SAFEGUARD R FOR LIFE-ENDING DECISIONS

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

  
  
    A common worry raised by some opponents of the right-to-die
is that vulnerable patients might be coerced into 'choosing' death
before death would be wise for them.
The experience of Oregon in the USA shows no such pattern.
But if the patient and/or the proxies are worried
about the right-to-die becoming the duty-to-die for specific groups,
they can choose to have their life-ending decisions
reviewed by people especially attuned to their situations.

    This safeguard is completely optional for the patient and/or the proxies,
since most people will not be worried about being 'railroaded' into death
because they belong to a disfavored group in society.

    The patient's Advance Directive for Medical Care
might be a good place to make a special request
for such a review of any life-ending decisions in the future.
The maker of the Advance Directive could take that opportunity
to suggest exactly what individual or group might be most appropriate
to review any life-ending decisions that might be made
after the patient is no longer able to make medical choices.

    If any member of a disadvantaged group
believes that the right-to-die could never be applied rationally
to any patient belonging to his or her group,
then he or she should rule out any and all life-ending decisions
in his or her Advance Directive for Medical Care.

    A comprehensive Advance Directive for Medical Care can ask this Question.
Here is one formulation of the Question about the right-to-die:
Question 16:  Do you endorse more active means of ending your life?
Do you believe you have a right-to-die?  Voluntary death?  Merciful death?
The person who fears being forced to die because of group-identity
would say "no" to this Question:
"For myself, I reject any so-called 'right-to-die'."

    The most radical members of some disability groups do take this position.
They might say something like the following in their Advance Directives:
"The question of the right-to-die should never be considered for me
because of the overwhelming danger
of others choosing premature death for me because of my disability."
Any person with such worries will choose proxies, consultants, & advocates
who will always say no to any suggestion of a chosen death.

    However, some members of less-favored groups
can see beyond the issue of possible discrimination
and do want to keep all of their options open,
including the option of choosing a wise death at an appropriate time.

    In specifying any such special advocate,
the patient will select some individual or group
in sympathy with their own settled values about life and death.
For example, a member of a minority group
might select a leader of that minority community
to review any life-ending decisions.
And if the patient wants to affirm the right-to-die,
this special advocate must be open to that option.
It would make no sense for the special consultant always to say "no"
just because of the generalized worry that members
of that minority group might be discriminated against.
Members of all identifiable groups
should have the same rights as everyone else.

    In some cases, the mental limitations of the patient
might be a possible basis for discrimination.
Then, consultants who work with the mentally-challenged and their families
might be appointed to review any life-ending decisions for such patients.

    Physically disabled patients can appoint consultants
to protect them against discrimination on the basis of such disabilities.

    Let the patient and/or the family decide
which members of the community (if any) would be best qualified
to review any proposed life-ending decisions.
The patient and/or the family will know whom to trust with this role.

    This consultant or community leader might be asked to review
the death-planning record to look for any signs of discrimination.
And if there are none, this person can write a statement
supporting the inclination of the patient and/or the proxies
to go ahead with a life-ending decision.
And the fact of this review can be made known to anyone who worries
that the patient might have been given different treatment
because he or she was part of some identifiable group.
Sometimes the news media raises such doubts
whenever someone belonging to a particular group
might be receiving sub-standard treatment because of group-identity.
But the fact that some responsible person from the same
identity-group
has reviewed the death-planning process
especially looking for any signs of discrimination
should settle all such distant second-guessing.

    Even when a special advocate or consultant has been asked
to protect the patient from possible discrimination,
the particulars of the death-planning process should not be made public.
But in rare cases, it might be disclosed that a special advocate
who represents the same identity-group as the patient
has reviewed the planning for death and found no signs of discrimination.



 
HOW STATEMENTS BY ADVOCATES FOR PARTICULAR GROUPS
WILL DISCOURAGE IRRATIONAL SUICIDE
AND OTHER PREMATURE DEATHS


     The basic purpose of all safeguards for life-ending decisions
is to prevent foolish choices and to permit wise outcomes.
And patients from particular groups should have the same protections.

    If a disabled person is tempted to commit irrational suicide,
then an advocate for disabled people should be asked to consult,
so that the disabled patient will know
that others have decided to live with that disability.
Sometimes a newly-disabled person does not want to go on living
because the disability seems so overwhelming.
But meeting other people who have learned to cope with that disability
can give the patient a different perspective on life.

    Whatever identity-groups the patient belongs to,
there are members of those groups who can recognize premature death.
And when asked to evaluate the situation,
members of those groups might bring some special perspectives
that would not be present in the discussion
if only main-stream persons were involved. 
If these special advocates see their role as preventing premature death,
they should be able to raise doubts where such concerns are valid.
And they should be able to affirm the life-ending decision
when death is the wisest choice, given all the circumstances.

    The social and political goals of anti-discrimination groups
should not stand in the way of the right-to-die for all persons.
Who would say that because women sometimes suffer discrimination
that no life-ending decisions should ever be made for women?
Should all women be denied the right to choose a reasonable death
because in many societies women are second-class citizens?
Or would it be wiser for women who fear discrimination
to select other women who are aware of possible prejudice against women
to serve on their Medical Care Decisions Committees so that
the patients will not suffer inferior medical care because of being female?

    Likewise, could strong advocates of the rights of the disabled
protect disabled patients from discrimination
by serving (when invited) as special advocates for these disabled patients?
Would this be better than attempting to outlaw all forms of chosen death?



Created January 2007; revised 2-13-2007; 2-21-2008; 3-21-2008; 6-24-2008;
2-6-2010; 5-19-2010; 5-21-2011; 12-16-2011;
1-31-2012; 2-11-2012; 2-23-2012; 3-23-2012; 8-2-2012; 8-22-2012; 12-6-2012;
5-21-2013; 6-27-2013; 12-21-2013; 7-4-2014;
2-11-2015; 7-9-2015; 12-7-2017; 11-8-2018; 6-6-2020;



Because some disfavored groups might suffer discrimination,
a special advocate could be appointed to protect the patient from premature death.
This discussion is Safeguard R in How to Die: Safeguards for Life-Ending Decisions:
"Statements from Advocates for Disadvantaged Groups
If Invited by the Patient and/or the Proxies".



Go to the Catalog of Safeguards for Life-Ending Decisions



Go to the list of 26 recommended safeguards.



Go to the index page for the Safeguards Website.



Go to the Right-to-Die Portal.



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