more examples of
HELPING WISE, END-OF-LIFE MEDICAL CHOICES
which should not be criminal offenses anywhere

    (4)  Two young parents give birth to an infant
with birth-defects so profound and complicated
that there is no chance that the infant could survive
even with the most extensive medical supports.
With good medical advice, the parents decide
not to pursue any further medical treatments for the infant.
The elaborate life-supports are disconnected.
The infant dies a natural death.
If proper medical procedures were followed,
no one should be charged with any criminal offense.

    (5)  A teen-age girl contracts a neurological disease
that will leave her completely paralyzed for the rest of her life.
After consulting with groups supporting quadriplegics,
she decides that she cannot accept life with those limitations,
even tho she understands that many others
have learned to cope with such disabling conditions.
With the support of her parents, her clergy-person, & her doctors,
she decides to end her life by giving up food and water.
No one should be charged with any crime.

    (6)  A middle-aged man is drying of lung cancer,
which has now spread to so many other organs
his life cannot be saved by surgery.
As his suffering deepens, he chooses more and more sedation.
Eventually he approves completely sedation
to last for the rest of his biological life
—which is predicted to be only a few days.
His doctor orders terminal coma,
coupled with the withdrawal of all drugs and life-supports,
including food and water provided by tubes.
He dies three days later,
without regaining consciousness.
Since all appropriate safeguards were fulfilled,
no one who cooperated with this end-of-life plan
will be subject to any criminal or professional investigation.

    (7)  A young mother of three children
is faced with a variety of medical problems,
any one of which could end her life within the next two years.
After continuing medical treatments for several months,
she is advised that her problems are so intractable
that she will probably never live outside of the hospital.
She knows that she cannot be an active mother for her kids.
She decides to shorten her inevitable process of dying
by authorizing ever-increasing doses of the medications
that have been controlling her symptoms.
The institutional ethics committee of the hospital
agreed with her decision to decrease her medical treatments
and increase her symptom-control,
even with the knowledge that such decisions
will shorten the process of her dying.
Because medical advice supports her end-of-life decisions,
there will be no criminal investigation after her death.

    (8)  After a few heart-operations, a man is advised
that unless a heart-transplant can be found for him,
he will die within the next three years.
He waits for two years, often in the hospital,
but no matching heart becomes available.
He decides to spend the rest of his life at home
if a new heart cannot be located for him.
Because he has refused further hospitalization
(except for a heart-transplant),
he dies at home when his next heart-attack strikes.
Because his end-of-life plan was reasonable
and because it was approved by everyone close to him,
there will be no adverse legal consequences for anyone
as the result of his choice to forgo further medical treatment.

    (9)  An aging grandmother decides that she has had enough.
She has a variety of minor medical problems,
all of which can be treated by common medical supports.
Because she is tried of living
and because she sees no further meanings to be achieved,
she sets an approximate date of death for herself.
She plans to give up eating and drinking
in order to end her life at what she regards as the best time. 
Her family is somewhat divided by her decision to die.
Some want to keep her alive by declaring her incompetent,
thereby invalidating her end-of-life plan.
But others understand her plan to choose a voluntary death.
She has established a Medical Care Decisions Committee,
which consists entirely of relatives who support
her decision to end of her life on her own terms.
A psychiatrist has examined her and found her fully capable
of making her own end-of-life decisions.
She finds a hospice that agrees that she has the right-to-die
according to her carefully-organized plan.
The hospice program will help her handle
all of the symptoms of dying by dehydration.
This includes a plan to increase medication at the end
if the problems of dying become too difficult for her to bear.
Because her legal proxies and her doctors agree with her plan,
there will be no legal consequences after her death takes place.

    (10)  An accident victim suddenly finds himself
thrust into a world alternating between pain and treatment.
Unfortunately, there is no other way to prevent his suffering
except to keep him completely asleep.
Whenever he is allowed to awaken,
his only experience of life is constant pain.
After trying a full range of medical methods of solving his problem,
everyone agrees that there is no medical solution.
His life offers nothing to look forward to except further suffering.
Thus, he agrees to terminate his life by means of terminal coma:
The doctors will order that
he be kept completely unconscious for the rest of his life,
which will be short because everyone involved agrees
that withdrawing all life-supports—including food and water—
should accompanying his terminal sedation.
He is put into a deep sleep by sedative drugs.
And he dies a few days later.
Because careful safeguards were used for this life-ending decision,
no one will be prosecuted for any crime associated with this death.

