Editor’s note: This is an updated segment that originally aired on November 2, 2014.
STEPHEN FEE: Like millions of Americans, Oregonian Pam Wald was riveted by the video of Brittany Maynard, a 29 year old woman suffering from brain cancer who moved here last year to end her own life.
PAM WALD: “I looked at that video. I studied, especially the last time I saw that video, I don’t think I left her eyes.”
STEPHEN FEE: Maynard lived in California but relocated to take advantage of Oregon’s Death With Dignity law that permits what advocates call physician assisted dying but is more commonly known as physician assisted suicide.
BRITTANY MAYNARD: “I will die upstairs in my bedroom that I share with my husband, with my mother and my husband by my side.”
STEPHEN FEE: Maynard, who ended her own life in November, was featured in a media campaign by a group called Compassion and Choices — twenty years earlier, its predecessor group played a key role in advocating for Oregon’s first-in-the-nation right-to-die bill.
In 1994, Pam Wald considered herself a supporter of Oregon’s Death With Dignity Act.
STEPHEN FEE: “So you voted for it, but you never thought, ‘This has to do with me.’”
PAM WALD: “No, no. It was kind of like out of compassion. The idea that, you know, someone gets in this situation, they deserve a right, you know, to choose. You know, it’s important to choose how we live our lives and how we die.”
STEPHEN FEE: “But then you found yourself in this situation.”
PAM WALD: “Yes.”
STEPHEN FEE: “Where you — where it’s, now it’s the story’s about you.”
PAM WALD: “Yeah.”
PAM WALD: “This is my husband.”
STEPHEN FEE: In 2011, Pam’s husband of 43 years, Ben Wald, discovered an earlier bout of cancer had returned — soon after, the disease began taking a lethal toll. Pam and daughter Bonnie watched as the once robust Ben rapidly lost weight. As the cancer spread to his bones, the pain became intolerable.
PAM WALD: “Ben woke me up in the middle of the night and he said, ‘Pam, we gotta talk. I don’t want to keep, you know — I’m dying, Pam. I’ve had a good life with you and Bonnie. I really don’t want to just keep living like this. I want to explore Oregon’s Death With Dignity law.’”
STEPHEN FEE: Under Oregon’s law, a doctor must determine a terminally ill patient has six months or fewer to live. The physician can write a life-ending prescription only after a second doctor signs on and both agree the patient is of sound mind. The patient must request the drug again 15 days after the initial request. But once the patient has it, the doctors’ role is over.
STEPHEN FEE: Since the law went into effect in 1997, over 1300 people have received life-ending prescriptions — but just 859 have actually taken them and died. Others died sooner and some changed their minds.
STEPHEN FEE: As Ben’s health deteriorated, he and Pam sought help from Compassion and Choices, the group that supported Brittany Maynard. In 2012, the group connected them with two doctors who signed off on Ben’s wishes.
PAM WALD: “Monday, Ben got the order for the prescription so it meant we could pick it up on Wednesday. And I thought at that point we would have it and then we would just kind of see. I thought I had more time with him. But he said to me, ‘Pam, I want to take it on Friday of that week.’”
STEPHEN FEE: Portland physician Bill Toffler also followed the case of Brittany Maynard — Brittany’s story struck a chord with him, too. Toffler’s wife of 40 years was diagnosed with cancer in 2009.
DR. BILL TOFFLER, PHYSICIANS FOR COMPASSIONATE CARE EDUCATION FOUNDATION: “We were blessed with five years after the diagnosis was made. And she died just four and a half months ago.”
STEPHEN FEE: For Dr. Toffler and his wife, assisted suicide was never an option. He leads a group, Physicians for Compassionate Care Education Foundation, that opposes prescribing lethal drugs to terminal patients.
DR. BILL TOFFLER: “Every day we lived differently because we knew that we had a limited amount of time in a way that I never perceived before I had a wife what that clear diagnosis. And I’d hope that patients recognize that I value them as a doctor, regardless of how disabled they are, regardless of how sick they are, that their life still has meaning and value. And I want to reflect that, even when they don’t see it themselves.”
