Gentle
Poison:
The
Demand for Quick Death
SYNOPSIS:
For
many people, the 'right-to-die' means death-on-demand.
They
want the capacity to choose instant death for themselves
and
for all the people whose end-of-life situations they handle.
And
most right-to-die laws do set forth the circumstances
under
which dying patients can choose a speedy death.
However,
when other medical methods of managing dying are offered,
then
using a lethal chemical to cause death seems less desirable.
Gentle
poison becomes a last resort.
OUTLINE:
1.
OTHER MEDICAL METHODS OF MANAGING DYING
2.
THE IDEAL DURATION FOR THE PROCESS OF DYING
3.
GENTLE POISON AS A LAST RESORT
4.
HOW INFREQUENTLY GENTLE POISON IS USED
5.
SAFEGUARDS FOR USING GENTLE POISON
RESULT:
The reader who begins with the
wish to die by gentle poison
might have that original plan modified by the exploration
of other medical methods of managing the process of dying.
If the same destination can be reached,
then the other pathways might become more attractive.
And if the other ways of choosing death are
unsatisfactory,
then the option of lethal chemicals is available in some locations.
Gentle
Poison:
The
Demand for Quick Death
by
James Leonard Park
1.
OTHER MEDICAL METHODS OF MANAGING DYING
In
the early years of the right-to-die movement
and
in all of the first right-to-die laws,
the
only method of causing death
was
using lethal chemicals to bring death quickly.
But
more advanced forms of end-of-life legislation
take
into account how terminal medical care
is being
provided by doctors who take care of the dying.
The most common forms of managing dying are:
1. providing comfort-care only.
2. inducing terminal coma.
3. ending curative treatments and life-supports.
4. giving up water and other fluids.
Providing
comfort-care only means
adjusting
the pain-killers already in use
to
whatever level of comfort the patient wants.
When
everyone acknowledges that death is coming,
the
doctor might even establish in advance
a
regular schedule for increasing the drugs
(in
order to keep up with tolerance)
with
a reasonable estimate of the amount of time
that
will probably remain in this patient's life.
When the patient is receiving all appropriate
pain-medication
---keeping the patient comfortable as death
approaches---
why demand a faster death by means of gentle poison?
Inducing
terminal coma is a step beyond
keeping
the patient comfortable
by
using drugs to control all the symptoms of dying.
If
being awake for even brief periods of time
means
the return of terrible suffering,
then
the merciful choice is to keep
the patient asleep
for
whatever remains of the process of dying.
The
doctor orders all needed adjustments of drugs
so
that this patient will never again have a moment of consciousness.
The
medical order is for continuous, deep sleep.
Whatever
is causing the patient's death
will
proceed without any further attempts to 'save' the patient.
When all forms of suffering are prevented by
terminal coma,
why go thru the complicated and time-consuming process
of applying for gentle poison, administering it,
and then reporting to the required agencies of government?
It might take longer to apply for gentle poison
than to manage this death by terminal coma.
Ending
curative treatments and life-supports means
giving
up all of the medical methods of trying to prevent death.
Drugs
intended to cure the disease or heal the condition
can
now be completely withdrawn.
Only
drugs needed for comfort should be continued.
There
will be no more surgeries, no more chemotherapy,
no
more tests and medical procedures.
Whenever life-supports were in use,
these
will also be discontinued and disconnected.
Depending
on whatever is causing this patient's death,
the
doctor can explain how long it will take
for
the normal processes of dying to result in death.
No special application or review-process is required
for this very-common method of managing dying.
Ending life-prolonging medical treatments is always an option.
With good symptom-control, a peaceful and pain-free death results.
Giving
up water and other fluids means that
even
such simple methods of keeping the patient alive
can now be terminated.
When
death is inevitable, there is no point in continuing
to
provide nutrition and hydration.
Perhaps
the patient already stopped eating some days before.
And
now these more elementary life-supports can be discontinued.
Without fluids, this life will end in a few
days.
And appropriate symptom-controls can manage any problems.
Everyone already has the right to refuse fluids.
And the death should be recorded as caused by the underlying disease.
