Advantages of the Premature-Death Approach to the Right-to-Die
Applies to All
Life-Ending Decisions,
Not Just those Cases that Choose to Be Covered by the Law
LAWS THAT PERMIT LIFE-ENDING
CHEMICALS ARE OPTIONAL
Right-to-die laws that provide for
making application for permission
to end one's life
all depend on the initiative of the patient,
the proxies, and/or the
doctors involved.
And the history of such laws in the west coast states
of Oregon and
Washington shows that only 1-4 deaths
in 1,000
was covered by the Death with Dignity Acts.
Life-ending decisions take place much more often
than that.
Of deaths that take place in hospitals, some estimates suggest
that 80% of such deaths under medical care involve choices.
In other words, even in Oregon,
where voluntary
death has been permitted since 1997,
only a small fraction of
deaths are explicitly placed
within the protocol of the Oregon Death with Dignity Act.
There are meaningful and effective
safeguards
in
the Oregon Death with Dignity Act.
But these safeguards are not
applied when the patient, family, & doctors
decide to make their
terminal-care choices outside of that law.
How could we craft right-to-die laws
so that more
life-ending decisions would be covered?
What modifications of such laws would make them more widely used?
Adding more safeguards, more review committees, & more paperwork
does not seem likely to encourage more people to use such
laws.
And laws authorizing the use of life-ending chemicals
can probably never require
that all life-ending
decisions follow any safeguards.
For example, it is becoming more common in Holland
to use terminal sedation
rather than death by lethal
injection.
Keeping the patient unconscious until natural death occurs
does not require any special safeguards, protocols, etc.
CRIMINAL LAW COVERS EVERYONE
However, when laws are written to prohibit any form
of homicide,
such laws automatically apply to all situations
in which someone might
be killed.
Specifically, if the law prohibited causing a premature death,
then everyone involved in any form of action or behavior
that might result in someone else being harmed
by having his or her life terminated too soon would come under
that law.
Laws against homicide are
universal, not optional.
Thus the
safeguards embodied in any law against
causing premature
death would apply to all
life-ending decisions.
Whenever human beings make choices about terminal care,
the end-of-life decisions
might harm the patient
by bringing the patient's life to an end too soon.
Whenever such mistakes, abuses, errors, & harms
take place,
the punishments in any new law against causing premature death
should be applied to everyone found guilty
of causing the patient to
die too soon.
The safeguards explicitly separate
those life-ending decisions
that result in premature death
from those choices that
result in death at an appropriate time.
In most deaths that take place under medical care,
just a few safeguards will easily demonstrate
that the life-ending choices were wisely decided.
The medical record itself might be sufficient proof
that all available options have been explored
and that several means of healing were actually tried.
But in those few marginal cases,
where at least a few people of good will might raise doubts,
then those who are making the life-ending decisions
will be more diligent to
fulfill more of the safeguards
listed in the law against causing premature death,
each of which adds to the evidence
that these end-of-life choices were carefully and wisely made.
The safeguards ensure that several
independent persons
—both
medical professionals and laypersons—
are asked to examine the facts and offer their opinions.
As each safeguard is fulfilled, a new document is
written.
In the vast majority of cases, there will be no need for anyone
other than those directly involved in the life-ending decisions
to know anything about these documents.
But if ever there is reason to open a homicide
investigation
because of a possible premature death,
then the documents will be readily available
to constitute defense against
the charge of causing death too soon.
And even when a prosecutor decides to open an
investigation,
in most of these cases, the documents already collected
will be overwhelming proof
that no premature death occurred.
Thus the prosecutor will not continue the investigation
and no charges of violating any law will be brought.
However, in those very rare cases
when someone commits
the crime of causing a premature death,
then the law specifies the punishments to be applied
to anyone who participates in such a crime.
Here are some guesses about numbers:
When we consider all situations of terminal care
in which some life-ending decisions were made,
probably less than 1 death
in 1,000 would be worth investigating
under any new law against causing premature
death.
If and when some jurisdiction on the Earth
enacts such a law,
we shall see just how many cases are opened by the prosecutors.
And we will see what percentage
of these suspected cases of
causing premature death
were proven to be criminal
acts under the law.
Nevertheless, even if there are only a few
prosecutions each year,
all people who make life-ending decisions
---especially doctors and others who recommend such decisions---
will be well aware of the safeguards contained in the law.
And in the back of their minds, they will consider the evidence
that might be presented on each side of such a criminal case.
Doctors are already doing such thinking every day
when they consider the possibility of civil suit for malpractice.
They create documentation that will prove
that they did not make a
medical mistake
that could put them in court to defend against a malpractice
suit.
In other words, the safeguards embodied
in the law
against causing premature death
will apply universally to all
life-ending decisions,
even when the case is so
obvious that a few seconds of thought
will resolve any question about the legality of the end-of-life choices.
Any participant in a life-ending decision
might be charged with causing a premature death.
And every participant will know what safeguards have been fulfilled
to show that the chosen death
was NOT PREMATURE.
Created April 9,
2007; revised 4-13-2007; 2-1-2008; 2-28-2008; 8-25-2008;
3-5-2009; 6-7-2009;
3-27-2010; 2-15-2011; 1-5-2012; 1-17-2012; 1-22-2012
; 3-30-2012; 7-19-2012; 9-7-2012;
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2-22-2018; 12-1-2020