Advantages
of the Premature-Death Approach to the Right-to-Die
Brings Underground Chosen Deaths
Above Ground
UNDERGROUND
CHOSEN DEATHS IN OREGON
When we note that
only 2-4 deaths in 1,000 in Oregon
has been reported as using the Oregon Death with Dignity Act,
it seems that there must be many
more chosen deaths
that were kept outside of this law.
The people of Oregon voted twice to create their
right-to-die law.
So at least half of
the people who died in Oregon in the last
two decades
voted in favor of the
Oregon Death with Dignity Act.
So, what happened to them at the end of their lives?
Perhaps it was sufficient for them to affirm the
right-to-die.
And when it came time for their own deaths,
they decided to go ahead with a planned death
but they decided not to
bother with the paperwork
required by the Oregon Death with Dignity Act.
They and their doctors just conspired to avoid the law
and keep this death outside the reporting required by the DWDA.
We should not assume these deaths were wrongly
decided.
Good safeguards might have been used in choosing death.
But if there was some
aid-in-dying,
it was not correctly reported to the Oregon Department of Health.
The element of choice was not mentioned on the death-certificates.
These death-certificates merely name the underlying disease or
condition
---omitting any mention of
the
decision to shorten the process of dying.
That is the way all deaths are handled
when life-supports systems sustain the patient's life toward the end.
The withdrawal of
life-supports is not recorded as a cause of death.
If we examined the medical records,
we would learn exactly which medical measures were in use
and which changes in medical orders occurred just before death.
But it was not relevant to mention these facts on the certificate
of
death.
When the life-support machines, etc. were turned off and detached,
the death that was predestined to happen took its natural course.
And cancer (or whatever) was recorded as the cause of death.
In Oregon, patients and doctors are finding other
ways to bring death
than applying for the complex protocol
prescribed by the Oregon Death
with Dignity Act.
Why wait for two weeks
when relief is needed right
now?
(In 2020, this waiting period was eliminated
for patients likely to die in less than two weeks.)
Most of the deaths outside of the DWDA were probably
not caused
by
life-ending chemicals prescribed by a physician.
Rather, other, more readily-available means were chosen,
perhaps involving giving up
some forms of medical treatment
that were keeping the patient alive.
Maybe life-ending chemicals will not be a popular
method of dying.
Doctors can more easily increase
the pain medication already in use.
And the process of dying will be shortened as a result.
Doctors can even order terminal coma,
which will keep the patient unconscious until death.
Terminal coma will probably be coupled with giving up food and
water,
since an unconscious patient cannot eat or drink normally.
Or perhaps the patient will decide to
stop food and water.
But even voluntary
death by dehydration
might not be mentioned on the certificate of death.
The death-certificate will probably name the underlying condition
that led the patient and/or the proxies to choose death by dehydration.
BRINGING MORE CHOSEN DEATHS INTO
THE OPEN
In the Netherlands, where shortening the process of
dying
has been well accepted for many years,
about 5% of all deaths
were achieved with the help of a physician.
(In
recent years, Dutch physicians have increasingly been choosing
increasing pain-medication and induced terminal coma
instead of applying for permission to use lethal injection.
Since such methods do not need to be reported,
the number of deaths assisted by physicians might be much higher.)
5% might be a reasonable goal for other advanced
cultures.
As noted at the beginning, in Oregon only 2-4 deaths per thousand
are reported as having used the Oregon Death with Dignity Act.
Here are the easy-to-remember numbers for the first ten years:
About 300,000 Oregonians died.
Only 300 chose the official Death-with-Dignity pathway towards death.
Why so few?
If the Dutch pattern prevailed,
50 times as many Oregonians would be choosing timely deaths
rather than following the pathway of standard terminal care.
Probably more
than these 300 citizens of Oregon
chose timely deaths,
but for reasons unknown they did not choose
to apply for the right-to-die under the Oregon Death with Dignity Act.
If the Netherlands proportions hold in Oregon,
for each person who
followed the official route,
there were 50 others
who kept their chosen deaths underground.
Over ten years, this amounts to
about 15,000 underground
chosen
deaths in Oregon.
As said before, when chosen deaths remain
underground,
there is no certainty that they were wisely chosen
because no public safeguards
were used in the end-of-life discussion.
There are about 10
different
safeguards in Oregon's
Death
with Dignity Act.
Perhaps some changes should be
incorporated
in other right-to-die laws that follow the pattern set in Oregon
so that more people who are
choosing timely deaths
will take advantage of the right-to-die
and have their deaths
correctly recorded.
A fifty-fold increase in applications for voluntary death
would mean that the deaths of many more people
would come under the
safeguards for life-ending decisions
that are intended to prevent premature death.
When laws are written that most people avoid,
it means that patients and their families will not benefit
from the public safeguards embodied in those laws.
LAWS AGAINST CAUSING
PREMATURE DEATH
MIGHT BE MORE
WIDELY HONORED
The other approach to the right-to-die suggested here
puts the public safeguards
into the homicide section of the laws.
People who are giving secret aid-in-dying now
know there is a remote chance they will be caught helping others to die
and be charged with some form of homicide.
