Completed Life or Premature Death?


    The Netherlands has taken another new initiative in the right-to-die.
There is a popular movement to allow people over 70 years of age
to choose to end their lives even if they do not meet the criteria
established in Dutch law for assistance in dying from a physician.
If Dutch citizens decide that they are tired of life
or have completed everything they want to do with their lives,
then they should be permitted to 'check-out' before natural death.

    Under current Dutch law, the patients must be suffering unbearably
before physicians are explicitly authorized to help them to die.
And generally, this means that they must be terminally-ill.
But this new movement of older people
seeks to permit other reasons to be acknowledged
as valid reasons for wanting to die.

    In the United Kingdom, a similar movement has begun.
They use the name: SOARS: Society for Old Age Rational Suicide.
Here is their website, with much useful information and discussion:
http://www.soars.org.uk/

    In October 2016, this organization changed its name to
My Death My Decision
and broadened its scope to include all ages
of people who have valid reasons for choosing death:
http://www.mydeath-mydecision.org.uk

    However, does this new 'completed life' movement
take into account the problem of irrational suicide?
If we approve of people ending their own lives when they choose,
how does this differ from condoning foolish self-killing?

    This chapter will attempt to lay out some reasonable methods
for separating wise end-of-life choices
from foolish decisions that will result in premature deaths.

    I began the first draft of this essay when I was in the 70th year of my life.
Thus, I am old enough to qualify for any such new provision in law or practice.
Everything in this chapter applies to myself.

OUTLINE: 

1.  IRRATIONAL SUICIDE NEAR THE END OF LIFE.

2.  SHOULD TERMINAL ILLNESS BE REQUIRED?

3.  DOES IT MATTER HOW MY DEATH WILL BE RECORDED?

4.  WAYS TO SEPARATE COMPLETED LIFE FROM PREMATURE DEATH.

    A. ADVANCE DIRECTIVE FOR MEDICAL CARE

    B. REQUESTS FOR DEATH FROM THE PATIENT

    N. STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

    D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    E. INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

    C. PSYCHOLOGICAL CONSULTANT
            EVALUATES THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

    G. UNBEARABLE SUFFERING

    H. UNBEARABLE PSYCHOLOGICAL SUFFERING

    O. A MEMBER OF THE CLERGY APPROVES OR QUESTIONS CHOOSING DEATH

    P. RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    U. WAITING PERIODS FOR REFLECTION

5.  HOW MANY PEOPLE WILL JOIN THESE END-OF-LIFE DISCUSSIONS?

6.  ARE MORE SAFEGUARDS NEEDED?

7.  DECIDING WHEN MEANINGFUL LIFE IS OVER.

HOW THIS CHAPTER MIGHT CHANGE YOUR MIND:

    Most readers coming from the right-to-die movement
will probably begin reading this chapter with the assumption
that anyone who wants to die should have that right.

    But a note of caution will be introduced
when we consider that some chosen deaths might be premature.
What safeguards will help to separate dying at the very best time
from dying too soon because of worries about developments
that might happen if we wait too long.

    Might it be helpful to consider the best time to die
by asking what meanings still remain possible?



Completed Life or Premature Death?

by James Leonard Park


1.  IRRATIONAL SUICIDE NEAR THE END OF LIFE.

    When we think of people killing themselves for foolish 'reasons',
we often think of teen-agers:
When they have deep problems, it sometimes seems to them
that the only way out is to kill themselves.
Some pregnant girls kill themselves rather than face their parents.
Sometimes deep disappointments related to 'love'
cause teens to end their own lives before they have really begun.
Angst is often associated with the teen years.
And sometimes it gets so bad that the victims 'choose' irrational suicide.

    But much less attention has been paid to older people killing themselves
for reasons that might be equally questionable.
An additional problem with some older people
is that our minds are not working as well as they once did.
We might have more difficulty forming thoughts
and drawing rational conclusions from several factors.
When our thinking process becomes deeply dysfunctional,
then other (more rational) adults must decide for us.

    If we are experiencing some forms of mental decline,
then we should not be trusted to make important decisions on our own.
This includes, of course, any choices that would end our lives.

    On the other hand, if we have good reasons to 'check-out' from life,
then we can explain our thinking to other reasonable people.
And if our reasons are genuinely wise and compassionate,
then others who affirm the right-to-die should agree with us. 



2.  SHOULD TERMINAL ILLNESS BE REQUIRED?

    Under many concepts of choosing the best time to die,
terminal illness is often high on the list of required conditions.
And wouldn't we agree that being somewhere in the process of dying
would be a meaningful factor in all end-of-life choosing?

