Some
modification of this proposed law should replace
all existing state and
national laws against
'assisting suicide'.
Or if the laws against assisting suicide
are still wanted to discourage assisting an irrational suicide,
a revised law against
helping others to commit foolish self-killings
could replace the present ambiguous laws.
This model law against
causing premature death
deals with patients who were believed to be dying.
It should be placed within the homicide law,
as the lowest degree of
homicide,
perhaps after negligent vehicular homicide.
The
numbers in the left margin
are intended to facilitate
discussion and revisions.
Only the numbered lines are intended as text for the law.
Each state or national
legislature will create its own version
of this proposed legislation.
1. Section I.
Definitions
2. "Premature death" shall mean
3. the ending of a human life before the best time for
that life to end.
4. Those who cause premature death
5. have acted to end
the life in question too soon.
6. The operational proof that a death was not premature
7. consists of fulfilling substantially all the
safeguards in Section V.
2. "Life-support systems" shall
mean
3. all procedures, devices, and medications intended
to sustain life.
4. These include but are not limited to the
following:
5. respirators, heart-lung machines, dialysis
machines,
6. blood transfusions and other intravenous fluids
and nutrition,
7. feeding tubes to supply nutrition and hydration,
8. drugs to maintain blood pressure, and cardio-pulmonary
resuscitation.
9. And it shall include new methods of supporting
vital functions
10. that will be invented in the future.
11. But it will not include means of controlling
pain and providing comfort.
2. "Irrational suicide" shall
mean the premature ending of one's own life.
3. As a matter of public policy,
4. this state does not wish to encourage irrational
suicide,
5. but neither irrational suicide
6. nor attempted
irrational suicide is prohibited by this law.
7. However, assisting an irrational suicide of a
dying patient
8. or assisting an attempted irrational suicide
9. are both prohibited as forms of causing premature
death
10. or attempting to cause premature death.
2. "Voluntary death" shall mean
ending one's own life
3. at the right time according to one's own ethical
principles
4. and by the methods of one's own choosing.
5. To be certified and recorded as a voluntary death
6. the choice must meet all four of the following
criteria:
7. (1) It must be a benefit to the patient,
not a harm.
8. (2) It must be a rational decision
by the patient.
9. (3) It must be planned well in advance,
10. taking the
opinions of those who will be affected into account.
11. (4) It must be regarded as a commendable
and admirable choice
12. by others who
know all the facts.
13. Operationally, these four
criteria will be fulfilled
14. if the death-planning record shows that
substantially all
15. of the safeguards in Section V have been
fulfilled.
16. Neither voluntary death nor
assisting a voluntary death
17. is prohibited by this law.
2. "Mercy-killing" is the
premature ending of the life of another person,
3. whether requested by the decedent or not.
4. Mercy-killing is distinguished from other forms
of homicide
5. in Section II of this law.
6. Mercy-killing remains a punishable crime under
this law.
2. "Merciful death" is the
practice of ending the life of another person
3. at the right time and by the most appropriate
means
4. according to the ethical principles of the
proxies duly authorized
5. to make life-ending decisions for the patient.
6. To be certified and recorded as
a merciful death
7. the choice
must meet all four of the following criteria:
8. (1) It was a benefit to the patient,
not a harm.
9. (2) It was chosen rationally
10. by
duly-authorized proxies for the decedent.
11. (3) It was planned and announced
sufficiently in advance
12. to allow
all concerned to express
13. their
options about the decision.
14. (4) It is regarded by those who know
the facts
15. as a wise
and compassionate choice.
16. Operationally, these four
criteria are satisfied
17. if substantially all of the safeguards
18. in Section V of this law are fulfilled.
19. Merciful death is not
prohibited by this law.
20. And persons who perform or cooperate in a
merciful death
21. are protected from prosecution
22. by fulfilling substantially all of the safeguards
in Section V.
1. Section II. Causing Premature Death
Distinguished from other
forms of
Homicide
2. Causing premature death shall
be distinguished
3. from other forms of homicide by the following
factors.
4. The act shall be classified as causing a premature
death
5. when all of the following factors are present:
6. (1) The perpetrator personally
knew the decedent.
7. (2) The perpetrator believed
with good reason
8. at
the time of the act that the decedent was dying.
9. (3) The perpetrator believed
with good reason
10. at the time
of the act that the decedent was suffering
11. and that
the causes of that suffering
12. could not
be cured or changed.
