26 SAFEGUARDS SUGGESTING NO PROSECUTION FOR MURDER, MANSLAUGHTER, OR ASSISTED
SUICIDE
If substantially all of the following safeguards
have been fulfilled,
the prosecuting authority can decide not to prosecute anyone
who was involved with a specific voluntary
death
or merciful
death.
In fact, the suggested safeguard-procedures should
be
fulfilled
and possibly reviewed by the prosecuting authority (Safeguard S) before the proposed
death takes place.
Each specific end-of-life situation will suggest
which of the following procedures are most relevant.
And some will be impossible if the patient is already unconscious,
such as a request for death from the patient (Safeguard
B)
or informed consent from the patient (Safeguard J).
When the patient can no longer participate in the life-ending
decisions, all previous expressions of
the patient's wishes become more important.
Because these end-of-life choices usually occur
in a medical context,
the person whose life is coming to an end is called the "patient".
And those who offer support and assistance
are known by their ordinary relationships and roles:
spouses, children, siblings; other relatives, friends, clergy;
doctors, nurses, hospital staff and volunteers, etc.
When the following procedures have been carefully
applied,
the decision to end the life in question
will be a wise and
compassionate choice,
rather than any form of harm
done to the patient.
And when there is no harm,
there is no crime.
Yes, the patient has died.
But if the safeguard-procedures were carefully applied,
this death was not murder, manslaughter, or irrational suicide.
The 26 recommended safeguards—when carefully
fulfilled—
will lead to a reasonable, compassionate, & ethical life-ending
decision.
When the prosecuting authority decides that no crime was committed,
then, of course, there is no reason to prosecute anyone.
Fulfilling most of the following 26 safeguards for
life-ending decisions
should convince everyone that the proposed death will not be premature.
If these guidelines have been carefully applied,
the resulting death will be reasonable and timely.
And no prosecutions would be warranted.
Each of the following 26 proposed safeguards for
life-ending decisions
is linked to a more extensive explanation of how to apply that
safeguard.
Anyone who wishes to apply a specific procedure
to a particular patient at the end of his or her life
should follow the link to read the more detailed presentation.
If any jurisdiction suggests judicial
consent
for life-ending decisions,
then, fulfilling the following 26 safeguards
will be ample proof that the
proposed death will not be a crime.
And the judge might issue a ruling
stating that no crime will be committed
if the planned death is achieved as explained in the documents
proving that the safeguards have been fulfilled.
This written, signed, & witnessed document
sets forth the patient's philosophy of life and death.
The patient's Advance Directive should be the basis
for all future medical decisions—especially
life-ending
decisions.
Life belongs to each individual patient.
His or her settled values should shape all medical decisions.
Once the patient has created an Advance Directive
for Medical Care,
he or she will share the AD with significant others —especially those
chosen as proxies.
And other people should create brief statements
expressing their agreement with
the Advance Directive
and (if they are proxies) their commitment
to carry forward the settled
values of the patient.
The patient owns his or her own life
and death.
While the patient is still capable of making medical decisions,
any and all serious requests for death should be recorded,
stating the date, time, & circumstances.
The patient should also explain why he or she thinks death at the chosen time
would be better than death
at some later time.
Such requests for death might lead to creative discussions
among all people concerned with this patient's life and death.
If the patient is no longer capable of making
medical decisions,
the duly-authorized proxies then have the power and responsibility
to make any reasonable requests for death on behalf of their patient. (Proxy requests for death is Safeguard
K.)
If anyone has any doubts about
the patient's capacity
to make medical decisions
—including any
decisions that will terminate his or her life—
then this capacity should be clarified by the testimony of laypersons
who have known the patient for some period of years
as well as by the professional evaluations
of licensed psychologists or
psychiatrists.
The most important document created by a medical
professional
will be the primary physician's summary
of the patient's condition and
prognosis.
In order to avoid any confusion, ambiguity, or misunderstanding,
this statement should be put
into writing
as well as explained to the satisfaction of those who must decide.
Whenever making life-or-death decisions,
it is always wise to seek a second, independent, professional opinion.
This second evaluation might be sought from a specialist
in the disease or
condition from which the patient is possibly dying.
If there are differences in these professional evaluations,
they should be resolved by further investigation
before any plans for a voluntary
death
or merciful
death
proceed.
Even tho the patient does not need to be dying to request death,
if the disease or condition is in fact likely to lead to death,
the same physicians who have written the full statements
of the
patient's condition and prognosis
might also create a specific document to certify terminal illness
if the patient is likely to die within the next 6 months.