    But careful thought might uncover many end-of-life conditions
that do not qualify as 'terminal illness', which would nevertheless
qualify as good reasons for dying now rather than dying later.

    Alzheimer's disease would be a prime example:
If we lose most of the capacities that made us persons,
then what is the point in keeping our bodies alive?
As more people on the Earth reach advanced age,
there will be more patients suffering from various forms of dementia.

    At least if we have clearly expressed our wishes to die
if we 'lose our minds' before natural death,
we should be granted the merciful deaths we request.
In most cases, dementia cannot be classified as a terminal illness,
since we could live for several years in mental decline.

    Another chapter explicitly addresses this question:
"Life-Ending Decisions for Alzheimer's Patients".

    What degree of decline would justify choosing death?

    Terminal illness is usually defined as having less than 6 months to live.
Sometimes 'terminal illness' means likely to die within one year—or more.
But, as we all know, such predictions by doctors are always imprecise.
And only a few of the people who are now dead
ever had an official declaration of terminal illness in their medical records.



3.  DOES IT MATTER HOW MY DEATH WILL BE RECORDED?

    I know nothing of the Dutch language.
But every language should have separate expressions
for what in English we call IRRATIONAL SUICIDE
distinguished from VOLUNTARY DEATH.

    And 'vital statistics' should also separate these two phenomena.
Perhaps in Dutch the expression for "suicide" is not very negative.
But most of us who are considering wise end-of-life medical choices
would never want "suicide" to appear on our death-certificates.

    In English, "voluntary death" would be more acceptable.
And with careful continued use,
we should be able to get the recording laws changed
to create a new category for the statistics of death:
A certain percentage of us will die by choosing a "voluntary death".

    There are more irrational suicides than voluntary deaths.
Perhaps there are 10 or 20 irrational suicides for each voluntary death.
These numbers might be somewhat different for people of advanced age. 
But even the elderly have more irrational suicides than voluntary deaths.

    Exactly how to draw the line between these two forms of chosen death
is explained in Chapter 19 of How to Die:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"?
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-IS-VD.html

    Briefly, this chapter asks four open-ended questions:
Was this death a harm or a benefit to the person now dead?
Was this death foolish (irrational) or wise (reasonable)?
Was this death capricious or well-planned?
Was this death admirable and commendable or tragic and regrettable?

    Since I myself intend to choose a voluntary death,
I hope that the laws of my state can be changed by that time
to allow my death to be correctly recorded as a voluntary death.
Who wants to be lumped together with regrettable irrational suicides?



4.  WAYS TO SEPARATE COMPLETED LIFE
            FROM PREMATURE DEATH.

    What methods should we apply to resolve this question:
When is the best time for this life to end?

    The following safeguard-procedures have been selected from
the complete list of 26 recommended safeguards for all life-ending decisions.
And they retain the letters used in that original list.
Each safeguard is linked to a more complete explanation on the Internet.
Here these safeguards are listed beginning with those that are most relevant
for separating completed life from premature death.

    These 11 practical procedures are not just thought-experiments.
Each will result in at least one written document. 
The patient will explain why his or her life has been completed.
Then several other people will offer their opinions.



    A. ADVANCE DIRECTIVE FOR MEDICAL CARE

    When we create our own Advance Directives for Medical Care,
we are considering how we will spend the last year of our lives.
Writing comprehensive Advance Directives empowers us to explain
our settled values with respect to living and dying.
If we consider the remaining years of our lives,
when would we say that our lives have been completed and fulfilled?

    Another chapter—Choosing Your Own Pathway Towards Death—
offers 18 specific Questions to help plan the last year of our lives.

    While we still have all of our mental powers,
we can describe our settled values with respect to life and death.
We can be as explicit as we please about our own medical ethics,
including our own choices concerning the right-to-die.

    If so moved, we can even wax lyrical about the meanings of our lives.
What have we sought to achieve with our hours on Earth?
To what degree have we fulfilled our chosen meanings?
And (perhaps regretfully) we can name the goals we never achieved.
Maybe no human life is ever completely fulfilled. 
But we can explain in our Advance Directives
the ways we might evaluate progress toward our life-purposes.

    As we decline towards death, our physical limitations
will slow and then halt our pursuit of meaning.
And in this sense, every human death will be premature:
There was always something more we might have achieved.
But when we accept our limitations—physical and mental—
we might be content for our lives to end
without labeling our deaths 'premature'.