13. (4) The perpetrator's motive
was mercy rather than malice.
1. Section III. Three Classes of the Crime:
Causing Premature Death
2. The prosecutor shall decide
which of the following
3. three classes the alleged crime fits most closely:
4. (1) Premature ending of medical
treatments
and/or
withdrawal of
life-support systems.
5. (2) Assisting another person in
an irrational suicide.
6. (3) Acting to cause the
premature death of another person.
This crime is
commonly known as "mercy-killing".
1. Section IV. Punishment
2. If found guilty of any form of
causing premature death,
3. the court shall sentence the perpetrator
4. to imprisonment for a term of one year or less,
5. depending on the circumstances of the crime
6. and any prior convictions the perpetrator might
have.
7. This term of imprisonment shall
be less than
8. the punishment for any other form of
homicide.
9. The term of
imprisonment for the person found guilty
10. of causing a premature death
11. shall not be greater than the number of days lost
by the victim.
1. Section V. Safeguards for Life-Ending
Decisions,
which may be offered as Defense
Against the Charge of
Causing Premature Death
The thrust of these defending factors
is to show that the death was not premature,
that the patient's life ended at a reasonable time
and by a painless means.
If these conditions are met, no harm came to the patient.
And hence no crime
was committed.
2. Any and all of the following
factors shall constitute a defense
3. against the charge of causing a premature death:
1. A. ADVANCE
DIRECTIVE
FOR MEDICAL CARE
2. The patient issues an
advance directive for medical care.
3. This will normally be prepared years before the
patient's death.
4. An
advance directive sets forth the patient's medical ethics.
5. The patient explains how to separate
6. the conditions that
lead to the choice of continued life
7. from the conditions that lead to a life-ending decision.
8.
Probably as an appendix to the patient's
advance directive,
9. the chosen proxies and perhaps others close to
the patient
10. can create their own statements
11. expressing their agreement with the advance directive
12. and (if they are proxies) their commitment
13. to carry forward the settled values of the patient.
1. B. REQUESTS
FOR
DEATH FROM THE
PATIENT
2. The
patient
repeatedly asked for death
3. over a period of several weeks.
4. If the patient put these requests into
writing,
5. as in a 'living
will' or
advance directive for medical care,
6. this defense is strengthened.
7. If the patient was not capable of making any
requests for death
8. at the time of death, his or her prior requests
for death
9. under similar circumstances are definitive.
10. And any written records of such requests
11. also strengthen the case for the defense.
12. If the patient was not capable of making
requests for death
13. but had authorized a proxy or proxies
14. to make medical decisions for him or her,
15. then any requests for death given by such proxy
or proxies
16. shall have the same standing as requests from
the patient.
1. C. THE
PATIENT IS
MENTALLY CAPABLE OF MAKING A LIFE-ENDING DECISION
2. The patient was mentally
capable of deciding his or her death
3. at the time any requests were made.
4. This capacity may be established by the testimony
of laypersons
5. as well as by the professional
opinions
6. of
licensed
psychologists or psychiatrists.
1. D. PHYSICIAN'S
STATEMENT
OF CONDITION AND PROGNOSIS
2. A
physician had
issued a professional opinion
3. that the patient was dying or had an incurable
condition
4. or was in a debilitated or unconscious condition
5. from which he or she would probably never
recover.
6. Such conditions include, but are not limited to,
7. persistent vegetative state and permanent coma.
1. E. INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
2. An
independent
physician confirmed and substantially agreed
3. with
the
diagnosis and prognosis of the physician mentioned in D.
1. F. CERTIFICATION
OF TERMINAL ILLNESS OR INCURABLE CONDITION
2. The same physicians who have written
3. full
statements of the patient's condition and prognosis
4. can create a separate
document to certify
5. that
the
patient has a terminal illness or condition
6. if they can say with confidence that the patient's
illness or condition
7. will lead to death within 6 months.
8. They should say whether this projection includes
life-supports or not.
1. G. UNBEARABLE
SUFFERING
2. The patient requests death because of
physical suffering
3. that cannot be relived sufficiently by any known means.
4. This suffering is documented as well as possible
5. by the doctors who have been consulted.
1. H. UNBEARABLE
PSYCHOLOGICAL SUFFERING
2. The patient suffers from psychological
problems
3. that do not yield to any known methods of treatment.