These
four medical methods of managing the process of dying
can
be used in any combination.
The
specific end-of-life situation will suggest the best choices.
The
most general pattern might simply be called
giving
up all further forms of medical support.
Nature
will now be allowed to run its course.
More
than half of all deaths in modern hospitals already include
some
combination of these methods of managing the process of dying.
2.
THE IDEAL DURATION FOR THE PROCESS OF DYING
When
we think about the right
time to die,
we
might be able to project the best duration of the process
that
will ultimately lead to our deaths.
Active
dying embraces that last phase of our lives
in
which the main thing that is happening every day
is our bodies beginning to shut down.
We
might be able to do a few other things
such
as complete our final good-byes
with
the people who have been closest to us
and
make any changes to our estate plans,
which
will distribute our assets after we are dead.
Other
people will also be deeply involved in this process.
These
other people will be both professionals
who
are employed to fulfill their roles in the process of dying
and
the people who have been close to us
in
the last few years of our lives.
The
professionals might not have any vested interest
in
whatever pathway towards death we choose.
They
will generally cooperate with our end-of-life decisions.
But
the people who will be most deeply affected by our deaths
might
have strong views about the best time to die.
Their
first reaction to the news of our coming-to-an-end
might
be that it should not happen
now.
Those
who have appreciated what we contributed during our lives
will
feel sorry to lose what was so meaningful to them.
Allowing
others a few days to adjust to our coming end
might
be as important as our own reasons
for
choosing one day to
die rather than the next.
My
own view from age 79 is that about one week
would
be the best duration of my process of dying.
This
will allow me to make any last-minute changes,
if I am still
able to make meaningful decisions.
If
we are managing our own deaths,
we
can select the best combination of methods
that
will lead to the best time to die.
Giving
up food and water might be the first step we will take.
This
would be especially appropriate
if
our bodies are already having trouble with food and water.
Later
in any such process,
we
might ask for appropriate drugs and other aids
to
deal with the symptoms of lack of water.
And
if that does not make the process tolerable,
we
can ask for terminal sedation,
which
will keep us completely unconscious
for
the rest of the process of dying.
3.
GENTLE POISON AS A LAST RESORT
The
five medical methods of managing dying
all
depend deeply on the cooperation of our terminal-care physicians.
And
our doctors will approve the usual methods of managing
dying
before
they would be inclined to prescribe a gentle poison.
Likewise,
the people who are closest to us at the end
are
more likely to accept the established ways of handling dying.
But we might find the
standard methods of terminal care inappropriate.
Why
would we reject the normal methods of handing dying?
Pain-medication
is a method of managing dying
that
can be carefully adjusted to just how we are feeling
—both
physically and psychologically.
We
will be awake part of each day
in order to do what we find important.
And
we will have restful sleep at night,
probably
helped by whatever combination of drugs works best for us.
Only
if all the drugs still leaves us in terrible
suffering
might
we decide that death by gentle poison would be better.
The
steady increase of drugs might slowly move us toward
what
might best be called terminal sedation.
And
we could approve being
kept asleep for the rest of our
lives
if
every moment of consciousness is intolerable suffering.
We
should discuss the option of terminal coma
before
it becomes an absolute necessity.
How
much worse would our condition have to become
before
we and everyone around us would agree
that
keeping us completely
unconscious is the best option?
And
if terminal sedation is a satisfactory pathway towards death,
what would make gentle poison a better choice?
In an induced terminal coma everyone knows that death is coming.
And
the approximate date of death can be projected.
Our family might appreciate the extra time to get ready for our death.
In
locations where gentle poison is a legal end-of-life option,
our doctors and nurses can help us to consider that method of dying.
And
because of the waiting periods required by law,
the
whole process of dying by means of gentle poison
might
take longer than using the other methods described above.
Two
weeks is a common waiting period for death by gentle poison.
The
other methods might take less total time,
since
there are no waiting periods for beginning
any
of those medical methods for managing dying.
But
there might be circumstances that make this last method best.
Patients who have already started some methods of managing dying
might
like to know that they have been approved for gentle poison
if
and when that becomes a better choice
than
the pathway they are already following.