    (11)  A victim of Alzheimer's disease
is no longer able to make medical decisions.
But he left a comprehensive Advance Directive,
written, signed, & witnessed before he lost his mental capacities.
His Advance Directive covers what to do in case of mental decline.
And he appointed proxies who are willing and able
to carry forward his end-of-life decisions.
Because of his advancing age and ever-declining mental abilities,
the proxies agree (following his criteria) that his meaningful life is over.
Then, in cooperation with the patient's primary-care physician,
they decide to withdraw all curative medical treatments,
including drugs needed to stabilize certain conditions.
And since the patient can no longer feed himself,
they also decide to discontinue all means of providing food and water.
They agree that sufficient sedatives should be given
to allow the patient to have a completely painless and peaceful death.
Because they followed all applicable safeguards,
there will be no investigation for any crime associated with this death.

    (12)  In a very complicated end-of-life case,
the proxies for the dying patient
have prepared for the public prosecutor
a complete record of the medical treatments already applied.
Written statements from two doctors
give the full explanation of the patient's condition and prognosis.
An institutional ethics committee has already reviewed this case.
And their professional recommendation is to allow death.
The public prosecutor reviews these records
and obtains any further relevant facts and professional opinions.
Since the prosecutor sees no reason to open a case-file
—which would be appropriate for any suspicious death—
the prosecutor issues an official statement
that no one will be investigated for any crime
if the plans for death are carried forward as written.
Then the proxies and the doctors choose
whatever combination of methods of dying they find best.
And this dying patient receives excellent terminal care,
which includes the chosen methods of dying.
The patient's life comes to an end.
And the doctor records the cause of death
as the underlying disease or terminal condition.
As promised, the prosecutor does nothing further.

    (13)  A patient has spent years in a persistent vegetative state (PVS).
Members of the patient's family are deeply divided about what to do.
Some refuse to acknowledge the PVS.
They cite what they believe are signs of cognitive life.
Other family members agree that the patient's condition is hopeless.
Additional neurologists are called upon to evaluate the patient.
They also conclude that the patient is in PVS and will never recover.
Because there was no Advance Directive or 'living will',
an appropriate court is required to decide
who has the power to make medical decisions on behalf of the patient.
Once the proper deciders are identified and empowered,
they decide to 'pull the plug' because this patient's life is over.
The life-supports are all disconnected and the patient dies.
Because careful safeguards were applied,
there will be no investigation by the police or the public prosecutor.

    (14)  An adult patient who is mentally like a three-year-old
has now contracted a life-threatening disease.
Because the patient cannot weigh the medical options,
an ad hoc Medical Care Decisions Committee (MCDC)
emerges from the relatives who care about this patient.
This MCDC receives all of the medical input from the doctors
and then reaches the conclusion that their patient
would not understand or tolerate the extensive medical treatments
that would be required to save him from death.
So they decide not to authorize any further curative treatments.
Rather, they agree to have their patient receive comfort-care only
for the remainder of his natural life.
The patient dies of natural causes.
And there is no investigation by anyone
because proper safeguards were used by the MCDC
in making what turned out to be a life-ending decision for their patient.

    (15)  A 90-year-old man with a heart-assist device in his chest
has now lost most of his mental capacities due to vascular dementia.
Not getting enough blood to his brain
has deprived him of most of the decision-making power he once had.
He can no longer make any important medical decisions on his own.
His children now decide that all meaningful phases of his life are over.
And they decide to deactivate his implanted heart-assist device.
This will allow him to have the natural death
that this new technology has been preventing for the last several years.
The family gets the approval of the doctors most familiar with his case.
The ethics committee of the nursing home where he is living also agrees.
And they even ask their local public prosecutor
if anyone will be charged with any crime
if they disconnect this internal form of life-support.
The prosecutor assures them in writing
that no crime will be committed if they carry forward their end-of-life plan.
The patient remains in his nursing-home bed
while the family gathers for his last day.
The doctor turns off the internal life-support
and the patient dies a natural death the next day.
Because this death was entirely expected
and the method of dying was approved by the public prosecutor,
no further investigation is needed.

