PRESERVING
GOOD DOCTOR-PATIENT RELATIONS:
WILL MY DOCTOR DECIDE TO KILL ME?
Physicians often oppose the 'right-to-die'
because they fear that
allowing doctors to
recommend death
will
harm the trust
between doctors and their patients.
Such
fears are not well-grounded in reality,
since most doctors are
committed to the well-being of their patients.
But some patients
already have an
irrational fear of doctors.
And
permitting doctors to take any part in life-ending decisions
might
seem to corrupt
the mission of the healing professions.
Many patients are already reluctant to consult doctors.
Thus,
adding the new worry that doctors
might recommend death
if
a particular case becomes too difficult or troublesome
might not
improve doctor-patient relations.
When we
consult doctors, we want to know in advance
that our doctors will
do everything reasonable to
save us from death.
If
we fear doctors as people who
might provide death pills,
we
might want to stay away from such 'executioners'.
This confusion is not helped by advocates of the right-to-die
when
they refer to life-ending chemical as "medication".
How
are we supposed to react when offered pills?
Even if most such fears are completely groundless,
we would trust
our doctors somewhat more
if we knew that they were not
considering death as an option.
The doctor
will consult with everyone legitimately involved
before agreeing
to participate in a chosen death.
But even thinking that death
might be recommended by the doctor
can turn us away from the
healing services of the physician.
If the
right-to-die is not
associated
with the healing professions,
if, for example, someone
else
could provide gentle poison,
then the patients would not be
confused about the role of their doctors.
They would know that
their doctors are completely committed to curing.
See
the first safeguard linked below.
And if a doctor decides that cure
is no longer possible,
he
or she might refer
the patient to another kind of professional,
who will help to
clarify the end-of-life options.
This would keep the doctor always
associated with healing
and
allow others
to take over the care of the patient
when choosing death might be
the best option.
SAFEGUARDS
FOR GOOD DOCTOR-PATIENT RELATIONS
When we consider what safeguards to include in new right-to-die
laws,
we should try to keep the doctor-patient relationship
as
meaningful
and positive
as possible.
The following 20 specific procedures
should help to ensure that wise decisions are made.
The
doctors will provide medical information and recommendations.
But
the patient and/or the proxies
will be responsible for making all
end-of-life choices.
These safeguards are arranged beginning with the most powerful.
The
blue
title
links to a complete explanation of that safeguard.
The red
comments explain
how that procedure
will enhance good doctor-patient
relationships.
SPECIFICALLY-LICENSED
TERMINAL-CARE PHYSICIAN
AGREES
TO PROVIDE LIFE-ENDING CHEMICALS
Good doctor-patient relations will be preserved
between all
regular doctors and their patients
because only
specifically-licensed physicians
will be authorized to provide life-ending chemicals.
Patients
will know when they have been referred
to
these specially-licensed terminal-care physicians.
These
special doctors are licensed to
provide lethal chemicals
for patients who choose this pathway
towards death.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
When
the physician who has primarily responsibility for the patient
issues his or her written statement of condition and
prognosis,
he or she might mention medical treatments
still worth trying.
Everyone who reads such a statement will note
that the best interests of the patient are
uppermost.
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
When another physician makes an independent assessment,
once
again all concerned will know
that good doctor-patient relations
are being maintained.
The contents of all such statements
will
show that these doctors are not
acting as executioners.
And
this second professional evaluation
is intended to catch any
mistakes coming from the first physician.
If the first physician
has recommended death prematurely,
then the second physician will
raise appropriate doubts.
HOSPITAL
OR HOSPICE ENROLLMENT
When
the patient is being cared for in a hospital or hospice,
several
professionals and laypersons are participating in the care,
even
if everyone knows that the patient is dying.
In such settings of
patient-care,
doctors will not choose death capriciously or
prematurely.
INFORMATION
ABOUT PALLIATIVE CARE
AND
OTHER ALTERNATIVES TO DEATH
When
the patient is given everything he or she needs to know
about
palliative care and other alternatives to immediate death,
there
will be less worry that the providers
are pushing for death
prematurely.
PALLIATIVE
CARE TRIAL
When
some actual methods of palliative care are applied,
everyone
concerned will see how well the patient is being cared for
and
that there is no premature decision to 'pull the
plug'.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE
PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
When a professional psychologist or psychiatrist
evaluates a
patient and his or her plans for death,
it should be clear to
everyone that maximum care is being observed
to do what is best
for the patient.
Medical and psychological professionals are
cooperating
in helping the patient to choose the best pathway
towards death,
even if they recommend postponing death as long as
reasonable.
ADVANCE
DIRECTIVE FOR MEDICAL CARE
The
patient creates an Advance Directive for Medical Care.
By doing
so, the patient provides the most important input
for making all
future medical decisions.
The terminal-care physician follows the
patient's
settled values,
rather
than applying abstract, generic medical ethics to all
cases.