Or such certification could be included in the doctors' statements.
These certifications of terminal illness or incurable condition
should specify whether the projections include
life-supports or not.
An important question for any life-ending decision
is whether the patient is suffering
in some way that cannot be relieved
and which the patient
finds intolerable.
Such physical suffering can be explained and documented
by the doctors who are called upon to treat the suffering.
The patient might also be suffering emotionally.
Only the patient can ultimately decide
whether such suffering is
intolerable.
But professional efforts to alleviate the psychological suffering
should also be documented.
Both lay and professional views can attempt to evaluate
what is happening inside the patient's mind and 'heart'.
And if the psychological suffering is so great
as to make the patient incapable of making wise medical decisions,
then the power to decide passes to the duly-authorized proxies.
The proxies will make any life-ending decisions
if death now seems
wiser than death later.
The actual application of comfort care
by medical professionals well trained in the care of the dying
will help to decided which is the wisest course of action.
Sometimes physical and psychological suffering can be so reduced
that the patient and/or proxies no longer believe
that death is the best
choice at this time.
However, in some obvious cases, palliative care
would be useless,
for example, when the patient is already permanently unconscious.
But at least the patient and/or proxies
should know about the
benefits of
palliative care
and even consult with a palliative-care specialist
if that seems relevant for this patient's end-of-life situation.
The patient must have full information
about his or her condition
and all the relevant medical treatments that still remain
open.
Only when the patient has received and understood
the doctors' statements concerning
condition and prognosis
is the patient able to make wise end-of-life choices.
If the patient can no longer make
meaningful medical decisions,
then the decision-making power shifts to the proxies,
who have been carefully chosen by the patient
when the patient was still fully able to make all medical
decisions.
The proxies shall carefully consider all of
the facts and opinions
expressed by the others—both
laypersons and professionals—
who are considering what would be
best for the patient.
Then the proxies can
decide to make requests for death
in exactly the same ways
as such requests were once possible
for the patient.
If the patient is
being treated in a hospital
or receiving terminal care in a hospice program,
any such medical institution will keep careful records
of all
discussions and decisions regarding the care of the patient
---including all discussions concerning
end-of-life choices.
Beyond the official medical records kept by
the hospital or hospice,
statements can also be created by nurses, doctors, & volunteers
who have had
meaningful connections with the patient.
Did they discuss the patient's end-of-life choices?
Other persons who
have known the patient
for meaningful
periods of time
either agree with the life-ending decision
or question the wisdom of ending the patient's life now.
Even tho these significant other persons might not be directly involved
in the process of making any life-ending decisions
and they will not be responsible for carrying out any terminal choices, they
know of
the
plans for death well in advance.
And they create written statements
either affirming the choice of death
at this time
or questioning the plan for voluntary death or merciful
death.
What do family members think about the proposed death?
A member of the
clergy of any religious organization
or the professional leader of an ethical
organization
known by the patient approves or questions the life-ending
decision.
If the patient is not part
of any such
organization,
another similar responsible member of the
wider community
might fill this role of neutral
ethical
observer.
If chosen by the patient, some person (or persons)
who is an authority on
the doctrine
of the religious organization with which the patient is
affiliated
could apply those moral principles to the
end-of-life
decisions
being considered by the patient and/or the proxies for
the patient.
If that
interpretation of doctrine supports a life-ending
decision,
then a written statement to that effect
could be included in the
death-planning record.
If the religious principles would not support a life-ending
decision
under the current circumstances,
a statement to that effect would be appropriate.
If the patient and/or the proxies so choose,
some non-religious moral principles
could be brought to bear on the end-of-life choices.
An ethics
committee of the institution
where the patient is being cared for
reviews all of the documents created for the
death-planning process
and approves or questions the life-ending decision.
If possible and appropriate,
the ethics committee will consult with the patient himself or herself.
The report of the ethics committee
will explain the bases of its
recommendations.
If the patient worries that he or
she might be discriminated
against because of belonging to a group sometimes
disfavored by society,
he or she can select an advocate from that
identity-group
who will review the death-planning documents to make sure that no
discrimination has taken place.
Adding any such statements to the other death-planning documents
should assure distant doubters
that the end-of-life discussions and decisions
were as free as possible from discrimination.
The patient received terminal medical care independent
of group-identity.
If those who are planning a specific
voluntary death or merciful death
have any doubts about the legality
of their
proposed course of action,
they can opt to send a report of
the death-planning process
to the local
prosecuting authority for review.