4. Because being in a such psychological state
5. might render the patient unable to make wise medical
decisions,
6. proxies for the patient have been appointed,
7. who then must make the final life-ending decision
8. if death seems better than all the other alternatives.
1. I. PALLIATIVE
CARE
TRIAL
2. The patient actually received comfort care
3. from medical personnel well trained in the care of
the dying.
4. This goes beyond explaining the
benefits of palliative care.
5. And it is more than a consultation with a palliative
care specialist.
6. The patient actually received physical and psychological
care
7. from providers who know how to care for the dying.
9. However, if the patient knew
the benefits
of palliative care
10. and/or consulted with a palliative care specialist,
11. these facts support the claim that the death was
not premature.
1. J. INFORMED
CONSENT FROM THE PATIENT
2. The patient must have full information
about his or her condition
3. and all the relevant medical treatments that are still
possible.
4. Only when the patient has received and understood
5. the doctor's statements concerning
condition and prognosis
6. is the patient able to make wise life-ending decisions.
1. K. REQUESTS
FOR
DEATH
FROM THE PROXIES
2. If the patient can no longer make medical
decisions,
3. then the decision-making power shifts to the proxies,
4. who have been carefully chosen by the patient
5. when the patient was still fully able to make medical
decisions.
6. The proxies shall carefully consider all
the facts and opinions
7. from other persons protecting the
best interests of the patient.
8. Then the
proxies can
decide to request death
9. in the same ways the patient could request death while
capable.
1. L. ENROLLMENT
IN A
HOSPITAL OR HOSPICE
2. The
patient was
treated in a hospital or a hospice program,
3. which kept careful records of all
discussions and decisions
4. regarding the care of the patient,
including but not limited to
5. all discussions and decisions related to
end-of-life choices.
1. M. STATEMENTS
FROM
HOSPITAL OR HOSPICE STAFF MEMBERS
2. Beyond the hospital's or hospice's official
medical records,
3. nurses, doctors, and volunteers
4. who have had
meaningful connections with the patient
5. can also create statements
about their discussions
6. with
the
patient about life-ending decisions.
1. N. STATEMENTS
FROM FAMILY
MEMBERS
AFFIRMING
OR
QUESTIONING CHOOSING DEATH
2. Other
persons who
knew the patient
3. for
meaningful
periods of time agreed with the life-ending decision.
4. Even though these significant other persons
5. might not have been directly involved
6. in the process of making the life-ending decision
7. and were not responsible for carrying it out,
8. they
knew of the
plans well in advance of the
death
9. and in their considered opinions, it was a wise
choice.
1. O. A
MEMBER
OF THE
CLERGY
APPROVES
OR
QUESTIONS CHOOSING DEATH
2. A
member of the
clergy of any religious organization
3. or the professional leader of an ethical
organization
4. known by the patient approved the life-ending
decision.
5. If the patient was not part of any such
organization,
6. another similar responsible member of the
community
7. may fill this role of neutral
ethical observer.
1. P. RELIGIOUS
OR OTHER MORAL PRINCIPLES
APPLIED TO THIS
LIFE-ENDING DECISION
2. If chosen by the patient and/or the
proxies,
3. some authority on
the doctrine of the religion with which
3. the patient is
affiliated reviews how those moral principles
4. apply to the
end-of-life
decisions
5. being considered by the patient and/or the proxies for
the patient.
6. If that
interpretation supports a life-ending
decision,
7. then a written statement to that effect
8. could be made
part of the death-planning record.
9. If the patient and/or the proxies so choose,
10. some non-religious moral principles
11. can be brought to bear on this life-ending decision.
12. Such moral reviews can show that the
death was not
premature.
1. Q. AN
INSTITUTIONAL
ETHICS COMMITTEE APPROVES THE DEATH
2. An
ethics
committee of the institution
3. where the patient is being cared for
4. reviews all of the documents created for the
death-planning process
5. and approves the life-ending decisions.
6. Whenever possible,
the ethics committee (or some member thereof)
7. should consult with the patient in person.
8. An independent ethical
consultant can also fill this role.
1. R. STATEMENTS
FROM
ADVOCATES FOR
DISADVANTAGED GROUPS
IF
INVITED BY
THE PATIENT AND/OR THE PROXIES
2. If the patient has any worries about
discrimination
3. because of membership in a group sometimes
disfavored by society,
4. he or she can select an advocate from his or her
identity group
5. who will review the death-planning documents
6. to make sure that no discrimination has taken place
7. because of the group-identity of the patient.