    (16)  A homeless man is hospitalized with several medical problems.
Years of alcohol consumption has ravaged his body and mind.
He needs a liver transplant because his own liver is shot.
He has no family or close friends to help him to make medical decisions.
The transplant-team is reluctant to give him a new liver
because there he has no record of keeping medical appointments
or staying on the medications that have been prescribed in the past.
His body is likely to reject a new liver
because he will not take the anti-rejection drugs as prescribed.
His county social worker wants him to have the transplant
because it is the only thing that can save his life.
These two sides present their arguments to the ethics committee
of the hospital that would be the location of any liver-transplant.
Some committee members visit the man in his hospital room.
After due deliberation, the ethics committee says no.
The next available liver will go to a patient who is well matched
and who has a good record of following medical advice.
The homeless man dies a few months later of liver failure.
Because of the careful procedures for allocating available organs,
no crime was committed.
And no investigation is opened by the public prosecutor.

    (17)  A woman from a large religious family lies in a hospital,
her life supported by a variety of drugs, tubes, & machines.
Several medical experts conclude that her many medical problems
mean that she will never leave the hospital alive.
Some members of her family favor disconnecting the life-supports,
which is recommended by her doctors.
But they are not insisting on 'pulling the plug' immediately.
So everyone agrees to ask for the professional opinion of their priest.
He considers all of the medical facts and opinions
as well as the readiness for death of the patient
and the fact that at least some family members
favor disconnecting  the life-supports.
He issues a written statement to the effect that Roman Catholic faith
does not require indefinite sustaining of life by medical technology.
The doubtful family members are convinced by this affirmation.
So they too agree to follow the recommendation of the doctors.
The patient's life-supports and switched off and she dies a natural death.
Because of the careful procedures for making this life-ending decision,
no criminal investigation is ever considered by anyone.

    (18)  A woman is dying from incurable brain-cancer.
She moves to a state with a death-with-dignity law.
Following the safeguards established in that state,
she finds a doctor who prescribes a gentle poison.
She takes the poison and dies.
Because she followed the right-to-die law,
there is no criminal investigation following her death.

    (19)  A disabled person found life intolerable with his disability.
He tried many forms of assistance to cope with his limitations.
Nevertheless, he decided that he would rather be dead.
Because of his disability,
he wisely asked for a review of his end-of-life plans
by a committee of other disabled persons.
They reviewed everything about his medical care, making certain
that he did not receive inferior care because he was disabled.
They met with the disabled person
to make certain that he really wanted to die
and that he was not being unduly influenced by anyone.
Because his disabling condition was not life-threating,
there were no life-supports that could easily be switched off.
Rather, with the agreement of everyone concerned,
he chose to die by giving up all fluids.

He received all appropriate medical supports as he died.
And this included appropriate medications to ease his symptoms
when it became clear that his suffering was no longer meaningful.
He died a peaceful death following his careful advance plan.
Because of his full consultation with several others
before he started his terminal dehydration,
no investigation by the police or the public prosecutor followed.
His death was recorded as a voluntary death,
rather than an irrational suicide.

    (20)  A dying doctor laid out a careful plan for this last year.
He knew the likely path of his decline
because he was familiar with the disease that claimed his life. 
He had an Advance Directive for Medical Care,
in which he explained and authorized his preferred terminal care.
In cooperation with his own terminal-care physician,
they created a joint End-of-Life Medical Order (ELMO),
which specified his preferred methods of dying
when his condition worsened to the degree
that death would be better than continued suffering.
One of the expected contingencies did happen:
He became unconscious before he could actualize his plans for death.
But  because he had fully authorized his proxies to act on his behalf,
when the best time came, they requested death for their patient.
This request for death was honored by the terminal-care physician.
An induced terminal coma made certain that this dying doctor
would never again have another moment of consciousness.
He died without ever regaining consciousness.
Because of the careful advance planning,
there is no need for any further investigation by anyone.
The cause of death was recorded as the underlying disease.
And the full medical record shows what terminal care he received.

  

Return to the opinion article
for which these are additional examples of
helping to make wise end-of-life medical decisions.

Created May 7, 2015; Revised 5-8-2015; 5-12-2015; 5-17-2015; 9-2-2015; 11-30-2015;
1-24-2018; 6-17-2019; 3-11-2020; 

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