SAFEGUARDS FOR LIFE-ENDING DECISIONS
AS FOUND IN VARIOUS LAWS AND PROPOSED LAWS



QUEBEC'S RIGHT-TO-DIE LAW: An Act Respecting End-of-Life Care

Allows refusal or termination of any life-sustaining medical treatment,
continuous palliative sedation, & medical aid-in-dying.
17 embedded safeguards are highlighted and organized.
This law came into effect on December 10, 2015.

SUGGESTIONS FOR OTHER PROVINCES OF CANADA

Why not officially authorize all five methods of managing dying?
Up to 18 safeguards will make these better right-to-die laws.

CANADA'S NATIONAL RIGHT-TO-DIE LAW:
MEDICAL ASSISTANCE IN DYING


   In June 2016, the national Parliament of Canada
enacted a new law permitting "medical assistance in dying".
This right-to-die law takes the form of creating
a new exception to the law prohibiting 'assisting suicide'.
Doctors and nurse practitioners are authorized
to prescribe and/or provide gentle poison for dying patients.
If they fulfill all 12 safeguards embodied in the law,
they will not be charged with
culpable homicide,
aiding suicide, or administering a noxious thing.

And this immunity from prosecution extends to all others
who cooperate in the authorized medical assistance in dying.

CANADIAN CRITERIA FOR MEDICAL ASSISTANCE IN DYING

    This summary of the safeguards embodied in Canada's law
also comments on their interpretation and application.




RIGHT-TO-DIE IN FRANCE

France officially authorizes the four standard
medical methods of managing dying:
(1) increasing pain-medication,
(2) beginning terminal sedation,
(3) ending medical treatments and life-supports,
(4) giving up food and water.



Guidelines for Prosecuting 'Assisting Suicide' in the UK

Such pros and cons for prosecutors
could form the basis for new right-to-die laws.

UNITED KINGDOM, HOUSE OF LORDS BILL 42, 2016-2017

This bill calls for a judge of the family court
to approve the request for assisted dying.
13 safeguards are applied to the life-ending decision.



EUTHANASIA SAFEGUARDS IN BELGIUM

18 safeguards mentioned in the euthanasia law of Belgium, 2002.
The right-to-die was extended to dying children in 2014.



SAFEGUARDS USED IN THE NETHERLANDS

13 safeguards can be found in the 2002 law 
and Dutch practice of euthanasia and physician-assisted suicide.



THE CALIFORNIA END OF LIFE OPTION ACT, 2015

    The text of this bill, with safeguards highlighted,
and comments added at the end.


    The official text of End of Life Option Act,
which came into effect in California in June, 2016.

SAFEGUARDS EMBEDDED IN CALIFORNIA'S RIGHT-TO-DIE LAW


These are presented here in the order of their importance
in protecting patients from premature death.
Each safeguard is linked to a complete explanation on the Internet.
The Internet presentation of the safeguards are not part of California law.
In this list of the California safeguards,
the letters come from the comprehensive list of 26 recommended safeguards.



B. REQUESTS FOR DEATH FROM THE PATIENT

D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

E. INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

F. CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE CONDITION

J. INFORMED CONSENT FROM THE PATIENT

U. WAITING PERIODS FOR REFLECTION

V. OPPORTUNITIES FOR THE PATIENT TO RESCIND OR POSTPONE ANY LIFE-ENDING DECISIONS

X. COMPLETE RECORDING AND SHARING OF ALL MATERIAL FACTS AND OPINIONS

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

AA   Information about Palliative Care and other Alternatives to Death

DD  The Patient Must be an Adult Resident of the State

By this count, there are 11 safeguards embedded in this law. 
The letters for each safeguard come from the complete list of 26 recommended safeguards.

An explanation of how patients and their doctors might fulfill these safeguards:
CALIFORNIA END OF LIFE OPTION ACT
SAFEGUARDS TO FULFILL IN ORDER TO QUALIFY FOR HELP IN DYING




The following bill (2007) did not become law in California,
but the safeguards might have been better than the law passed in 2015, above.
However, the most important safeguards were included in the End of Life Option Act.
An important omission in the 2015 law is the psychological consultation.

SAFEGUARDS EMBEDDED IN

CALIFORNIA'S COMPASSIONATE CHOICES BILL, 2007

    The text of the California Compassionate Choices Bill
with safeguards highlighted and linked
.