8. Adding any such statements to the death-planning
record
9. will assure others who are not as close to the
patient
10. that the
life-ending
decisions were not tainted by discrimination
11. and that the patient's terminal care
was appropriate.
1.
S. REVIEW
BY
THE
PROSECUTOR (OR OTHER LAWYER)
BEFORE
THE DEATH
TAKES PLACE
2. If those who are making plans
for death
3. have any doubts about the legality of their
proposed course of action,
4. they can opt to send
a report of
the death-planning process
5. to
the local
prosecuting authority for review.
6. They might explain which of the
following they are planning:
7. (a) withdrawal or withholding life-support
systems,
8. (b) assisting in a voluntary death, or
9. (c) granting a merciful death.
10. And the several documents of the death-planning
process
11. might be shared or summarized for the prosecutor
12. to show that the proposed course of action
violates no laws.
13. The prosecutor should be
allowed one week to respond.
14. The prosecutor can reply that the death should go
ahead
15. and that all who participate or cooperate in the
planned death
16. will not be subject to prosecution for any crime.
17. Or the prosecutor can ask for additional
information
18. to make certain that this death will not be
premature.
1. T. CIVIL
AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
2. Civil
and
criminal penalties will remain in place.
3. Anyone tempted to encourage or cause a premature death
4. will know that there are criminal and civil
penalties
5. that will be applied if someone does any harm to another
6. under the guise of making life-ending decisions.
7. Fulfilling the other safeguards for
life-ending decisions
8. will show that this death was a wise, end-of-life
medical choice.
1. U. WAITING
PERIODS
FOR REFLECTION
2. Appropriate
waiting periods are allowed to elapse
3. between the time when the life-ending decision is
taken
4. and when the act is performed:
5. (a) one week for the
withdrawal of life-support systems,
6. (b) one year for a voluntary
death, or
7. (c) six months for a merciful
death.
8. These waiting periods may be adjusted
9. when adequately explained by
10. the special circumstances of this life-ending
decision.
11. Spreading the life-ending decision over significant
periods of time
12. allows all concerned to re-think their previous
decisions.
1. V. OPPORTUNITIES
FOR THE PATIENT TO RESCIND OR POSTPONE
ANY
LIFE-ENDING
DECISIONS
2. If the patient has already
begun the death-planning process,
3. ample
opportunities shall be provided
4. for
the patient
to change his or her
mind.
5. The people offering these opportunities shall
document
6. that the patient was giving several chances
7. to
reverse
or delay the death-planing process.
8. Does the patient decline each opportunity to
change course
9. and reaffirm his or her determination to choose
death?
1. W. PHYSICIANS
REVIEW THE COMPLETE DEATH-PLANNING RECORDS
2. When most of the other statements
have
been written,
3. the physicians most responsible for the patient's
terminal care
4. will
read and
respond to each statement
5. and
make a final recommendation.
6. If authorized by law, and if the
terminal-care physician is convinced
7. that in his or her professional judgment
8. death
now would be better than death
later,
9. this
physician
is permitted to write a prescription
10. for
life-ending
chemicals to be taken by the patient
11. for
the purpose
of causing a peaceful and painless death.
1. X. COMPLETE
RECORDING AND SHARING
OF
ALL MATERIAL
FACTS AND OPINIONS
2. The death-planning process
should be honest and open.
3. The
written
statements of all persons involved
4. should
be
shared freely among all persons
5. who
have
legitimate rights to take part in planning this death.
6. The fact of such open sharing and
discussion
7. —
with signed and
recorded opinions from many
participants—
8. should help to prove that this is a
well-considered decision,
9. not a hidden or secret conspiracy to cause a premature
death.
1.
Y. THE
PATIENT IS CONSCIOUS AND ABLE TO CHOOSE DEATH
2. While not a required to prove the
life-ending decision was wise,
3. if the patient
remained conscious until the last moment of life
4. and possibly took
some
life-ending action by his or her own hand
5. then this death was not
premature.
1.
Z. THE
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
2. If the process of planning the patient's
death
3. has employed a death-planning
coordinator
4. or if someone volunteers to organize the
death-planning
records,
5. this level of organization for the death-planning
process
6. will be evidence that the chosen death was a
wise decision.
