OPEN SAFEGUARDS KEPT
PRIVATE:
END-OF-LIFE MEDICAL
DECISIONS
SHOULD NEVER BECOME
PUBLIC INFORMATION
SYNOPSIS:
Wise end-of-life medical decisions necessarily
include
exploring medical facts and professional medical opinions.
Under present law and practice, all medical records are
private.
But this does not
mean that doctors make their recommendations
without clearly-articulated medical methods.
As the death-planning process comes out of the
shadows,
the deliberations about the last months of each life
should also be based on clear principles and guidelines.
The safeguards for end-of-life decisions should be open and
public.
This website itself—Safeguards
for Life-Ending Decisions—
illustrates how guidelines can be presented and discussed
without disclosing private information about any particular
patient.
When the safeguards are fulfilled for particular
patients,
all such deliberations and the documents created
are private medical
information.
OUTLINE:
1. INTRODUCTION—FULFILLING
SAFEGUARDS IN WRITING
2. KEEPING THE DEATH-PLANNING RECORD
COMPLETELY PRIVATE
3. THE MEANING OF "OPEN SAFEGUARDS"
4. SECRETIVE DEATHS, DISGUISED
CAUSES,
FALSE OR
INCOMPLETE
DEATH-CERTIFICATES
5. THE DEATH-PLANNING RECORD
WILL
NEVER BECOME PUBLIC INFORMATION
OPEN SAFEGUARDS KEPT
PRIVATE:
END-OF-LIFE
MEDICAL
DECISIONS
SHOULD
NEVER BECOME
PUBLIC INFORMATION
by James Leonard Park
1. INTRODUCTION—FULFILLING
SAFEGUARDS IN WRITING
When patients and/or their proxies are considering
which pathway towards death would be wisest for the
patient,
it might be best to record the entire death-planning process in writing.
More specifically, there should be a written record
of the safeguards that have been fulfilled.
We all endorse the concept of having
strong safeguards
to make sure that mistakes
and
abuses do not occur
when patients are considering how best to meet death.
Each fulfilled safeguard will result in a written
document,
which should clearly record who
took the steps to fulfill that safeguard.
And who certifies
that the safeguard has been applied as designed?
For example, when we ask the primary-care physician
to present his or her diagnosis and prognosis,
this should not only be given verbally to the patient and/or the
proxies,
but the physician should also create a written summary
of the diagnosis and prognosis.
This should be in addition to the regular medical
records,
which are often recorded in the short-hand
and technical terms of the
medical profession.
The diagnosis and prognosis should be in non-technical terms,
spelling out all medical abbreviations and explaining what they mean.
This summary diagnosis and prognosis
could also be
made a part of
the official medical record,
but it will be created primarily for the death-planning process,
which will be conducted by laypersons for the most part.
2. KEEPING THE
DEATH-PLANNING RECORD
COMPLETELY PRIVATE
Just as all medical records are kept private
unless there is some suspicion of wrong-doing,
(in which case law-enforcement authorities can obtain all documents),
the written records that show the fulfillment
of the relevant
death-planning safeguards
should be kept private from
the eyes of all except those persons
with a legitimate right to be involved in planning this death.
Strangers have no right to read our medical charts.
And strangers should have no right to read our death-planning records.
The safeguards will be fulfilled and certified by creating written
documents,
but these records will not
be available to strangers or to the news
media.
The most extreme opponents of the right-to-die
would like to examine every
death-planning record
looking for all possible errors and omissions that might have slipped
in.
And where the record is not complete,
these most extreme opponents of the right-to-die will assume (and
assert)
that terrible crimes have been omitted from the record.
This is a worst-case scenario,
but it is not beyond
the realm of
possibility.
We need only to consider what happened in the case of Terri Schiavo:
Every conceivable abuse and mistake was asserted
based on very flimsy 'evidence'
and gaps in her medical record as it was leaked to the public.