    An organized list of the 16 specific safeguards found in the California bill:

    SAFEGUARDS TO BE FULFILLED BY PHYSICIANS
        AND OTHER PROFESSIONAL CONSULTANTS

       PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS
           
       INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

       INFORMATION ABOUT PALLIATIVE CARE

       HOSPITAL OR HOSPICE ENROLLMENT

       CERTIFICATION OF TERMINAL ILLNESS OR CONDITION

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

       THE DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS

       PHYSICIAN AGREES TO PRESCRIBE GENTLE POISON TO CAUSE DEATH

  


    SAFEGUARDS TO BE FULFILLED BY THE PATIENT

       THE PATIENT MUST BE AN ADULT RESIDENT OF THE STATE

       REQUESTS FOR DEATH FROM THE PATIENT

       INFORMED CONSENT FROM THE PATIENT

       UNBEARABLE SUFFERING
     
       WAITING PERIODS FOR REFLECTION

       OPPORTUNITIES FOR THE PATIENT TO RESCIND OR POSTPONE THE LIFE-ENDING DECISION

       THE PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH

       NOTIFY FAMILY OF LIFE-ENDING DECISION

              


California Compassionate Choices Bill of 2007
minor problems and their solutions




THE CALIFORNIA RIGHT TO KNOW END-OF-LIFE OPTIONS LAW
   
    The text of this law, enacted in 2008, is presented
together with a detailed critique and recommendations for improvement.


    In 2014, this law was slightly revised,
still omitting the more controversial methods of choosing death.



MINNESOTA LAW PERMITS SOME FORMS OF PHYSICIAN AID-IN-DYING

    The state of Minnesota has already revised
its law against 'assisting suicide' to allow doctors
to withdraw life-sustaining medical treatments
and to use drugs to ease suffering
without being charged with 'assisting suicide'.

THE MINNESOTA COMPASSIONATE CARE BILL of 2015

   
The text of this proposed law, with safeguards highlighted,
and comments added at the end.


    This bill was reintroduced for the 2017-2018 session
with the new name: End-of-Life Option Act.



SAFEGUARDS EMBEDDED IN
OREGON'S DEATH WITH DIGNITY ACT

(AND IN THE WASHINGTON STATE CLONE)

    The text of Oregon's Death with Dignity Act
with safeguards highlighted and linked
.

    The text of Washington State's Death with Dignity law
with safeguards highlighted and linked
.

    Eleven specific safeguards found in Oregon's Death with Dignity Act
(and the Washington law copied from the Oregon Act):

PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

CERTIFICATION OF TERMINAL ILLNESS OR CONDITION

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

THE PATIENT MUST BE AN ADULT RESIDENT OF THE STATE

REQUESTS FOR DEATH FROM THE PATIENT

INFORMED CONSENT FROM THE PATIENT

NOTIFY FAMILY OF LIFE-ENDING DECISION

WAITING PERIODS FOR REFLECTION

OPPORTUNITIES FOR THE PATIENT TO RESCIND OR POSTPONE THE LIFE-ENDING DECISION

COMPLETE REPORTING OF ALL MATERIAL FACTS



SIX TECHNICAL CHANGES SUGGESTED
FOR THE OREGON DEATH WITH DIGNITY ACT


All bills patterned after the Oregon Death with Dignity Act 
can avoid these small problems and ambiguities.




SUICIDE-MODEL RIGHT-TO-DIE
VS.
MEDICAL MODEL RIGHT-TO-DIE

Most of the laws listed here follow the suicide-model.
But a few are based on authorized medical practices.



SAFEGUARDS IN THE PROPOSED
MODEL LAW AGAINST CAUSING PREMATURE DEATH

    The text of the Model Law against Causing Premature Death
with safeguards highlighted and linked.

    Section V of this draft legislation lists 26 safeguards
the A to Z of choosing a wise, ethical, & timely death.

    All of these recommended safeguards
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-Z.html
are included in the Model Law against Causing Premature Death.
This model law does not require the patient
to be an adult or a resident of any particular state.
One can be a victim of premature death
at any age and no matter where one lives.



SAFEGUARDS EMBEDDED IN
THE SOUTH AUSTRALIA VOLUNTARY EUTHANASIA BILL 2006

    The text of the South Australia Voluntary Euthanasia Bill 2006
with safeguards highlighted and linked
.


    Nine specific safeguards found in
the South Australia Voluntary Euthanasia Bill 2006:

PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS

CERTIFICATION OF TERMINAL ILLNESS OR CONDITION

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

THE PATIENT MUST BE AN ADULT RESIDENT OF THE STATE

REQUESTS FOR DEATH FROM THE PATIENT

UNBEARABLE SUFFERING

PALLIATIVE CARE TRIAL

WAITING PERIODS FOR REFLECTION


Critique of the South Australia Voluntary Euthanasia Bill of 2006



ARIZONA AID IN DYING BILL

ARIZONA PATIENT-ADMINISTERED MEDICATION BILL

Safeguards Used by the Final Exit Network in the USA


revised August 24, 2008; 8-27-2008; 11-23-2008; 5-13-2010;
3-29-2012; 4-7-2012; 6-6-2013; 5-28-2014; 11-20-2014;
3-16-2015; 3-20-2015; 4-30-2015; 10-15-2015; 10-16-2015; 10-19-2015;
11-11-2015; 11-13-2015; 5-4-2016; 6-16-2016; 7-8-2016; 7-29-2016;
5-17-2017; 3-16-2018;



{Other laws and proposed laws to be added here.
Please send links to laws and proposed laws
already posted on the Internet:
James Park, e-mail: PARKx032@TC.UMN.EDU  }



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Safeguards for Life-Ending Decisions.



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