7. And the complete collection of death-planning
documents
8. should be permanently stored in case there is ever
any reason
9. to review this life-ending decision.
10. The death-planning
records shall not be made available
11. to the public, to any government officials
12. (except as might be required by law-enforcement
investigations)
13. or to any news-gathering organizations.
1. Section VI. Recording of Deaths
2. The commissioner of health of
this state,
3.
(or other authority responsible for keeping records of deaths)
4.
the medical examiner of each county,
5. and the prosecuting authorities throughout this
state
6. shall establish three new statistical categories
for deaths
7. as defined by this law:
8. (1) voluntary deaths (as
distinct from irrational suicides),
9. (2) merciful deaths (as
distinct from mercy-killings), and
10. (3) premature deaths (a form of homicide).
11. Physicians responsible for
filing death certificates
12. shall also conform to these definitions.
13. If the medical examiner finds
the death-planning record
14. fulfills the definition of a voluntary death in
this law,
15. that death shall be recorded for all purposes
16. as a voluntary death, not an irrational suicide.
17. And if the death-planning record explains the reasons
18. for the voluntary death to be a fatal disease,
illness, or
condition,
19. that fatal disease, illness, or condition
20. shall be recorded
as the primary cause of death,
21. with the additional notation
22. that the patient chose a voluntary death
23. rather than waiting for natural processes to
kill him or her.
24. If the medical examiner finds
the death-planning record
25. fulfills the definition of a merciful death in
this law,
26. that death shall be recorded as a merciful death,
27. not any form of homicide, including causing
premature death.
28. And if the death-planning record explains the
reasons
29. for the merciful death to be a fatal disease,
illness, or
condition,
30. that fatal disease, illness, or condition
31. shall be recorded as
the primary cause of death,
32. with the additional notation that the proxies
chose a merciful death
33. rather than waiting for natural processes to
kill the patient.
34. No new statistical category
need be established
35. for recording deaths that result from
36. the withholding or withdrawal of life-support
systems.
37. These deaths will automatically be recorded
38. as caused by the underlying disease, illness, or
condition.
39. But the record should also show that a careful
process was followed
40. in reaching the decision to remove the life-support
systems.
Revised several times
in January, 2007; revised 2-17-2007; 3-9-2007; 3-29-2007; 12-31-2007;
4-4-2008; 8-25-2008; 2-23-2009; 1-13-2010;
1-5-2012; 1-15-2012;
2-28-2012; 3-16-2012; 4-8-2012; 4-11-2012; 9-6-2012;
4-6-2013; 6-14-2013; 6-20-2014; 7-15-2015; no changes 8-25-2016;
12-6-2018;
The above draft
legislation was first created in
1995 by James Park.
It was revised by him in 2004, 2005, 2007, 2008, 2009, 2010, 2012,
2013, 2014, & 2015.
Some of the safeguards embodied in Section V
were originally published in a small book by James Park entitled
Ten Safeguards for
Life-Ending Decisions, 1995.
Here is an updated summary of that book,
now called "Fifteen Safeguards for Life-Ending Decisions":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-10SG.html
Several advantages of
this form of legislation
in contrast to the more conventional laws allowing life-ending chemicals
are discussed here:
Advantages
of the Premature-Death Approach to the Right-to-Die
Other safeguards might
also be included in any state
or national law
defining and prohibiting encouraging
or causing premature death.
A website discussing such safeguards was established in January 2007:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG.html
The above draft will be further revised
following the suggestions of any readers.
Send your suggestions to James Park, e-mail:
parkx032(CAPS2)umn.edu
If and when any state or national legislatures adapt
any similar laws
repealing, replacing, or supplementing laws against assisting
irrational suicide,
such laws will be listed here, with appropriate links.
In 2016, the national government of Canada
created a new right-to-die law
making exceptions to the earlier law prohibiting assisting suicide.
Doctors and nurse practitioners are now permitted
to provide medical aid in dying
without fear of being prosecuted for 'assisting suicide':
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/RTD-CAN.html
In connection with Section VI.
Recording of Deaths,
an
additional line has been suggested for all Certificates of Death:
medical methods of managing
dying or life-ending
decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/DC-LED.html
If other such
suggestions exist on the Internet,
they can be linked from here.
Different versions of the provisions above
can also be offered here.
Completely different approaches to achieving the
same ends
are also welcome.
Let's be as creative as we can be.