Or they can hire a private lawyer
to evaluate the legality of their proposed course of action.
They might explain which of the
following they are planning:
(a) withdrawal or withholding life-support
systems,
(b) assisting in a voluntary
death,
or
(c) granting a merciful
death.
And the several documents of the death-planning
process
might be shared or summarized for the prosecutor (or other lawyer)
to show that the proposed course of action
violates no laws.
The prosecutor should be
allowed one week to respond.
The prosecutor might reply
that the planned death will
not harm the
patient
and that all who participate or cooperate in the
planned death
will not be subject to prosecution for any crime.
Or the prosecutor could ask for additional
information
to make sure that this death will
not be
premature.
If the prosecutor always automatically says "no"
to any proposed life-ending decision,
that prosecutor should be replaced.
The prosecutor must be able to recognize wise end-of-life decisions.
And the best prosecutors will issue guidelines
so that everyone knows in advance
what kinds of behavior will result in prosecution
and what kinds of conduct will be condoned.
For example, the prosecutor might endorse some or all
of these 26 proposed safeguards for life-ending decisions.
Penalties will remain in place for civil harms or
criminal behavior.
Anyone tempted to encourage or cause a premature death
will know what legal consequences might follow
if someone does any harm
to another
under the guise of the right-to-die.
The plans for death should be reviewed by everyone
over appropriate periods of time:
(a) one week for the
withdrawal of life-support systems,
(b) one year for a voluntary
death, or
(c) six months for a merciful
death.
These waiting periods may be adjusted
when adequately explained by
the special circumstances of this life-ending
decision.
Spreading the discussions over significant
periods of time
encourages all concerned to re-think
their previous
decisions.
Once the patient has already
begun the process of planning for death,
ample
opportunities shall be provided
for the patient to change his or her
mind.
The people offering these opportunities shall
document
that the patient was giving several chances
to
reverse or postpone the plans for
death.
Does the patient decline each opportunity to
change course
and reaffirm his or her determination to choose
a voluntary death?
Once most of the other statements have
been written,
the physicians most responsible for the patient's
terminal care
will read and
respond to each statement
and
make a final recommendation.
In some locations on the Earth,
physicians are permitted by law to give a lethal injection
or another method of bringing a peaceful and painless death.
Any such life-ending actions shall take place only after
all the the relevant and applicable safeguards have been fulfilled.
The death-planning process
should be open and transparent.
The written
statements of all persons involved
should be
shared freely among everyone who has a
legitimate right
to take part in (or to know about) these deliberations
that might lead to a life-ending decision.
The fact of such open sharing and discussion —with signed and
recorded opinions from many
participants—
should help to ensure that this is a
well-considered decision,
not a hidden or secret conspiracy to cause a premature
death.
Y. THE
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
Even tho under modern terminal medical care,
the patient need not be awake and aware at the end of life
for life-ending medical decisions to be made,
remaining fully conscious until the last moment of life
would be strong proof that this was a wise decision.
The patient gives final assent to death
or takes some life-ending action with his or her own hand.
If the process of planning the patient's
death
employs a death-planning
coordinator
or if someone volunteers to organize the death-planning
records,
this level of organization for planning this death
will be impressive evidence that the chosen death is a
wise decision.
And the complete collection of death-planning documents
can be permanently stored in case there is ever any
future reason
to review this life-ending decision.
The death-planning
records shall not be available to the public,
to any government officials
(except as might be required by law-enforcement
investigations)
or to any news-gathering organizations.
The end-of-life choices for specific patients
should never become a matter for public debate.
This list of 26 recommended safeguards
is organized in a different way in an on-line essay named:
"A New Way to Secure the Right-to-Die:
Laws Against Causing Premature Death": https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-RTD-N.html
In this article, the 26 recommended safeguards are organized into 6
groups,
according to who
is primarily responsible to fulfill each specific safeguard:
SAFEGUARDS TO BE
FULFILLED BY
PHYSICIANS
AND OTHER PROFESSIONAL CONSULTANTS
SAFEGUARDS TO BE FULFILLED BY THE
PATIENT
SAFEGUARDS TO BE FULFILLED BY
PROXIES FOR THE
PATIENT
AND/OR FAMILY MEMBERS
SAFEGUARDS TO BE FULFILLED BY
MEMBERS OF THE CLERGY
SAFEGUARDS TO BE FULFILLED BY THE
PROSECUTING
AUTHORITY
SAFEGUARDS TO BE FULFILLED BY THE
DEATH-PLANNING
COORDINATOR