    When we come to the last phase of our lives,
we might have good reasons to update our Advance Directives,
so that we can take into account the emerging conditions
that might lead us to choose voluntary death.
There might be new medical facts to take into account.
The more recently we have reaffirmed our settled values,
the more convincing our Advance Directives will be,
especially to more distant critics who might question
the relevance of documents created years before.

    Our plans for the last year of our lives can now be put into action
—with appropriate modifications as required by new circumstances.

   When we are drawing our lives to a close,
it will be especially important to have the support
of the people who are closest to us at that time.
When we first created our Advance Directives for Medical Care,
we got the cooperation of our families and our proxies.
And when we create our more specific requests for death,
do the people closest to us at the end of our lives
agree with our plans for death?

    When we have mentioned specific new circumstances
that are leading us to choose a timely death,
the people closest to us can include their own evaluations
of any and all new conditions and thinking
in their statements of understanding and support.
Statements from people who know us well would be especially relevant
if we are losing our mental powers toward the end of our lives.

    The people who love us, will not endorse irrational suicide.
They do not want us to harm ourselves, even if we have stopped caring.
Input from other people will help us to make our deaths
admirable and commendable rather than tragic and regrettable.

    And if we were on the verge of choosing a foolish death,
the people who have been closest to us
can help us to avoid harming ourselves.
Perhaps they will suggest postponing our deaths for a few months.
And their statements could include what new conditions
would cause them to change their minds
about finally approving a chosen death.

    Such evaluations from those who are close to us at the end of life
will help to separate completed life from premature death.



    B. REQUESTS FOR DEATH FROM THE PATIENT

    When we believe that we have completed our lives,
when we are ready to select our date of death,
we should put our plans for death into a short written statement.

    It might be helpful to list the things that we have accomplished.
Can we describe 10 goals we have fulfilled?
If we begin with the positive achievements of our lives,
such requests for death will not seem like suicide notes.

    We want to convince others that we have completed our lives
and that our end-of-life decisions are as rational as they can be.
We might present all of the factors that are leading us
to the decision to choose a voluntary death now
rather than waiting for the natural processes of dying to take us.

    Some of our reasons for choosing death might be medical facts.
And herein our requests for death can refer to the doctors' statements.
See Safeguards D & E below.

    But many of our reasons for choosing voluntary death
will be more personal and subjective.
If the meaningful purposes of our lives have been completed,
if we can no longer pursue our basic goals,
or if no more values can be achieved,
we can explain in our own words why we are ready to die.



    N. STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

    Once we have started to plan our own deaths,
we might collect written statements from family members
and others who know us well at the end of our lives
either supporting or questioning our proposed deaths.
When other people agree with our reasons for choosing death,
we can have our own thinking validated.
Our friends and family might even comment
on each of our reasons for choosing death.

    If we have carefully listed the factors favoring voluntary death,
our family members can give their own evaluations of each factor.
Do they agree that all of the facts add up to a completed life?
Do they agree that we can no longer pursue our life-meanings?

    Or if they have valid doubts about choosing death at this time,
their written statements would be a way to raise those questions.
Do family members believe that this death would be premature?
Perhaps they would never approve a freely-chosen death.
If so (and if we affirm our right-to-die), such views can be discounted.
And open-minded statements questioning the plans for death
might specify what new factors would resolve those questions.

    When the patient and the family-members all agree
that the proposed death would be a wise end-of-life decision,
they can all cooperate to create a dignified end for this completed life.



    D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    As said at the beginning, 'completed life' is not a medical category.
But in some cases, our physical condition will be very important
in deciding just when would be the best time to die.
The written statement of our primary-care physician
should explain as completely as possible
our physical condition and its likely next stages.
If we have a progressive disease or some degenerating condition,
then that can be explained by the doctor in charge of our care.

    Does our physical or mental condition and prognosis
explain why we can no longer pursue our life-meanings?

    But if our basic reasons for choosing a voluntary death
are personal rather than medical,
then the doctor has no veto power over our choice.
Our doctors are medical advisors—not the dictators of our lives.



    E. INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

    Especially when medical facts are a major reason for choosing death,
it might be wise to obtain a second written medical opinion.
This will either confirm the first doctor's professional evaluation
or mention new factors or options beyond the first doctor's statement.
We should always have a clear grasp of the medical facts
before we proceed with our plans for death.



