer in social medicine at Harvard Medical School who's currently writing an article for the New York Review of Books about Dr. Atul Gawande's new book, Being Mortal: Medicine and What Matters in the End. “I think her argument, her way of dealing with it, and her youth will get a lot more supporters among a generation who didn't think this issue had anything to do with them.”
In her final month, Maynard launched an online video campaign with Compassion & Choices, a not-for-profit that advocates for end-of-life choices, urging adoption of death-with-dignity state laws around the country.
She also published an op-ed on the CNN website.
Currently, only Montana, New Mexico, Oregon, Vermont and Washington allow physician aid in dying. Past efforts to enact a death-with-dignity law in Maynard's home state of California have failed.
“When my suffering becomes too great, I can say to all those I love, "I love you; come be by my side, and come say goodbye as I pass into whatever's next," Maynard wrote. “I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can't imagine trying to rob anyone else of that choice.”
Some observers aren't sure Maynard's campaign will have any major effect. Art Caplan, a bioethics professor at NYU Langone Medical Center, told the Oregonian newspaper that voters and legislators will still have to decide on the ethics of physician aid in dying and whether it's a slippery slope to legalized suicide or euthanasia for patients who are not terminally ill.
Angell said her husband wanted the same opportunity Maynard had. “He wasn't afraid of suffering so much as he was afraid of the effect on his mind of taking drugs to prevent suffering,” she said. “For my husband, everything to him was about being clear in his mind.”
After being diagnosed with metastatic cancer in February, Relman asked his physicians whether they would provide him the means to end his life quickly if he chose to do so, Angell said. One doctor said he wouldn't do it even if it were legal because of his personal moral feelings. There were others she felt would have been willing to help if it were legal. “They hastened to assure him he wouldn't suffer,” she said.
But he did suffer. “He died of breathlessness, with his lungs filled with tumor,” she said. “Pain is the least of the symptoms for dying patients, it's the easiest to relieve. But breathlessness, nausea, clouding of thinking, these things are much harder to deal with.”
She suspects that Massachusetts doctors are fearful about legal consequences since the death-with-dignity ballot initiative was defeated in 2012. “I think there is a little bit of doctors looking over their shoulders because they are aware that people are watching,” she said.
She talked with Compassion & Choices about helping her husband end his life but was told that option was not available in Massachusetts. In addition, even for doctors like Relman and Angell, barbiturates are difficult to obtain, in part because European manufacturers are reluctant to sell them in the U.S. for fear they will be used for capital punishment.
Her husband's manner of death convinced her that assisted dying is even more important than she previously thought. “I can't think of a more important right,” she said.
She predicts that a death-with-dignity ballot initiative in Massachusetts would pass if it were placed on the ballot again, though she's not sure she would get involved in the campaign next time. “I don't think the public could be scared like the last time, with all those creepy, negative ads,” she said. “Brittany will have had an effect.”
Follow Harris Meyer on Twitter: @MHHmeyer
