PROTECTING PATIENTS FROM
FAMILY PRESSURE TO DIE



WHEN EXTENDED DYING
            BECOMES A BURDEN TO THE FAMILY


    The right-to-die might sometimes become the duty-to-die
when the family of the patient is also suffering thru
a long, drawn-out process of the patient dying.
If the patient is still aware of his or her impact on others,
the patient might worry that prolonged dying
has become a burden not only to the patient himself or herself
but also a burden to other family members.

    Sometimes families abandon their dying relatives.
They stop visiting the dying 'loved one' in the hospital.
Or they visit less frequently and stay for shorter periods of time.
Dying can become an emotional burden for the family
as well as for the patient.

    And especially if the dying patient is being cared for at home,
the daily problems of taking care of that person (or former person)
can become overwhelming, especially for an elderly spouse.
There can be a serious tension between
the desire to care for the dying person
and the desire to end the whole ordeal.
Sometimes the family care-giver needs a long rest.
And sometimes there will be genuine relief
when the care-giver can resume the rest of his or her life.

    Even when such burdens are not explicitly acknowledged,
they should be taken into account.
The family members might all say how wonderful it is
to care for their dying relative.
But deep within their own emotions,
they know that it is also a burden.

    However, sometimes the family members become explicit
about their desire to bring the dying process to an end.
They ask the doctor what could be done to shorten the process.
When they are called upon to make medical decisions,
do they favor the options
that will bring death sooner rather than later?




THE DANGER OF A 'SUICIDE PACT'
            BETWEEN LIFE-PARTNERS


    Sometimes undue influence takes the form of a 'suicide pact'
for a long-time married couple.
When one of them is clearly dying, the other one might agree
to die at the same time in order to avoid the grief of surviving.
They make a plan to end their lives together,
at the same time, in the same place, and by the same method.

    If each partner independently has good reasons to die,
then this might not be an example of family pressure to die.
But quite often one spouse is healthier than the other
and could physically go on living for a number of years
after the death of the less-healthy spouse.
In heterosexual couples, the husband is often the dominant partner.
And he might be the one who convinces his wife
that it would be best for them to die together.

    It is nevertheless possible that both persons have good reasons
to end their lives at about the same time.
And if both voluntary deaths could be approved
by fulfilling the safeguards explained below,
then
in the considered judgment of several other persons
a joint decision for voluntary deaths would be reasonable.

    If each proposed death would be a wise choice at this time,
then avoiding the additional psychological suffering
of bereavement by dying together would be a positive factor.
One of the major reasons for making rational choices of death
is to avoid further suffering.
The grief of surviving a long-time partner
is an additional form of psychological suffering,
which can be a legitimate factor in planning for the end of life.

   
The possible financial motives are discussed in another worry:
PROTECTING PATIENTS FROM GREEDY RELATIVES:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-GREED.html
And the general problem of discriminating against dependent patients
is discussed here:
PROTECTING VULNERABLE PATIENTS FROM DISCRIMINATION
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-VUL.html

 


PROTECTING AGAINST FAMILY PRESSURE TO DIE


    Careful safeguards can help to prevent
premature deaths motivated by family fatigue.
The safeguards that would counter-balance
the desire to get rid of a burdensome relative
call for the considered judgments of neutral persons
who are not burdened by caring for the dying patient.

    Sometimes it will be wise to remove the patient
from the daily care of the family
in order to separate the burden of caring
from the process of deciding what is best for the patient.
A nursing home might be a better place for the patient to live.
And a hospice program might dramatically reduce family problems.
In many cases, a new living situation with professional support
would be a better option than choosing immediate death.
See Information about Palliative Care and other Alternatives to Death.

    How should we prevent the unfortunate result of a 'suicide pact'?
One partner has valid reasons to choose a voluntary death.
But the other partner might feel pressure to commit irrational suicide.
If this is a serious danger, careful thought should be given
to helping the healthier partner to continue living
after the chosen death of the sicker partner.

    If both partners are ready to die,
the death-planning process should evaluate
the reasons for choosing death for each partner independently.
In other words, the safeguards for life-ending decisions
should be applied to each patient
without regard to how the other patient fulfills the safeguards.
If both partners are near the end of their lives,
then simultaneous voluntary deaths or merciful deaths might be wise.
Or it might be a merciful death for a partner in a coma
alongside a voluntary death for the partner who is still mentally capable.

