By
JAMES LEONARD PARK
Minnesota and several other states
are now considering legislation
to extended the doctor-approved methods of dying.
Oregon was the first state to allow dying patients
to request a prescription for gentle poison.
But even in such 'Death with Dignity' states,
the vast majority of dying patients
choose other pathways towards death.
Public discussion of this new method of dying
will make everyone more aware
of the end-of-life options already available.
Everywhere in the developed world
the following four methods of managing dying
are completely legal and ethical: (1)
comfort-care only;
(2) terminal coma;
(3) ending curative treatments and life-supports;
(4) medical dehydration.
(1) Comfort-care only
is the most common method of managing dying.
Within the standards of terminal medical care,
the doctor can provide palliative drugs
with the recognition that the medications
for controlling
symptoms
might shorten the process of dying.
(2) Terminal
coma means
keeping the patient
completely unconscious
until death occurs from natural causes.
Continuous, deep sedation is chosen
when the suffering of being awake
is worse than being kept permanently asleep.
Continuously administering the sedative drugs
guarantees that the patient will 'die in his sleep'.
(3) Ending
curative treatments and life-supports
means withdrawing or withholding all medical treatments
that are intended to save the patient from death.
If the life-support was a breathing-machine,
the patient will probably die immediately.
(4) Medical
dehydration means discontinuing
any means of providing fluids to the patient.
If terminal coma has already been chosen,
then all means of providing food and water
are usually also discontinued
since an unconscious patient cannot eat or drink
and continuing tube-feeding would only
prolong the process of
dying.
Gentle
poison
legislation adds a fifth
doctor-approved method of choosing death:
After specified safeguards have been fulfilled,
the doctor can write a prescription for a deadly drug,
which will be taken later by the dying patient.
In states where this life-ending option is already
available,
only 1-3 dying patients out of 1,000 take advantage of it.
There was wide public support for this right-to-die beforehand,
but once this new method of choosing death was legalized,
the vast majority of dying
patients did not use it.
These five ways to manage dying
require some cooperation from doctors.
And normal terminal care already includes
using drugs to control symptoms,
disconnecting the life-supports,
and giving up food and water.
But in a few rare cases,
the doctor might agree that using gentle poison
would improve the process of dying.
Nevertheless, discussing this new method
of choosing immediate death
will make everyone more aware of the
methods and procedures already available at the end of life.
And if more safeguards are needed
for making end-of-life medical decisions,
then such safeguards should apply
to all methods of managing
dying,
not just the decision to die by gentle poison.
Right-to-die laws will gain more support from
doctors
when they explicitly authorize the end-of-life decisions
already used by doctors for their dying patients.
Why not give doctors official, legal authorization
for the methods of dying they routinely employ?
And some doctors will approve new method of dying —gentle
poison to bring a quick, painless death.
The new
right-to-die
law in Quebec
endorses all of the existing methods of choosing death
and adds "medical aid in dying",
which means a physician prescribing gentle poison.