THE RIGHT-TO-DIE:
26 RECOMMENDED SAFEGUARDS (A-Z)
,


WHICH CAN BE APPLIED SELECTIVELY
FOR ANY LIFE-ENDING DECISION


    Even in situations where no safeguards are required or suggested by law,
individuals faced with end-of-life choices
might want to apply some of the following recommended safeguards
as a way to make sure that a decision to end someone's life
is a wise and compassionate choice
rather than some kind of mistake that would result in a premature death

    For example, if we are required to make
life-or-death decisions for a retarded member of the family,
we will clarify our options by applying the safeguards discussed below.
When we ask others for their personal and professional opinions,
we are more likely to make wise choices.

    These safeguards are offered as a method for examining all options
near the end of someone's life.
Almost all are non-technical and can be applied by ordinary people.
These are not government-imposed safeguards,
setting up a complicated bureaucracy to review end-of-life decisions.
No death panels are mentioned.
Rather, the application of these 26 recommended safeguards
will call upon the personal and professional opinions
of perhaps two dozen people for any specific end-of-life situation.

    We can also apply these safeguards in the last year of our own lives.
Perhaps when we are dying,
our thinking might be distorted by our terminal disease or condition.
We will probably have complicated feelings as we face our own deaths.
Therefore, we might want to use some of the procedures below
to make certain that we are wisely choosing voluntary death
rather than foolishly considering irrational suicide.

    And if we are reviewing the plans for the last year of someone else's life,
the same safeguard-procedures can help us to separate
a merciful death for a friend or relative from a mercy-killing.

    Each of the following 26 proposed safeguards for life-ending decisions
is linked to a more extensive explanation of how to use that safeguard.
If we wish to apply a specific safeguard
to an end-of-life situation we are currently considering,
we will probably want to read the more complete presentation.




A. ADVANCE DIRECTIVE FOR MEDICAL CARE

    A written statement explaining the patient's philosophy of life and death
is probably the most basic document for making end-of-life decisions.
Life belongs to each individual patient.
His or her settled values should shape all medical decisions.

    Here's what to include in a comprehensive Advance Directive:
Advance Directives for Medical Care: 24 Important Questions to Answer.

    Once the patient has created an Advance Directive for Medical Care,
he or she will share the Advance Directive with significant others
especially those chosen as proxies.
And they 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.



B. REQUESTS FOR DEATH FROM THE PATIENT

    The patient owns his or her own life and death.
Whenever the patient is still able to make medical decisions,
any and all serious requests for death should be recorded,
stating the date, time, circumstances, & witnesses.
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 the people concerned with this patient's life and death.

    If the patient is no longer able to make medical decisions,
the duly-authorized proxies then have the power and responsibility
to make any reasonable requests for death on behalf of their patient.
See Safeguard K below: Requests for Death from the Proxies.



C. PSYCHOLOGICAL CONSULTANT EVALUATES
     THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

    If there is any doubt about the patient's
mental capacities to make medical decisions
including any decisions that will terminate his or her life
then the patient's decision for death should be evaluated
by a licensed psychologist or psychiatrist.



D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    The most important document created by a medical professional
will be the physician's summary of the patient's situation and future.
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.



E. INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

    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 recommendations,
any such uncertainties should be resolved by further investigation
before the plans for death proceed.



F. CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE CONDITION

    Even tho the patient need not be in a terminal condition to request death,
if the disease or condition is 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 separate 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' other statements.
Certification of terminal illness should specify
whether the projected period of survival includes life-supports or not.



G. UNBEARABLE SUFFERING

    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 have been treating the suffering.



H. UNBEARABLE PSYCHOLOGICAL SUFFERING

    The patient might also be suffering emotionally.
Only the patient can decide whether such suffering is intolerable.
But professional efforts to alleviate the mental suffering
should also be documented.
Psychological suffering can be evaluated by both family and doctors.

    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 authorized proxies.
The proxies will make any life-ending decisions:
Is death now wiser than death later?



