Like many of you, I’ve been mesmerized by the bravery of Brittany Maynard, a 29 year old woman who is dying of Stage IV brain cancer. After hearing the course of the disease progression from her doctors and considering what the end of her days were likely to be like, she made the incredibly difficult decision to move to Oregon, one of a handful of states in which assisted suicide is legal, and choose the day and manner in which she will die.
While her story is compelling and awful, it is not so surprising a concept. For veterinarians, taking part in these sorts of heavy decisions is an everyday occurrence, and to the Maynard family I say: I am so glad you have the ability to make that choice.
As I travel to Indianapolis for the annual meeting of the International Association of Animal Hospice and Palliative Care (the mouthful acronym of IAAHPC), I find myself struck by the two most common things clients say to me when I come to their home to euthanize a sick pet:
- This must be so hard.
- I wish we had this for people.
Though we all wish for ourselves, and our pets, to die peacefully and unaware in our sleep, the truth is, that doesn’t always happen. Sometimes death is peaceful, but sometimes it is horrible and painful and agonizing and drawn-out. To say that is a fate worse than death is not a metaphor in this case. Death can be a relief. We don’t always get to choose the way in which we die, but when we know it is coming and it is going to be unpleasant, I am very grateful this is an option we have for our pets, and for some people.
I suppose in many ways veterinarians are leading the charge in normalizing people’s attitudes about this possibility, right in there with hospice workers and other professionals who deal with these realities. None of us probably gave that much thought when we signed the dotted line on vet school admission forms, but it’s there nonetheless.
There is a small but important distinction I wish more people made when talking about Brittany’s situation: they say, “She is choosing to die.”
This is not true. She wants very much to live. She has no choice in the matter. She is dying.
The accurate statement is, “She is choosing how to die,” and that is a vital distinction. I’ve seen differing views on this, people who genuinely believe that there is beauty in every moment of life, even in suffering an agonizing death with a ravaged body, and to that I simply say: I respect your view on it and your right to choose that end. I also respect those who choose as Brittany is doing, and I find beauty in that as well.
There are limits, of course. I do not show up at people’s homes and simply provide euthanasia on demand for pets who do not have a terminal disease. For my own emotional well-being I have very specific requirements and lines I do not cross. There are situations (such as a dangerously aggressive pet) where the lines about what is ethically acceptable are fuzzy, but my personal limits are not. I feel very proud and honored to be able to do what I do.
This is how I continue to do this every day: by reminding myself and the grieving owners that we are not killing a pet; the disease is killing him or her. We are simply aiding the process and making it more comfortable. I wish for the Maynards the same I do for my patients: comfort, peace, as much as can be gathered in a stressful situation.
I am the midwife at the end of life.
And I am OK with that.
That was beautifully said!
Susan Shields Montgomery says
People who speak against this are people who fear death so much they would do and suffer anything to put it off. Funny that so many of them are religious people, who speak about a heavenly reward. You have to wonder if they really believe in it if they are trying so hard to avoid going there.
I have made the decision to put down a suffering pet. Yes, it was crushingly hard, yes I doubted my decision, but it was the kindest, most humane thing I could do. I have watched animals and people die slow, long, agonizing deaths because their loved ones wouldn’t let go, or the laws required it. How is this kind and humane?
Animals don’t fear death. They live in the now. Now the treat is good, now they are in pain as they walk, now they are going to sleep. They easily step from this life to the next with no regrets. I am one that does believe they live on, have a soul, so death is just a doorway for them, as it is for us.
Given a choice of a few months of agony, and then death, or making their own choice on when to go, I understand choosing when the balance of happiness and pain is still on the positive side.
Heather Wilson says
I respectfully disagree with you. As someone who was given a death sentence and chose to fight (and who is not religious at all) it is not about avoiding death; it is about honoring the gift of life. I live in the now – and in my now I was living with a blood cancer that was *supposed* to kill me. 17 years later…It didn’t and I live a beautiful life because I chose to live in hope and life instead of death. There was agony beyond anything I’d ever wish upon any other living person. But the doctors were wrong. Their limitations were wrong. Hers could be, too…
Heidi P-O says
Thank you. I work with my hospital’s hospice and palliative care teams and we talk about stuff like this all the time. I’d rather choose how I die rather than suffer. I am extremely humbled by Ms Maynard’s decision. May she find comfort in her final days.
Connie KittyBlog says
oddly enough, I have never had a problem choosing death for any of my pets. As much as i want them to live and no matter how much I want them with me for ever and ever, I know that this is most likely the best possible gift I can give them. In each instance I have made that choice, there was no hope for the animal. his or her life was simply going to get worse and worse and it was no life for them to have to deal with. It is my normal. I know people fear ‘death panels’ and premature euthanasia because of money grabbing relatives, but I hope we are able to work through all of those issues and offer this with out the need to move to do it.
well said, as usual. I used to work with an occupational therapist who said “there are worse things than death.” I believe that with all my heart. And the things we do to pets and even our human children just to keep them “alive” and not have to let go because we have a “right” to do what we want, is awful. I could go on… but you have said it well.
Thank you Again Dr. V . It is the Terminal illness that is taking the life, not the Vet , or the owner .
There were times with both of my parents, who had specifically asked not to be kept alive until they suffered and died of their illnesses, that I wished I could choose this for them, but instead watched them live as they would never have chosen to. I have worked with my veterinarian and other veterinarians in the care of my cats and chosen euthanasia for most of them, and have no doubts about those choices. If only our doctors could have had the same means.
Michelle Ferrera says
I don’t think fear of death or heavenly reward is the issue, but the ethical difficulty of how to choose death. Brittany is lucid enough to make her own choice. I was horrified by what was done to Terry Schaivo , an incapacitated woman who was starved and dehydrated to death, even though her own parents wanted to take care of her, but her exhusband was the one with power of attorney. No-one should be forced to die like that. We should make our wishes clear to those close to us. I think that some fear the slippery slope of what would happen if government or insurance companies were to be involved in the decision. The only one defining quality of life should be you, with those closest to you, whom you trust. I am a veterinarian, and a Christian, and find euthanasia to be a final kindness to my patients, have compassion on those who suffer without relief (really, who wants to wait to die from terminal cancer), and can appreciate the moral challenges (if my life is really in God’s hands, is it ok for me to choose to leave life sooner than the body would die naturally). It is a difficult choice that should not be made lightly, but I think it is reasonable and humane to be able to make it.
Heather Wilson says
I have an extremely hard time with this. As someone who was told, at the age of 21, after my third cancer diagnosis, I would not live to see the age of 22…I have to wonder – what if? What if the day after she dies there is a cure? What if there is a cure a month later? A year later? What if there is a miracle for her, too? What if her doctors are wrong, too? Perhaps not. But, I was given the gift of ‘what if’…
I don’t disagree with the option. I don’t disagree with the right to the choice. I just feel her choice is too soon. I know what it is like to wish for the end. I know pain and I know hopelessness. I also know that I believe hope is a precious thing.
I cannot compare my story to hers; here I am – 17 years later and 38 years of age living a beautiful, precious life. Mine was a different form of the disease. When we end the life of an animal, in most cases, it is because they have deteriorated past a point of reasonable existence. I don’t believe she has reached that point. I do think she is pressing fast forward on her end and I disagree with her on this; however, it is a slippery slope when we begin to infringe upon the rights of others. I wish she would live her way into more answers, but I wish her and her loved ones as much peace as possible. It is something I hope I am never faced with again.