    C. PSYCHOLOGICAL CONSULTANT
            EVALUATES THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

    Especially if our mental powers might decline toward the end of our lives,
it would be a wise precaution to consult with a psychological professional.
At least a statement from this psychologist or psychiatrist
should reassure more distant doubters that this death was wisely chosen
—that it was not the result of distorted thinking or family pressure.

    A therapist can help us review our reasons for choosing death.
How valid is our conclusion that we have completed our lives?
Would the psychological professional regard this death as premature?

    If we ourselves can no longer make our own life-ending decisions,
perhaps this psychological professional can evaluate our prior thinking
that led to this decision to choose an earlier death at a reasonable time
rather than waiting for natural death at some later time.
And this professional consultant can support the proxies
as they carry forward the plans-for-death decided earlier.



    G. UNBEARABLE SUFFERING

    Deciding that our lives have come to a good stopping-place
does not necessarily mean that we are suffering at the end of our lives.
But if there is any suffering involved,
we can strengthen our case for choosing death
if we explain in our own words
exactly what kinds of suffering we are experiencing.
We alone are responsible for evaluating our degree of suffering.
But some medical testimony might also be useful here.

    If the future holds for us only more suffering,
that might be a good reason to decide that meaningful life is over.



    H. UNBEARABLE PSYCHOLOGICAL SUFFERING

    And if our suffering has components beyond medical measurement,
this would also be very relevant for choosing the best time to die.
Perhaps several attempts at healing have brought no relief.
If so, then voluntary death might be the best choice.
We should explain our inward suffering as fully as we can.

    But even if our lives are not complete according to our own criteria,
psychological suffering could tip the balance toward choosing death.



    O. A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING DEATH

    If we have any religious connections at the end of our lives,
we might find it wise to consult with our religious advisors
concerning the best time to die.
(Some religious leaders will automatically say: Live as long as possible.
Such advice would be useless for making any life-ending decisions.)
Enlightened leaders of liberal religions will be able to separate
foolish plans for irrational suicide from wise plans for voluntary death.
And most religious/ethical leaders should be able to separate
completed lives from premature deaths.



    P. RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    And if the specifics of any proposed death require deeper analysis,
then some religious or ethical authorities might be called upon
to apply their established moral principles to the situation at hand. 
Once again, religious leaders and written moral principles
have no veto power over our end-of-life decisions.
But such additional principles might help our deliberations.



    U. WAITING PERIODS FOR REFLECTION

    We should allow plenty of time for discussion and re-thinking.
Some new facts or opinions might come to light.
When we are asking if our lives are now complete,
a few more weeks of thinking might help us to see new possibilities.
If we had rushed ahead when we first thought about voluntary death,
we might have chosen death prematurely.

    Waiting periods to review past thinking
are more likely to benefit everyone involved than to harm anyone.



5.  HOW MANY PEOPLE WILL JOIN THESE END-OF-LIFE DISCUSSIONS?

    Beyond the patient himself or herself,
fulfilling these 11 safeguards will mean collecting the opinions
of at least 7 additional people.
Others will have no veto power over the final life-ending decision,
but having consulted them will support the claim
that this was really a completed life rather than a premature death. 
Several neutral observers examined the same facts and opinions
and came to the same conclusion:
For this person, dying now would be better than dying later.



6.  ARE OTHER SAFEGUARDS NEEDED?

    If these 11 safeguards do not seem sufficient
to separate completed life from premature death,
then there are several others included in the complete list of
recommended safeguards for all life-ending decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-Z.html



7.  DECIDING WHEN MEANINGFUL LIFE IS OVER.

    Each of us is responsible for defining his or her meanings-in-life.
Some possible areas of meaning can be suggested:
experiences, relationships, creations, & spirituality.

    A. EXPERIENTIAL MEANINGS

    Most 'bucket lists' contain various experiences we want before death.
What places on the Earth do we want to visit?
What adventures do we want to have?
What everyday experiences do we find meaningful?

    And when we have checked off most of the things on our bucket lists,
perhaps we are ready to die because no more experiences beckon us.
Do we reach a point when watching television is no longer meaningful?

    B. RELATIONSHIP MEANINGS

    Most of us find deep meanings in our personal relationships.
Have we had good loving relationships?
Did we raise children?
Have we appreciated other family connections?
Do we have meaningful relationships with our children or grandchildren?

    And when our interpersonal relationships become less significant,
or when they completely disappear,
relationship meanings-in-life are diminished.

    C. CREATIVE MEANINGS

    As we approach the end of our lives,
we can summarize the accomplishments of which we are proud.
What purposes beyond ourselves have we pursued?
Have we written books, composed music, invented products, solved problems?
Have we created or sustained organizations that will continue after we are gone?