And some desperate relatives resort to mercy-killing
because the medical system seems to offer no relief.
When laws against causing premature death are
enacted,
underground aid-in-dying and
mercy-killings might largely disappear.
Doctors, nurses, patients, & relatives will know what safeguards to
fulfill
to prevent anyone from being charged with causing a premature
death.
And desperate family members
who might otherwise have been tempted to commit mercy-killings
will decide that there are better ways to make life-ending decisions.
The safeguards embodied in the law
will tell them just what
steps they should take
to make certain that they are making wise end-of-life decisions.
The law tells everyone involved in planning death
exactly how to defend themselves
against the charge of causing a premature death:
If they carefully fulfill the safeguards,
this process will steer them away from pulling the plug too soon.
And helping the patient to die at the best time
will not result in prosecution for any crime.
Where laws against 'assisting suicide' are still on
the books,
people who give aid-in-dying might be prosecuted.
Free-lance, underground aid-in-dying can be charged
as 'mercy-killing' or as a form of 'assisting a suicide'
—both
of
which are crimes that
will be prosecuted
under some part of the laws against homicide.
If there is a trial before a jury of peers,
the jury will be asked to decide whether a crime was committed.
And even tho the jury does not approve of the behavior
of the one who
caused the death,
they can sympathize
with the thinking behind it.
So they refuse to send the perpetrator to jail:
At least one juror votes for acquittal.
And the person who caused a questionable death is not punished.
When the law explicitly allows such life-ending
choices,
then people can fulfill whichever of the specified safeguards
seem most relevant for the life that is now coming to an end.
And later they might risk prosecution if their decisions were unwise.
The most careful families will do the best job of fulfilling the
safeguards.
And when they present
their fulfilled safeguards to the prosecutor,
the prosecutor will see immediately
that there is no chance of
winning a conviction from a jury of peers
—people
who are like the family that chose a timely death.
When new laws define 'causing premature death'
and specify safeguards to defend oneself against that charge,
this give the potential defendants
explicit permission to present
any evidence
to support the conclusion that it was a wisely-decided death.
Under murder laws, such evidence is often excluded.
So the jury does not know what went thru the minds of the family.
The jury is only allowed to hear evidence of what the family did.
The jury knows nothing about the medical condition of the patient.
This exclusion of information sank the last case of Jack Kevorkian.
The family was not able to testify that they also agreed
that it was a wise choice for Thomas Youk to end his life
when he decided he could no longer tolerate his suffering due to ALS.
The fact that Thomas Youk could no longer
use his own hands to bring about his death
should not have sent Jack Kevorkian to prison.
Under laws against causing premature death,
Jack Kevorkian would have
known exactly what safeguards to fulfill.
And the judge and/or jury would have decided
that it was a wisely-chosen
voluntary death
—not
murder in the second degree.
In fact, if specified safeguards had been fulfilled in advance,
the prosecutor
would never have thought
to bring the charge of causing a premature death.
The death-planning record showing the fulfilled safeguards
would have proved that Thomas
Youk's death was
NOT PREMATURE.
Jack Kevorkian brought underground chosen
death into the open.
But the law of Michigan was not yet ready to recognize
the validity of making life-ending decisions
by fulfilling meaningful safeguards intended to prevent premature
deaths.
When Michigan—or
any other state or country—
enacts a law against causing premature death,
then everyone will know just
what safeguards might be fulfilled
in order to prove to any prosecutor, judge, or jury
that the life-ending decision
was a wise and ethical choice
under the circumstances
---not any crime that should
be
punished.
Those who help others to die using meaningful
safeguards
are providing compassionate help
to the patients, not harming
them.
When some jurisdiction outlaws causing premature
death,
everyone involved in making life-ending decisions
will know exactly what guidelines they must follow
to avoid being changed with causing a premature death.
The safeguards embodied in the law will be applied much more
broadly
than under laws that allow life-ending chemicals,
which, as we have seen, are widely
unused.
Can it be called a success
when public safeguards
are applied to only 2-4 deaths in a thousand?
Created March 30,
2007; revised 3-31-2007; 2-1-2008; 2-28-2008; 8-25-2008;
3-5-2009;
6-10-2009; 3-27-2010; 2-15-2011;
1-5-2012; 1-17-2012; 1-25-2012; 2-28-2012;
3-14-2012; 3-30-2012; 7-20-2012; 9-7-2012;
4-6-2013; 6-15-2013; 6-19-2013; 6-20-2014; 3-18-2015; 7-15-2015;
8-7-2016; 2-28-2018; 12-2-2020;
Underground
chosen deaths might not be wisely decided.
But
if there were a clear law against causing premature death
containing
specific safeguards to use to
defend against the charge
of causing premature death,
then
more openness and honesty in dying would be possible.
This
argument is Section F of Chapter 60 of
How
to Die:
Safeguards for Life-Ending Decisions:
"Brings
Underground Chosen Deaths Above Ground".
See
the Model Statute called Causing
Premature Death.
This
draft legislation embodies 26 recommended safeguards.