I. PALLIATIVE CARE TRIAL

    The actual application of comfort care
by medical professionals well trained in the care of the dying
will help to decide 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.
But at least the patient and/or proxies should be
fully informed about the benefits of palliative care
and even consult with a palliative-care specialist.



J. INFORMED CONSENT FROM THE PATIENT

    The patient must have full information about his or her condition
and all the possible medical treatments that still remain open.
When the patient has received and understood the medical statements
from the doctors concerning condition and prognosis,
the patient is empowered to make wise end-of-life choices.



K. REQUESTS FOR DEATH FROM THE PROXIES

    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 choices.

    The proxies shall carefully consider all of the medical facts,
taking into account the opinions of everyone legitimately concerned.
Then the proxies can decide to make requests for death
in the same ways as such requests were once possible for the patient.



L. ENROLLMENT IN A HOSPITAL OR HOSPICE

    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 explorations of end-of-life choices.
Terminal-care professionals deal with life-ending decisions frequently.
They will not support a premature death.



M. STATEMENTS FROM HOSPITAL OR HOSPICE STAFF MEMBERS

    The nurses, doctors, & volunteers who know the patient well
can also create statements about their discussions
with the patient about end-of-life choices.
Do those who see the patient every day agree with the life-ending decision?



N. STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

   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
or questioning the wisdom of the end-of-life plans.
What are their considered opinions about the proposed death?



O. A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING 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



P. RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    If chosen by the patient, some person (or persons)
with expertise on the doctrine and/or medical ethics
of the religious tradition with which the patient is affiliated
could review how those moral principles apply to the end-of-life decisions
being considered by the patient and/or the proxies for the patient.
If that interpretation of the principles supports a life-ending decision,
such as the withdrawal of life-supports when they are useless,
then a written statement to that effect could be included in the record.
If the religious principles would not support a life-ending decision
under the current circumstances, such a statement should be included.
If chosen by the patient and/or proxies, some non-religious moral principles
could be brought to bear on the end-of-life choices.



Q. AN INSTITUTIONAL ETHICS COMMITTEE
            REVIEWS THE PLANS FOR DEATH

    An ethics committee of the institution where the patient is receiving care
reviews all of the documents created for the death-planning process
and approves or questions any life-ending decisions.
The ethics committee should meet with the patient and/or the proxies.
If there is no ethics committee,
a private ethical consultant can review the plans for death.



R.
STATEMENTS FROM ADVOCATES FOR DISADVANTAGED GROUPS
            IF INVITED BY THE PATIENT AND/OR THE PROXIES

   If any patients worry that they might be discriminated against
because they are members of a group sometimes disfavored by society,
they can select advocates from their own identity-groups
who will review the death-planning documents
to make sure that no discrimination has taken place
because of the group-identity of the patient.
Adding any such statements to the death-planning record
will assure others who are not as close to the patient
that the life-ending decision was as free as possible from discrimination
and that the patient received terminal care independent of group-identity.



S. REVIEW BY THE THE PROSECUTOR (OR OTHER LAWYER)
            BEFORE THE DEATH TAKES PLACE

    If those who are considering end-of-life options for the patient
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.

    They should explain their proposed course of action:
Which pathway towards death is being chosen for this patient?
And the several documents of the death-planning process already created
might be shared or summarized for the prosecutor
to show that the proposed course of action violates no laws.

    The prosecutor should be allowed one week to respond.
He or she might reply that the planned death will not harm the patient
and that all who participate or cooperate in the death as planned
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 decisions,
that prosecutor should be re-educated about end-of-life law.

    In some cases, it will be better to consult a private lawyer,
who will evaluate the legality of the proposed life-ending decision.



T.  CIVIL AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH

    Court systems exist all over the Earth
for the purpose of trying potential criminals for possible crimes.
And every legitimate life-ending decision
might be distorted by criminal or monetary motives.
Thus civil and criminal procedures and penalties must remain in place
in order to discourage (and perhaps punish) any people
who cause premature death disguised as a legitimate end-of-life decision.

