SAFEGUARDS EMBRACED
 BY THE RIGHT-TO-DIE MOVEMENT

by James Leonard Park

H. UNBEARABLE SUFFERING

    High on the list of safeguards used by advocates of the right-to-die
is an articulation of the specific suffering
understood from the perspective of the patient.
Exactly what kinds of suffering lead this patient to request death?
Has the patient fully explained the nature and degree of the suffering?
How long has the patient been suffering?
Have physicians explained the causes of the suffering?
What methods have already been applied to relieve the suffering?

I. UNBEARABLE PSYCHOLOGICAL SUFFERING

    And the psychological suffering of the patient is also relevant.
If no relief can be obtained by any known method of treatment,
then some advocates of the right-to-die
allow psychological suffering alone
to be a sufficient reason for choosing death.
The specific psychological suffering should be described by the patient.
What psychological care and treatments have been tried?
Do psychiatrists agree that the psychological suffering cannot be cured?

C. REQUESTS FOR DEATH FROM THE PATIENT

    Because patient-autonomy comes first for advocates of the right-to-die,
close attention is paid to creating a clear statement
of the wishes of the patient under the present medical situation.
Does the patient clearly understand the end-of-life problems?
Is the patient clearly and consistently
affirming his or her decision to choose death?
Careful application of safeguards for life-ending decisions
makes sure that this wish for death is not temporary or fleeting.
Waiting periods provide time for reflection.
See Safeguard U below.

E. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    Careful advocates of the right-to-die always insist on
some kind of medical statement from a doctor
who has actually examined the patient.
Ideally such a statement would be written by the primary-care physician.
But when that doctor is not cooperating,
another physician who has examined the medical records
as well as physically examined the patient
should be able to create a summary statement
of the condition and prognosis of this patient.

F. INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

    Some individuals and organizations that offer aid in dying
endorse the safeguard of obtaining a second professional opinion
about the condition and prognosis of the patient.
Two doctors endorsing the plans for death makes a strong case.
Any differences should be resolved before the plans go forward.

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

    This consultation would examine the reasons for choosing death.
The psychological professional would evaluate
the patient's abilities to make well-reasoned medical decisions
—including any decisions that would bring his or her life to an end.
Also, is the patient under any pressure from relatives to 'choose' death?
Are there psychological or emotional problems
that might be pushing toward irrational suicide?
The psychological consultant will resolve all such doubts
before approving any life-ending decisions.

G. CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE CONDITION

    When the patient definitely has a terminal illness,
this fact could be included in the physicians' statements.
Or there might be separate documentation
—for example, if the patient has entered a hospice program.
Most hospice programs require a physician's projection
that the patient has less than 6 months to live.

    But more liberal right-to-die organizations
do not require the patient to be in a terminal condition.
It is sufficient that the medical condition is serious and cannot be cured.
How many doctors agree that the patient's problems are incurable?

U. WAITING PERIODS FOR REFLECTION

    In order to allow time to reconsider the decision for death,
most advocates of the right-to-die also endorse waiting periods.
Has the patient deeply considered what he or she is requesting?
Have other possible responses to the situation been tried?
For example, during reasonable waiting periods,
palliative care should be used to reduce the suffering if possible.
And if symptom-control works,
the chosen date of death can be postponed.

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

    Many individuals and organizations that assist patients to die
insist that the patient must be conscious and capable to the very end.
Requiring the patient to do something using his or her own hands
is dramatic proof that this life-ending choice was made by the patient.

    Other systems of helping patients to choose death
allow earlier affirmations of the choice of death to stand
if and when the patient becomes unconscious
or otherwise unable to achieve death.
As long as the decision for death under the current situation
was clearly affirmed in advance,
proxies for the patient (or the doctor himself or herself)
should be empowered to carry forward the careful plans for death.

    This safeguard often exists more to protect the helpers than the patient.
If an organization that helps patients to choose timely death
has legal problems because it assists patients to die,
answering such complaints will redirect time and resources
away from the primary mission of helping qualified patients to choose death.

    Because the essay above is the final chapter of PART THREE of
How to Die: Safeguards for Life-Ending Decisions,
this is where the summary appears in the printed book.
If you would like to read any of the following items,
look for that Safeguard or Chapter in the complete table of contents.

Summary of Part Three

26 Recommended Safeguards for Life-Ending Decisions

    Applying the most appropriate safeguards to any patient’s situation
will prevent hasty, irrational, or harmful medical decisions at the end of life.

    What characteristics make safeguards useful and workable?            Chapter 21

    The safeguards should be open and public but the specifics private.      Ch. 22

    Keeping government, media, & other strangers out of the loop.               Ch. 23

    The safeguards will be applied by the family.                                         Chapter 24

    Safeguards make certain that the choices are coming from the patient
and that they protect the best interests of the patient.             SAFEGUARDS  A & B

    Doctors and psychiatrists review the full situation.      SAFEGUARDS  C, D, E, & F

    How much is the patient suffering and has it been addressed?      SGS  G, H, & I

    Do the patient and/or the proxies give informed consent?     SAFEGUARDS  J & K

    Is the patient being cared for in a hospital or hospice?         SAFEGUARDS  L & M

    Do family members and clergy agree with the decision?   SAFEGUARDS  N, O, & P

    Has an ethics committee reviewed the options?                                SAFEGUARD  Q

    Does a representative of the patient's identity-group approve?    SAFEGUARD R

    Do experts in all applicable laws say the choice is legal?        SAFEGUARDS  S & T

    Has there been enough time to reconsider or postpone?      SAFEGUARDS  U & V

    Have the plans been appropriately recorded and reviewed? SAFEGUARDS W & X

    Will the patient be conscious and able to choose death?                SAFEGUARD Y

    Have the fulfilled safeguards been documented and collected?     SAFEGUARD Z

    How many people have been involved in this life-ending decision?         Ch. 25

    Which safeguards are embraced even by critics of the right-to-die?        Ch. 26

    Which safeguards are favored by advocates of the right-to-die?        Chapter 27

Further reading concerning safeguards for life-ending decisions:

Fifteen Safeguards for Life-Ending Decisions

Pulling the Plug:
A Paradigm for Life-Ending Decisions

A New Way to Secure the Right-to-Die:
Laws against Causing Premature Death

Choosing Your Date of Death:
How to Achieve a Timely Death
—Not too Soon, Not too Late

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Medical Methods of Managing Dying

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death 

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice

Do I Lose the Right-to-Die When I Lose Consciousness?

Created May 6, 2010; Revised 5-9-2010; 5-14-2010; 8-28-2010; 9-9-2010;
1-13-2012; 2-2-2012; 2-23-2012; 3-16-2012; 3-24-2012; 7-14-2012; 8-3-2012; 8-24-2012; 10-19-2012;
3-28-2013; 6-29-2013; 7-20-2013; 4-28-2014; 7-29-2014; 10-16-2014;
3-27-2015; 5-7-2015; 7-10-2015; 5-5-2016; 5-22-2017; 11-10-2017; 2-12-2018; 11-16-2018; 6-6-2020;