CAUSING PREMATURE DEATH


DRAFT ADDITION TO THE HOMICIDE LAW
OF EACH STATE OR COUNTRY
REPLACING THE LAW AGAINST ASSISTING SUICIDE




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 THE CHOSEN 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 THE CHOICE FOR 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;



   
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.




This draft legislation is also included in
How to Die: Safeguards for Life-Ending Decisions
as Chapter 57:
"Causing Premature Death:
Draft  of Legislation to Replace Laws Against 'Assisting Suicide' ".

Would you like to join a world-wide Facebook Seminar
discussing this book-being-revised?

See the complete description for this first-readers book-club:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-HTD.html

Join our Facebook Group called:
Safeguards for Life-Ending Decisions:
http://www.facebook.com/home.php#!/groups/107513822718270/



Go to the Right-to-Die Portal.



Go to the Medical Ethics Index Page.




Go to the Death Index Page.



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