STEPHEN FEE: But what about the fear and the pain that can surround dying? Why not help, I asked Dr. Toffler, if a patient asks?
DR. BILL TOFFLER: “It is a very scary time. And at that time, I want to come around the person. I want to walk alongside them. I want to be the best doctor I can be. I’m called to be more of a doctor than ever. I’m not supposed to be the person who helps her to kill herself. That’s all too easy.”
STEPHEN FEE: In a policy opinion, the American Medical Association says “physician assisted suicide is fundamentally incompatible with the physician’s role as healer.” And some religious groups, most notably the US Conference of Catholic Bishops, have strongly opposed the practice.
According to the Gallup polling organization, a slim majority of Americans supports assisted suicide. It’s only legal in Oregon, Washington, and Vermont — and since Brittany Maynard’s death, dozens of states have introduced or are reconsidering ‘death with dignity’ legislation.
And advocates have made progress in the courts. Decisions in Montana and New Mexico have opened the door to assisted dying. Last month, plaintiffs filed suit to allow the practice in California and New York, and Canada’s Supreme Court struck down that country’s national ban on assisted dying.
Bioethicist Arthur Caplan — who was an opponent of the practice but now supports it — says the terms of the debate haven’t really changed over the past 20 years, even with the publicity surrounding Brittany Maynard’s case.
We spoke to him before Maynard died late last year.
ARTHUR CAPLAN, NYU LANGONE MEDICAL CENTER: “I think what’s different in this debate is that Brittany Maynard is 29, attractive, articulate, almost– passionate about her right to choose here. That’s making the debate focus for a group that didn’t pay attention, younger people.”
Caplan says fears of figures like Dr. Jack Kevorkian helped derail the right-to-die movement in the 1990s — and that improvements in end-of-life care have eased Americans’ concerns over suffering at death.
BRITTANY MAYNARD: “I can’t even tell you the amount of relief that it provides me…”
But he says Brittany Maynard’s case may provide new momentum for supporters of assisted suicide.
ARTHUR CAPLAN: “I think she’s shifting the politics in a way that we may see some of the folks who got tied up in say, trying to broaden marriage laws and trying to see homosexuality gain wider acceptance move to say, this is a choice I want. This is something I care about because it’s her.”
STEPHEN FEE: On May 4, 2012, Pam and Ben Wald gathered their closest friends in the living room. They sang songs together, and afterward, in the bedroom they shared, Pam handed Ben the medication that would end his life. He took it without hesitating.
PAM WALD: “Early on when I got together with my husband and we were first together, we’d be laying in bed together and he was thinking, he’d go like this with his hands. His hands were always moving. It’s kind of like, it’s when he was thinking kind of thing and everything.
But what I’ve never forgotten is his hands were like this on his chest, and I held my hands on top of his. But his hands never went like that and they just stayed, because he was just at peace. And his last words were, ‘Thank you.’ And he died in two hours.”
STEPHEN FEE: Ben Wald was 75 years old.
So what can we learn from Oregon’s experience?
Katrina Hedberg of the state health authority — who’s neutral on the issue — tracks statistics on Oregon’s Death With Dignity law.
KATRINA HEDBERG, OREGON HEALTH AUTHORITY: “Initially there were a number of concerns that people had around would this be disproportionately used by people who were disenfranchised, so uneducated or people who might have had disabilities or those kinds of things. And we’ve really found that the people who are participating are people who really want to control the timing and manner surrounding their death.”
Still, Dr. Toffler says those final months and days should never be cut short, as he learned from experience with his own wife.
DR. BILL TOFFLER: “We were married for 40 years. And in the last five years I think we had the best years of our life — when she actually had a terminal diagnosis. And I wouldn’t trade those five years for anything.”
STEPHEN FEE: As for Pam, she’s now volunteering for Compassion and Choices, guiding other families through a process she now knows firsthand.
PAM WALD: “Nobody wants to talk about dying and death. But once we get into that, it really becomes an act of love. It really does.”