Everyone
will probably feel much better about the process
if
gentle poison was only used as a last resort.
4.
HOW INFREQUENTLY GENTLE POISON IS USED
In
all the jurisdictions on the planet Earth
where
the right-to-die includes the right to use gentle poison,
this
last medical method of managing dying
might
be held in reserve for such time
when
all of the other methods of management are not appropriate.
When
using drugs to control symptoms
and
even to keep us completely and continuously unconscious
no
longer yields the desired results,
then
it might be time to use the last resort
—administering
lethal chemicals to cause immediate death.
For
our purposes here, the concept “gentle poison”
embraces
both a lethal injection given by a doctor
and
some powder or liquid that can be consumed by the patient.
Even
tho there is wide-spread support for this end-of-life option,
wherever
it is available, it is
almost never used.
In
the state of Oregon, for example,
this
last method of dying has been available since 1997.
In
the early years, only one death in a thousand
used
the Oregon Death with Dignity Act.
Then
the rate moved up to two deaths out of every thousand.
And
finally, the rate seems to have settled at 3 or 4 per thousand.
Even
tho the citizens of Oregon voted to allow this end-of-life
choice,
less
than 1% of them use this option at the end of their lives.
Holland
has had the right-to-die for an even longer time.
But
even with the most explicit authorization in law,
about
5% of all people who die in the Netherlands
avail
themselves of what they still call
'euthanasia'
and 'physician-assisted
suicide'.
Evidently,
they find the other methods of managing dying
to
be satisfactory when they come to the end of their own lives.
5.
SAFEGUARDS FOR USING GENTLE POISON
When
using gentle poison to bring a human life to an end,
the
best safeguards to prevent premature death
are
essentially the same as the safeguards
that
should be used for any life-ending decision.
These safeguards are stated very briefly here.
But to discover more about how to apply any safeguard,
click the link for a complete explanation on the Internet.
SAFEGUARD
A Advance
Directive for Medical Care
When
we write our Advance Directives for Medical Care,
we
should be sure to include our thinking about end-of-life options.
Which
medical methods of managing our dying do we endorse?
Almost
all of us will agree with the first four methods
briefly
described at the beginning of this chapter.
And
if we also believe in using gentle poison to end our
lives,
we
should say so in our Advance Directives,
even
if that method might not yet be available
where
and when we create our Advance Directives.
SAFEGUARD
B Requests
for Death from the Patient
When
we are approaching the end of our lives,
we
might have enough mental power to request death.
Any
such requests should explain (in our own words)
exactly
what our end-of-life situation is:
What
forms of medical treatment have we already tried?
What methods of managing dying do we prefer?
SAFEGUARD
C Psychological
Consultant
Evaluates
the
Patient's Ability to Make Medical Decisions
Because
most wishes to be dead are quite irrational,
we
should meet with a psychological professional
in
order to get a written evaluation of our mental state
as
we approach the end of our lives.
Does
this psychologist or psychiatrist
agree
that we have good reasons for wanting our lives to end?
SAFEGUARD
D Physician's
Statement of Condition and Prognosis
In
addition to our own written explanation of our situation,
we
should also have our physician write a summary
of our medical problems and the methods of healing already tried.
Does
this doctor also agree that death would now be the best
choice?
SAFEGUARD E Independent
Physician Reviews the Condition and Prognosis
A
second doctor, perhaps one who specializes in our major problem,
should
also create an independent assessment of our situation.
Does
this physician also agree that taking gentle poison
might
be the best course of action, given all the medical facts?
SAFEGUARD F Certification
of Terminal Illness or Incurable Condition
When
we are on the verge of choosing death,
the
basic reason might be that we are already dying.
But what harm would it do to have a written statement from a doctor
certifying
that we are definitely on the pathway towards death?
SAFEGUARD
G Unbearable
Suffering
Are
we requesting death because of some physical suffering?
We
should explain and describe this suffering in writing,
so
that even distant people will have some sympathy for us.
Are
we at the point where a quick death by gentle poison
would
be better than any other pathway we could choose?
SAFEGUARD
H Unbearable
Psychological Suffering
It
might also be that we have deep inward problems,
which
are also leading us to want to be dead.