REQUESTS
FOR DEATH FROM THE PATIENT
When
the patient himself or herself
has decided that death
now
is better than death
later,
this
puts the patient's wishes ahead of the doctor's opinions.
Everyone
who reads a written request for death from the patient
will be
able to ask whether this is a wise decision
actually coming from
the patient.
INFORMED
CONSENT FROM THE PATIENT
Open
discussion between the doctor and the patient
results in a written
document spelling out what the patient wants.
When fully-informed
consent is obtained,
the doctor is not just following his own
rules of thumb.
Especially with regard to all decisions leading to
death,
care must be exercised to make sure
that the patient's
consent is based on full information.
OPPORTUNITIES
FOR THE PATIENT
TO
RESCIND OR
POSTPONE THE LIFE-ENDING DECISION
If
the patient has already made a life-ending decision,
that person
should be given several opportunities
to change his or her mind
about the choice and timing of death.
Each such opportunity shows
that the doctor
is not deciding:
The
patient is always in charge.
THE
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
And
if the patient himself or herself takes the life-ending actions,
then
it is certain that the
doctor is not putting the patient to death.
If
the patient takes the lethal chemicals, for example,
the doctor is
not killing the patient.
The
patient is freely and wisely choosing a timely death.
The
other safeguards help to ensure this is not an irrational
suicide.
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
When
an ethics committee has reviewed the plans for death,
this is
further protection for the patient,
preserving good doctor-patient
relations
and making sure that there
is no inappropriate pressure
from the doctor that might lead to a premature death.
Even the
fact that there
will be a review by an ethics committee
will
give the doctor pause about recommending death
until death is
obviously the best remaining alternative.
Several minds will
reach a better decision than just one mind.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING
OR
QUESTIONING CHOOSING DEATH
When
family members provide their written opinions,
they show their
cooperation in whatever end-of-life process
is unfolding for their
loved one.
Family members will usually not cooperate in any
premature death.
A
MEMBER OF THE CLERGY
APPROVES
OR
QUESTIONS CHOOSING DEATH
When
a member of the clergy approves the planned death,
only a few
people would continue to feel
that something harmful is being
visited upon the patient.
Clergy-persons bring their own
perspectives to end-of-life decisions.
RELIGIOUS
OR OTHER MORAL PRINCIPLES
APPLIED
TO THIS LIFE-ENDING DECISION
And
this religious advisor might prepare a document
explicitly stating
how the appropriate moral or religious principles
apply to the
life-ending decision now being considered.
REVIEW
BY THE
PROSECUTOR (OR OTHER LAWYER)
BEFORE
THE DEATH
TAKES PLACE
When
everyone knows that the prosecutor has reviewed the case
and found
nothing that warrants further investigation,
this should be good
evidence for everyone
that proper safeguards have been
fulfilled
and that the planned death will not be premature.
CIVIL
AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
And
if someone has broken the law,
then the appropriate penalties
should be applied.
Patients who know such safeguards are in
place
will have less reason to fear that they might be harmed in
any way.
The civil and criminal laws are the patients' safeguards
against the very rare 'angels
of death' among licensed physicians.
COMPLETE
RECORDING AND SHARING
OF
ALL MATERIAL
FACTS AND OPINIONS
Also,
during the process of creating the death-planning record,
several
people will have numerous opportunities to raise doubts
whenever
any reasons to question the decisions are warranted.
Everyone
involved knows that their actions and opinions
are
being placed into a permanent record of the patient's last year of
life.
THE
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
And
the final summary of the death-planning process
will be conclusive
proof that all appropriate safeguards were fulfilled.
Good
doctor-patient relations have been preserved.
This record will
show that there is no reason to suspect
that the doctor has pushed
the patient towards death
before the best time for that patient to
die.
If
these 20 safeguards do not seem sufficient
to preserve good
doctor-patient relations
and to reassure everyone that the
physician is not causing premature death,
there are a dozen more
listed in the complete catalog of
safeguards:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAT.html
Each
of these descriptions contains a few paragraphs
explaining how
that safeguard will discourage
all forms of choosing a premature
death.
Created
March 22, 2007; revised 4-12-2007; 9-26-2007; 7-16-2008; 11-2-2008;
1-29-2009; 3-26-2009;
3-30-2009; 1-30-2010; 5-21-2010;
2-25-2011;
12-29-2011;
1-27-2012; 2-21-2012; 3-28-2012; 7-18-2012;
9-12-2012;
5-3-2013; 6-21-2013;
7-17-2014;
10-10-2014; 7-2-2015; 12-1-2017; 6-28-2018; 8-30-2018; 5-27-2020;
Keeping
doctors associated with curing
rather than killing
by
using these 20 safeguards for life-ending decisions
has now become
Chapter 12 of
How
to Die: Safeguards for Life-Ending Decisions:
"Preserving
Good Doctor-Patient Relations: Will My Doctor Decide to Kill Me?"
Go
to other dangers,
mistakes, & abuses of the right-to-die.
Go to
the beginning of this website
James
Leonard Park—Free
Library