AN INSTITUTIONAL ETHICS COMMITTEE
REVIEWS THE PLANS FOR DEATH
If the patient is already in a
hospital or nursing home,
there might be an established institutional
ethics committee,
with regular procedures for reviewing life-ending decisions.
If so, the documents already completed for the death-planning record
should be reviewed by that ethics committee.
The careful documentation should be quite impressive,
since they usually only get a recommendation from a doctor.
If the committee does not
agree with the plans for death,
it should make its doubts known so any problems can be resolved
by collecting further facts and opinions if needed.
The final report of the ethics committee should list
all the documents created in the process
of
planning this death
that it has reviewed and found satisfactory.
Ethics committees usually consist of a doctor, a
lawyer, nurses,
an ethicist, religious leaders, & various other laypersons.
The members of the committee were selected
because they can weigh the various medical facts and opinions
that have any bearing on the decision at hand.
Their deliberations should yield a dispassionate recommendation
because they were not previously involved in the life of the
patient.
The ethics committee should meet with
the patient and/or the proxies.
This will help the ethics committee to assess the validity
of the reasons for choosing death at this time.
And if a life-ending decision would not be wise,
the committee
should say so.
If and when the committee is satisfied with
the life-ending
decision,
it should add its written conclusions to the death-planning record.
If there is no ethics committee in the
hospital or nursing home,
then the patient and/or the proxies might seek out
a private consultant in medical ethics.
Eventually, as the right-to-die is more widely accepted,
some consultants might specialize in life-ending decisions.
These people might be called "death-planning consultants".
And if there is no one else to gather and distribute the documents,
the death-planning consultant could take this administrative
role. See
another safeguard called: Death-Planning
Coordinator Organizes the Safeguards.
Ethics committees and death-planning consultants
have thought deeply about the medical ethics surrounding death.
While they must not impose their own values
on the real decision-makers—the patient and/or the proxies—
they might clarify issues the laypeople are facing for the first time.
These ethical consultants should not be
expected
to make any decisions
concerning the proposed death,
but they can help the decision-makers to examine all the options
and gather all the opinions relevant to the end-of-life choices.
The ethics committee or death-planning
consultant
can make sure that all of the proper safeguards have been fulfilled
and that all the documents have been gathered
and distributed to everyone who needs them.
If an institutional ethics committee has no
formal guidelines
for reviewing life-ending decisions,
it might adapt some of the safeguards discussed here
to become the official policy of the institution.
And any such policies, guidelines, & safeguards
should be made known to all potential patients and their proxies,
in case they might want to choose terminal care in that
institution.
HOW REVIEW BY AN INSTITUTIONAL ETHICS COMMITTEE
OR OTHER ETHICAL
CONSULTANT
COULD DISCOURAGE IRRATIONAL SUICIDE
AND OTHER PREMATURE DEATHS
Most people who are thinking of killing themselves
for foolish 'reasons'
will never ask an ethics committee to review the decision
for death.
But if any mistakes, abuses, or coercion might cause
premature death,
then an ethics committee should be able to uncover any such problems.
This consultation should not
merely approve decisions already made.
Rather, all of the facts and opinions gathered
to support the
life-ending
decision should be probed
and questioned.
The institutional ethics committee should have clearly in mind
exactly what it means for them to prevent a premature death.
The history of each ethics committee should show
that sometimes they say "yes"
to life-ending decisions
and sometimes they say "no".
And sometimes they ask for more information
or recommend delaying the proposed death
until some specified milestones have passed.
An
ethics committee of the medical institution caring for the patient might
have good principles for reviewing all end-of-life decisions. This
is Safeguard Q in How
to Die: Safeguards for Life-Ending Decisions: "An
Institutional Ethics Committee Reviews the Plans for Death".