We
should explain these to the best of our ability,
so
that other people will be able to understand our wish to die.
SAFEGUARD
I Palliative
Care Trial
Our
case for taking gentle poison will be strengthened greatly
if
we can show that we have already
tried
many other
possible methods of dealing with our medical problems.
Even
more impressive will be our account
of
the other medical methods of
managing dying
that
we have already tied and found unsatisfactory.
Do
we reject even induced terminal coma?
SAFEGUARD
J Informed
Consent from the Patient
The other statements we have already prepared
and
the statements from other family members and professionals
all
add to the data that should prove
that
we have fully considered all of the alternatives to death.
The
better the information upon which we base our request for death,
the
more likely we will be making a rational end-of-life
decision.
SAFEGUARD
K Requests
for Death from the Proxies
If we have already slipped beyond making our own
medical
decisions,
then our earlier explanations have greater weight.
But
the official power to decide our next step now shifts to our
proxies.
The
proxies might make a formal request for death
based
on all the gathered medical facts,
professional
recommendations, family statements, etc.
SAFEGUARD
L Enrollment
in a Hospital or Hospice
How long have we been receiving care from a hospital
and/or
hospice?
This medical history shows that
we do have serious medical problems.
And
if the medical care cannot cure us,
and
if the other methods of managing dying are not satisfactory,
then
we might have good reasons to end our lives using gentle poison.
SAFEGUARD
M Statements
from Hospital or Hospice Staff Members
The
nurses, counselors, chaplains, volunteers, etc.
of
the medical institutions that have taken care of us
might
also have their own perspectives to add.
Do
they agree that gentle poison is now the best means of dying?
SAFEGUARD
N Statements
from Family Members
Affirming
or
Questioning Choosing Death
Family
members will also be involved with our last days of life.
Because
they have already been following the medical treatments,
they
might also have come to the conclusion
that gentle poison is
the best option for the patient.
SAFEGUARD
O A
Member of the Clergy
Approves
or Questions Choosing Death
If
we have any religious connections at the end of our
lives,
we
might ask for a written statement from a clergy-person
who
knows our end-of-life situation well.
If we have chosen a religion close to our own thinking,
it is very likely that the professional religious leader
will follow the same facts to reach the same conclusion.
SAFEGUARD
P Religious
or other Moral Principles
Applied
to
this Life-Ending Decision
This
religious leader (or some other individual or group)
might
have created a set of principles for making end-of-life decisions.
If
so, is there support for choosing a shorter pathway towards death
—perhaps
using a gentle poison to end suffering?
SAFEGUARD
Q An
Institutional Ethics Committee
Reviews
the Plans for Death
The
ethics committee of the hospital or nursing home
might
have occasion to review the end-of-life situation.
Do
they agree that gentle poison would be the best solution,
given
all of the facts and prior failed attempts to cope with the
problem?
SAFEGUARD
R Statements
from Advocates for Disadvantaged Groups
If
Invited by the Patient and/or the Proxies
If
the patient belongs to any identity-group
that has sometimes suffered
discrimination,
then
it might be wise to ask for a written opinion
from some
representative of that group.
This consultant might agree that the end-of-life deliberations
have been wise and
comprehensive,
that there have been no deficiencies in the care provided.
Other
members of that same group might be comforted
to
know that this life-ending decision has been reviewed
by
a leading member of their own community.
SAFEGUARD S Review
by the Prosecutor (or other Lawyer)
Before
the
Death Takes Place
When
considering a somewhat-controversial method of dying,
it
might be wise to get the written professional opinion of a lawyer:
Is
this plan for dying by gentle poison legal in this
location?
If
the person making this evaluation is the public prosecutor,
then
there would be even less reason for anyone to worry
that
using this medical method of dying might be against the law.
SAFEGUARD
T Civil
and Criminal Penalties for Causing Premature Death
However,
there should always be the background fact
of
the possibility of prosecution for some crime
if
the reasons for choosing death by gentle poison
were
distorted or misrepresented in any ways.