    Without careful safeguards, 'pulling the plug' might actually be a harm.
If only a few people are involved in a proposed
'voluntary death',
it might actually be closer to a coerced or manipulated death.
And fulfilling careful safeguards will separate valid merciful deaths
from the dark and harmful mercy-killings that are all too common.

    Civil and criminal penalties will remain in place.
Anyone tempted to encourage or cause a premature death
should know that they might be punished
if they harm anyone by making a premature life-ending decision.



U. WAITING PERIODS FOR REFLECTION

    Appropriate periods for further reflection are needed
between the time when the first life-ending decision is made
and when the final life-ending act is performed:
(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 the specific patient.
Spreading the end-of-life discussions over significant periods of time
encourages all concerned to re-think their previous decisions.



V. OPPORTUNITIES FOR THE PATIENT TO RESCIND OR POSTPONE
            ANY LIFE-ENDING DECISIONS

    If the patient has already begun the death-planning process,
ample opportunities should be provided
for the patient to change his or her mind.
The people offering these opportunities should document
that the patient had several occasions to change the plans for death.
Does the patient decline each opportunity to change course
and reaffirm his or her determination to choose death?



W. PHYSICIANS REVIEW THE COMPLETE DEATH-PLANNING RECORDS

    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 cases, more than one physician will review the plans for death.



X. COMPLETE RECORDING AND SHARING
            OF ALL MATERIAL FACTS AND OPINIONS

     The death-planning process should be completely open.
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) this end-of-life discussion.

    The fact of such open sharing and discussion
with signed and recorded opinions from many participants
should ensure that the process leads to a well-considered decision
—not a hidden or secret conspiracy that might cause a premature death.



Y. THE PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH

    If the patient (1) remains conscious until the last moment of life
and (2) takes some life-ending action with his or her own hands,
these will be strong reasons to believe that this was a timely death.
But remaining conscious and capable to the end should not be required.



Z. THE DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS

    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 documents for planning this death
can be permanently stored in case there is ever any future reason
to review these end-of-life discussions.

       The death-planning records shall not be made available to the public
or to any government officials
(except as might be required by law-enforcement investigations)
or to any news-gathering organizations.



   
    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

    This essay organizes the safeguards 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

    The number of different people who would be involved
in such discussions of end-of-life choices is estimated here:
"The Number of People Reviewing a Life-Ending Decision
Using the 26 Recommended Safeguards":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-PEOPL.html




    If you would like to read a shorter summary of the most important safeguards,
go to "Fifteen Safeguards for Life-Ending Decisions":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-10SG.html



Created 12-31-2007; Revised 1-6-2008; 1-10-2008; 1-20-2008; 2-5-2008; 3-15-2008;
4-4-2008; 4-16-2008; 5-22-2008; 7-9-2008; 7-31-2008; 8-14-2008; 8-24-2008; 9-9-2008;
6-6-2009; 2-5-2010; 2-11-2010; 5-19-2010; 5-27-2011; 12-17-2011;
1-4-2012; 1-28-2012; 2-3-2012; 2-22-2012; 3-22-2012; 7-28-2012; 8-17-2012; 10-18-2012;
5-1-2013; 6-26-2013; 10-28-2013; 7-22-2014; 11-30-2014;
2-19-2015; 5-6-2015; 10-9-2015; 9-12-2018; 5-29-2020;



Go to the Catalog of Safeguards for Life-Ending Decisions.
This catalog includes the 26 recommended safeguards above,
plus a few more.


 
A book has been created around these 26 recommended safeguards:
How to Die: Safeguards for Life-Ending Decisions.

The summary above has become the Introduction to PART THREE:
26 Recommended Safeguards for Life-Ending Decisions



Go to the index page for the Safeguards Website.



Go to the Right-to-Die Portal.



Go to the beginning of this website
James Leonard Park—Free Library