Even the Congress of the United States
was convinced enough to try to pass a special law
to keep Terri
Schiavo connected to life-supports.
There are similarities between these most extreme
opponents
of the
right-to-die and conspiracy theorists,
who claim that John F. Kennedy was killed by
the CIA
and that the American government was behind the 9-11-2001
attacks.
They pick over the public record in great detail,
always looking for any shred of 'evidence' that might support their case
and pointing out gaps and doubts that suggest to them
that terrible crimes were committed and then covered up.
Thus, we might need to improve the security
measures now in
place
to protect the medical
records and the death-planning
records
of all patients who are considering exercising
their right to choose
the best pathway towards death.
The most radical opponents of the right-to-die
will attempt to use every possible gap in
security
to get records in order to raise doubts
and in order to keep every body 'alive' as long as possible.
(More moderate opponents of the right-to-die
will not use illegal methods to support their case.)
Here is further discussion
of this principle of privacy:
"Keeping Government Officials, the Media, & other Strangers Out of
the Loop":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-KEEP.html
3. THE MEANING OF "OPEN
SAFEGUARDS"
When we fulfill safeguards for
life-ending decisions,
we should always put these into complete writings
so that this record could be reviewed in a court of law
if there is any suspicion that a crime (harm) might have been committed
disguised as a reasonable life-ending
decision.
This is the law with respect to all written medical
records:
Civil and criminal courts have the power to subpoena medical
records
to help settle civil lawsuits and criminal cases.
Thus all the medical records must be kept in
standard formats
so that they can be understood by strangers
who might be called upon to examine them at some later time.
Medical experts for both sides of any case
will be called upon to review these records
to make sure that no mistakes in medical practice were made
and that no abuses took place under the cover of medical practice.
Likewise, the safeguards fulfilled when planning
death
should be recorded in formats that are standard enough
to be understood by
well-qualified experts who might be call upon
to examine the death-planning record at some
later time.
Even better, the death-planning records should be in
forms
that can easily be understood by laypersons
—both laypersons involved in
making the end-of-life choices
and laypersons who might be called upon to serve on a jury.
The easiest way to make sure the safeguards are
fulfilled as
intended
is to follow all the procedures as planned and to write down the
results.
Probably one page of writing for each safeguard
would be sufficient to prove that that safeguard has been fulfilled.
All safeguards should be simple enough for laypersons to understand.
And their fulfillment should be easy to verify.
Some safeguards will be more relevant than others.
The people most deeply involved in the life and death of the patient
should select the most appropriate of the recommended safeguards.
This should not become a cumbersome process.
How might each safeguard save this patient from premature death?
If and when our own lives and deaths
were
being decided,
we would not want the deciders to take short-cuts with the
safeguards
simply because they could not be bothered with all the paperwork.
As a preview of possible safeguards,
to make this abstract discussion more concrete, see:
"Fifteen Safeguards for Life-Ending Decisions":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-10SG.html
4. SECRETIVE DEATHS,
DISGUISED
CAUSES,
FALSE OR
INCOMPLETE
DEATH-CERTIFICATES
Open
safeguards might be contrasted with the
secretive
processes
that were used in the early years of the right-to-die movement.
When law-enforcement officials were not open to the right-to-die,
then the whole death-planning process was very secretive and hidden.
When safeguards were being fulfilled, these were never put into writing,
for fear that some people involved in the death-planning process
might be charged with some crime (such as 'aiding a suicide').
There were professional opinions given by doctors,
but these did not become part of the official medical records.
Often the methods of dying were omitted from the
death-certificate.
The doctor who completed the certificate of death
mentioned only the underlying disease or condition
that led to the (hidden) life-ending decision.
Because the right-to-die began as an underground
movement,
many who have been part of this movement for many years
will
resist
the idea of having open
safeguards,
even if the specific facts of each case are kept completely private.
Some aid-in-dying helpers used only secret and
informal guidelines,
which were never intended to be put into writing.
