Will Minnesota be the first place on Earth to create
a hospice
that allows all medical methods of choosing death?
Traditional hospice programs embrace only natural
death:
The process of dying is neither hastened nor prolonged.
But a right-to-die hospice would permit its patients
to select any combination of the following
four legal medical methods of managing dying:
(1) providing comfort-care only;
(2) inducing terminal coma;
(3) ending curative treatments and life-supports;
(4) giving up water.
(1) Providing comfort-care only
would apply to any
patient
who is already receiving medication to relieve symptoms.
Within the standards of terminal medical care,
the doctor could increase the same drugs
with the recognition that the medications for controlling symptoms
might also shorten the process of dying.
(2) Inducing terminal coma
means keeping the patient
completely unconscious until death occurs from natural causes.
Terminal coma is chosen when the suffering of being awake
is worse than being kept permanently asleep. Giving
the sedative drugs continuously 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,
death will come immediately.
(4) Giving up water
means discontinuing
any means of providing fluids to the patient.
If terminal coma has already been chosen,
then all means of providing water
are usually also discontinued
since an unconscious patient cannot drink normally
and continuing tube-feeding will only prolong the process of
dying.
No laws need be changed,
since these four medical methods of managing dying
are all completely legal and ethical
everywhere in the developed world.
Ten safeguards might be applied
to make certain that a chosen death is the best option
for each patient who uses the services of a right-to-die hospice.
(1) Does the patient have an Advance Medical
Directive?
Does this document authorize choosing death?
(2) Is the patient suffering?
The exact nature of the suffering will be explained by the patient.
What medical treatment have already been tried?
(3) Is some of the suffering psychological?
If so, what methods have been used to relieve inward suffering?
(4) Has the patient explicitly requested death?
If the patient can no longer make medical decisions,
have the proxies authorized life-ending choices?
(5) Has a physician written a summary
of the
patient's condition and prognosis?
(6) Has an independent doctor also examined the
patient
and created another document explaining the patient's problems
and likely decline under various treatment-options?
(7) Has a psychological consultant interviewed the
patient
to evaluate the mental capacities of the patient
and the reasons for
choosing death?
(8) Have the doctors certified that the patient
has
an incurable condition or a terminal illness?
(9) Does an ethics committee approve the plans for
death?
(10) Have meaningful waiting periods been observed
to re-examine all decisions that will lead to death?
Other safeguards might be suggested
so that it becomes absolutely clear to everyone involved
that choosing death for this patient
is the best option under the given circumstances.
Instead of delaying death as long as possible,
which is a common medical response to life-threatening
problems,
a right-to-die hospice program
will allow the patient and his or her proxies
to choose the best pathway
towards death for this patient.
When death is inevitable,
how should this patient spend his or her last days?
A right-to-die hospice program would allow all
reasonable, medical methods of managing dying.
This
essay is presented in two different formats:
first using the line-divisions preferred by the author (above)
and then as it would appear in a newspaper (below).
The text is the same both formats.
The hyperlinks in the first version
will not appear in the printed version of this essay,
unless it is permitted by the publisher
in the on-line version of this opinion article.
same essay with the length of
line used on the StarTribune op-ed page:
Right-to-Die Hospice
By
JAMES LEONARD PARK
Will Minnesota be the first place on Earth to
create
a hospice that allows all medical methods
of choosing death?
Traditional hospice programs embrace only
natural
death: The process of dying is neither
hastened nor prolonged.
But a right-to-die hospice would permit its
patients
to select any combination of the following
four legal medical methods of managing dying:
(1) providing comfort-care only;
(2) inducing terminal coma;
(3) ending curative treatments and life-supports;
(4) giving up water.
(1) Providing comfort-care only
would apply to
any
patient who is already receiving medication
to relieve symptoms. Within the standards of
terminal medical care, the doctor could increase
the same drugs with the recognition that the
medications for controlling symptoms might
also shorten the process of dying.
(2) Inducing terminal coma
means keeping
the patient
completely unconscious until death
occurs from natural causes. Terminal coma
is chosen when the suffering of being awake
is worse than being kept permanently asleep.
Giving the sedative drugs continuously
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, death will come immediately.
(4) Giving up water
means discontinuing
any means of providing fluids to the patient.
If terminal coma has already been chosen,
then all means of providing water
are usually also discontinued since an
unconscious patient cannot drink normally and
continuing tube-feeding will only prolong the
process of
dying.
No laws need be changed, since these four
medical methods of managing dying are all
completely legal and ethical everywhere in the
developed world.
Ten safeguards might be applied to make
certain that a chosen death is the best option
for each patient who uses the services of a
right-to-die hospice.
(1) Does the patient have an Advance Medical
Directive? Does this document authorize
choosing death?
(2) Is the patient suffering? The exact nature
of the suffering will be explained by the patient.
What medical treatment have already been tried?
(3) Is some of the suffering psychological?
If so, what methods have been used to relieve
inward suffering?
(4) Has the patient explicitly requested death?
If the patient can no longer make medical decisions,
have the proxies authorized life-ending choices?
(5) Has a physician written a summary of the
patient's condition and prognosis?
(6) Has an independent doctor also examined
the
patient and created another document
explaining the patient's problems and likely
decline under various treatment-options?
(7) Has a psychological consultant interviewed
the
patient to evaluate the mental capacities of
the patient and the reasons for
choosing death?
(8) Have the doctors certified that the patient
has
an incurable condition or a terminal illness?
(9) Does an ethics committee approve the
plans for
death?
(10) Have meaningful waiting periods been
observed to re-examine all decisions that will
lead to death?
Other safeguards might be suggested so that
it becomes absolutely clear to everyone involved
that choosing death for this patient is the best
option under the given circumstances.
Instead of delaying death as long as possible,
which is a common medical response to life-
threatening
problems, a right-to-die hospice
program will allow the patient and his or her proxies
to choose the best pathway
towards death
for this patient.
When death is inevitable,
how should this patient spend his or her last days?
A right-to-die hospice program would allow all
reasonable, medical methods of managing dying.
JAMES
LEONARD PARK is the founder of
Right-to-Die Minnesota and the author of
several books on medical ethics and the right-to-die.
These chapters (and two others) have now been put together
to form a small book of the same name: Right-to-Die
Hospice.
The short article above has become the Introduction.
WOULD YOU LIKE TO MEET OTHER
SUPPORTERS OF RIGHT-TO-DIE HOSPICE? If you like the idea of a
right-to-die hospice, consider joining a Facebook Group
and Seminar called "Right-to-Die Hospice".
The essay above has become the Introduction toRight-to-Die
Hospice.
Our Facebook Group of the same name discusses one chapter per week.
Here is a complete description of
this on-line gathering of advocates of the right-to-die: https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-RTDH.html And here is the direct link to our
Facebook Group:
Right-to-Die Hospice: https://www.facebook.com/groups/145796889119091/