SAFEGUARD U Waiting
Periods For Reflection
Because using gentle poison is so final and irrevocable,
there
should be meaningful periods for re-thinking this plan.
Perhaps
gathering all of the other written opinions
will
already have consumed sufficient time
so
that any second thoughts have already been amply explored.
But
if not, then a 'time out' can be declared,
which
will allow everyone involved to review everything
that
forms the background for making this life-ending decision.
SAFEGUARD
V Opportunities
for the Patient to Rescind or Postpone
the
Life-Ending Decision
There
should also be explicit occasions
when the deciders are asked if they want
to change their plans in any way.
Planning
for death by gentle poison should not move forward
just because the planning process has created its own momentum.
Especially
when the method of dying will be using gentle poison,
there
might be good reasons to postpone the death by a few days.
SAFEGUARD
W Physicians
Review the Complete Death-Planning Records
Because
any human process can have errors,
all
of the completed written documents should be reviewed one last time
by
the medical professional most in charge of this end-of-life care.
SAFEGUARD X Complete
Recording and Sharing
of
All Material Facts and Opinions
Everyone
involved in this life-ending process
should receive all of the documents as they are created.
And
they should review and revise their own statements as appropriate.
Then
the documents and records should all be gathered in one
place.
SAFEGUARD
Y The
Patient Must Be Conscious and Able to Achieve Death
Under
most gentle-poison laws, the patient himself or herself
is
required to be alert and capable up to the last moment of life.
This should assure everyone involved
that death is a truly free choice.
SAFEGUARD
Z The
Death-Planning Coordinator Organizes the Safeguards
And
after the death has occurred, someone should gather
all
of the documents generated for making this life-ending decision
into
one place for storage.
The records might be needed if ever
there is reason to re-examine this life-ending decision at some future
time.
Gentle
poison should not be the first
method of choosing
death.
The
standard methods of managing dying should be tried first.
And
in most cases, normal terminal care will achieve the same
results
—a
pain-free and peaceful death at the right time.
Created March 5, 2016, revised
3-18-2016; 3-25-2016; r 11-22-2017; 9-8-2018; 11-5-2019; 9-11-2020;
AUTHOR:
James Leonard Park is an advocate of
the right-to-die with very
careful safeguards.
His 26 recommended safeguards are applied
to
using gentle poison in this chapter.
(See the last section above.)
This discussion of gentle poison as a method of choosing death
is also a chapter of:
How
to Die:
Safeguards for Life-Ending Decisions
And
this gentle-poison chapter is also included in
Right-to-Die
Hospice
Could
gentle poison become a good method of dying?
Did you originally think that instant death was the best way to go?
Would you now be more inclined to try other methods
first?
When the most relevant safeguards are fulfilled,
is
gentle poison an appropriate pathway towards death?
Would you
approve gentle poison for someone you love who is dying?
Would you
choose gentle poison for yourself
at
the end of your life?
Closely
related chapters and on-line essays:
Four
Medical
Methods of Managing Dying
Methods
of Managing Dying in a Right-to-Die Hospice Program
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
The
One-Month-Less Club:
Live Well Now, Omit the Last Month
Choosing
Your Date of Death:
How to Achieve a Timely Death
—Not
too Soon, Not too Late
Losing
the Marks of Personhood:
Discussing Degrees of Mental Decline
Advance
Directives for Medical Care:
24 Important Questions to Answer
Fifteen
Safeguards for Life-Ending Decisions
Will
this Death be an "Irrational Suicide" or a "Voluntary
Death"?
Will
this Death be a "Mercy-Killing" or a "Merciful Death"?
Further
Reading:
Best
Books on Terminal Care (from the Doctor's Point of View)
Books
on Hospice Care
Terminal
Medical Care from the Consumer's Point of View
Books
on Advance Directives for Medical Care
Best
Books on Voluntary Death
Best
Books on Preparing for Death
Books
on Terminal Care
Medical
Methods of Managing Dying
Books
on Helping Patients to Die
Books
Supporting the Right-to-Die
Books
Opposing the Right-to-Die
Go
to the Book
Review Index
to discover 350 reviews
organized into 60
bibliographies.
Return
to the DEATH
page.