    If I may be personal for a moment, the very process of writing this book
has been one of the most meaningful things that I have done with my life.
I also have about 30 other books to my credit.
And I have found it meaningful to write book-reviews
of the creative efforts of other authors.

    I will also count my years in alternative adult education
as meaningful uses of my time and my life.

    But will I lose my creative capacities toward the end of my life?
Each of us can ask about the whole sweep of our lives:
What achievements will be remembered after we are dead?

    D. SPIRITUAL MEANINGS

    If we have become persons of spirit during our time on Earth,
then we might also name some spiritual dimensions of meaning.
We might have had important connections with organized religions.
Have we found deep meanings in our religious commitments?
Did we advance human understanding in the realm of spirit?

    If our mental powers decline before death,
we might also notice a decline in our spiritual meanings.

    E. WHEN THE POSSIBILITIES FOR MEANING CLOSE

    As we reflect on everything that has made our lives meaningful,
we will recognize that each meaning must necessarily end
—at least with respect to our involvement.
Unless we die suddenly, we will probably experience a period of decline,
in which the experiences, relationships, creations,
& even spiritual meanings are no longer as significant for us.

    If we have devoted our lives in meaningful ways,
we might be able to let go with a sense of accomplishment.
We will have completed what was most important for us to fulfill.

    Our capacity to enjoy life might diminish as our senses give way.
If our ability to remember diminishes, then experiences slip away.

    Perhaps most of our meaningful relationships are now in the past.
The purposes of those relationships have either been achieved
or the relationships have ended because of separation or death.

    Have our creative abilities become less powerful in recent years?
We might say that our best work is now behind us.

    And even our spiritual development might have reached its peak
—or passed its highest point because of mental deterioration.

    The people who have shared such meanings with us
might agree that the values we pursued are no longer possible.
And when most of our meanings-in-life are behind us,
it might be time to consider the best pathway towards death.

    Even if we have not fulfilled all of our dreams,
there might come a time when we have achieved everything we can.
How will we know when we have completed our lives?



AUTHOR:

    James Leonard Park is a long-time advocate of the right-to-die.
But in his view, this fundamental right should be tempered with
wise and careful safeguards to help decide the best time to die.

    Much more will be discovered about him on his website,
which is the last link below.
This exploritorium has more than 900 rooms.
The most relevant rooms open from the Right-to-Die Portal:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/P-RTD.html



    The essay above exploring voluntary death toward the end of life
has become Chapter 35 of How to Die: Safeguards for Life-Ending Decisions:
"Completed Life or Premature Death?"

Here are several related chapters from the same book:

Choosing Your Date of Death:
How to Achieve a Timely Death
—Not too Soon, Not too Late

The One-Month-Less Club:
Live Well Now, Omit the Last Month

One Million Chosen Deaths per Year?

Taking Death in Stride: Practical Planning

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Medical Methods of Managing Dying

The Number of People Reviewing a Life-Ending Decisions
Using the 26 Recommended Safeguards

Pulling the Plug:
A Paradigm for Life-Ending Decisions

Why Giving Up Water is Better than other Means of Voluntary Death

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

God Will Decide When Life Will End:
We Should Not 'Play God'

Created June 2, 2010; Revised 6-3-2010; 6-4-2010; 8-5-2010; 8-22-2010; 12-1-2010; 11-16-2011;
1-7-2012; 1-10-2012; 2-9-2012; 2-24-2012; 3-17-2012; 7-8-2012; 8-26-2012;
3-29-2013; 5-5-2013; 6-12-2013; 8-26-2013; 10-20-2013; 10-30-2013;12-17-2013;
2-7-2014; 7-31-2014;10-15-2014; 12-23-2014; 7-10-2015;
4-6-2016; 10-13-2016; 10-14-2016; 12-17-2017; 9-4-2018; 10-31-2019; 6-30-2020; 5-25-2021; 


WOULD YOU LIKE TO MEET OTHER SUPPORTERS
OF RIGHT-TO-DIE HOSPICE?

If you approve evaluating when your life has been completed,
consider joining a Facebook Group and Seminar called "Right-to-Die Hospice".

The essay above has become a chapter of Right-to-Die Hospice.

Here is a complete description of this on-line gathering of advocates of the right-to-die:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-RTDH.html

And here is the direct link to our Facebook Group:
Right-to-Die Hospice:
https://www.facebook.com/groups/145796889119091/


Go to the beginning of this website
James Leonard Park—Free Library