    Whenever there is danger of an irrational 'suicide pact'
which means that one partner would suffer a premature death
then the safeguards that call for evaluation by persons
who can see beyond the dependence of one spouse on the other
will become even more important.
For example, would their clergy-person approve of both dying together?
Would the prosecutor agree that no crimes will be committed
if the joint deaths are carried forward as planned?

    Many of the following safeguards call for the opinions of people
who are not involved in the daily care of the patient(s).
They should be aware of the danger of pressure from the family.
Here are ten safeguards that will be most effective against
family fatigue and manipulation by a dominant spouse or partner.
These selected safeguards are listed in order of effectiveness,
beginning with the most powerful.
The blue title links to a complete explanation of that safeguard.
The red comments explain how that safeguard
deals with the specific problem of family pressure to die.



THE PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH

    If both partners are conscious and able to make life-ending decisions,
then they can evaluate the wisdom of choosing simultaneous deaths.
The fact that the patient himself or herself takes the final life-ending action
is not absolute proof that this will be a wise death,
but a conscious choice is strong evidence that this is the best time to die.

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

    The public prosecutor can recognize hidden motives.
When a plan for two people to die together is offered,
the prosecutor will carefully look for the possibility
that one partner is manipulating the other.
And any experienced prosecutor can look carefully
for any other forms of family pressure to die.


CIVIL AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH

    If one of the life-partners is really being manipulated into death,
then the existence of sanctions
might encourage all who are cooperating in this plan
to make sure that both deaths are wisely chosen.
Anyone who exerts undue pressure to cause a premature death
should be subject to all appropriate civil and criminal penalties.

A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING DEATH

    If a clergy-person approves a decision for simultaneous deaths,
this will be strong evidence for more distant doubters
that both deaths were independently justified.
Whenever a member of the clergy endorses any life-ending decision,
this is strong evidence that this death is being wisely chosen
and that it is not the result of undue family pressure.

REQUESTS FOR DEATH FROM THE PATIENT

    When both partners make independent requests for death,
each request can be evaluated on its own merits.
Is any request for death influenced by family pressure to die?

INFORMED CONSENT FROM THE PATIENT

    Likewise fully-informed consent should be obtained from each patient.
And sometimes this question should be discussed privately,
away from any possible family pressure to die.

UNBEARABLE SUFFERING

    Suffering should be evaluated for the two patients independently.
If both request death for good reasons,
then the same methods and timing of death might be appropriate.
In every case, the suffering of the patient(s)
must be separated from the suffering of the family.

PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    Any physicians' statements of the medical facts and prospects
will be issued specifically for each patient.
Just as a physician might have two patients dying in the same week,
it is quite possible that two partners
might be nearing death within the same time-frame.
The objective facts about any patient
can be evaluated quite apart from family wishes.

ETHICS COMMITTEE REVIEWS THE LIFE-ENDING DECISION

    An institutional ethics committee will review each case separately.
If they agree with the life-ending decisions for both patients,
the ethics committee could approve their coordinated dying.
If only one patient has sufficient reasons for choosing to die now,
the ethics committee will not approve immediate death for the other.
And the ethics committee can be more dispassionate
about the medical facts and professional opinions than the family.
An ethics committee can counter-balance family pressure to die.

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

    Also, if either patient chooses someone to prevent discrimination,
then the written evaluation of that advocate
will counter-balance any foolish end-of-life plans made by anyone.
And the additional approval of this special advocate
should help to convince others that any chosen death
is not primarily motivated by the wishes of other family members.


    In very difficult cases of proposed joint deaths,
some other possible safeguards might clarify the situations.
It is better to examine the proposed deaths
using too many safeguards rather than applying too few.
Whenever family pressure might be a factor,
then bring in more neutral observers,
who can reach reasonable conclusions free of family wishes.

    Here is a separate chapter counting the number of individuals
who might become involved in a life-ending decision:
"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



created February 24, 2007; revised 3-11-2008; 8-30-2008; 11-5-2008; 12-9-2008;
1-30-2010; 5-21-2010; 2-25-2011; 12-18-2011;
 2-18-2012; 3-25-2012; 5-29-2012; 9-11-2012; 3-1-2013; 6-20-2013;
7-16-2014; 10-8-2014; 7-3-2015; 11-17-2017; 8-15-2018; 1-23-2019; 6-17-2020;


The discussion of possible family dynamics distorting plans for dying
has become Chapter 2 of How to Die: Safeguards Life-Ending Decisions:
"Protecting Patients from Family Pressure to Die".



Go to other dangers, mistakes, & abuses of the right-to-die.




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