And the methods of achieving death were never recorded
so that the cases would pass examination
by law-enforcement officials or judges and juries at some later time.
See bibliography on Helping
Patients
to Die.
But as the right-to-die becomes more open and public,
so will the safeguards become more open and public.
This parallels the trend toward more open medical decisions.
Old-school doctors did not think it necessary to explain everything
to their patients and/or the proxies for their
patients.
The doctor examined the patient and made a decision.
But now every medical decision is put into writing.
And doctors are well aware that there might be a judicial review
of their medical decisions at some time in the future.
They might be sued for malpractice in civil court.
Or there might even be a criminal complaint if someone thinks
that some law was broken under the cover of medical treatment.
Planning for death stretches
the
law more than most
medical practice,
because assisting an irrational suicide is still a crime in most places.
(And it ought to remain a crime when the
victim is harmed,
even if the dead person wanted to die.)
The open and public safeguards should
be
fulfilled in all right-to-die cases
because there
could always be some people who claim
that the patient
should not have died
or was coerced into
dying prematurely.
Following proper safeguards will prove that this
death was
(1) helpful, (2) rational, (3) well-planned, & (4) admirable.
These are the four criteria for a voluntary death or a merciful
death.
Not following the safeguards or merely pretending to fulfill them
could lead to an irrational
suicide or a mercy-killing.
The four corresponding criteria of such deaths are the following:
Irrational suicides and mercy-killings are:
(1) harmful, (2) irrational, (3) capricious, & (4) regrettable.
These differences are spelled out more completely in the following
chapters:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"?
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-IS-VD.html
Will this Death be
a "Mercy-Killing"
or a "Merciful Death"?
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-MK-MD.html
In the future, when
the right-to-die is acknowledged by all,
medical records will include all
discussions and decisions
that lead to the death of the patient.
Safeguards for life-ending decisions will be carefully and openly fulfilled.
And each chosen death will have a complete written record
of
how that death was achieved.
Death-certificates will explain both
the underlying disease or condition
and any life-ending
decisions taken by
the patient and/or the proxies.
5. THE DEATH-PLANNING
RECORD
WILL
NEVER BECOME PUBLIC INFORMATION
When we say that we want open safeguards that are
kept private,
we mean that the written record of fulfilling the safeguards
will never become public
information.
If one of the safeguards is
to have the prosecuting
authority review the
death-planning documents,
then we will know that a neutral third party,
who is familiar with obfuscations used by criminals to cover their
tracks
has read the death-planning documents
(which show how the other safeguards were fulfilled)
and has issued his or her own document saying that the planned death
will not violate any law in that jurisdiction.
It should be public information that the prosecuting authority
has ruled that the planned death can go ahead
because no crime will be committed
if the plans proceed as explained in
the documents.
The public and the news media
have only this right to know:
that the people responsible for prosecuting any possible crime
have examined the death-planning record and have found
that no crime will be
committed if the plans are carried forward.
To prevent second-guessing by extreme opponents of
the right-to-die,
the details of the
death-planning record will not be made public.
And perhaps it should be a new
crime
to disclose any such records to the public and/or to the news media.
When we make our medical decisions
—including any
decisions that will
lead to death—
we need to be certain that these medical records
will never become public
information.
In the past, no death-planning records were created,
which helped prevent extreme opponents of the right-to-die
from raising doubts about the cases.
But now we are probably ready for a more open and honest process
of making end-of-life decisions,
even tho in almost all cases, the death-planning documents
will never be disclosed to the public.
Even if we are certain about the decision for death,
we must be willing to have
the safeguards put into writing
because open safeguards, carefully fulfilled,
will prevent some unnecessary and unwise deaths.
We genuinely want to prevent
premature deaths of all sorts:
mercy-killings, premature withdrawal of life-supports,
manipulated 'choices' of death, & irrational suicides.
Other people will benefit if we fulfill the safeguards
as completely and honestly as
possible.
Created September
30, 2006;
Revised 11-24-2006, 1-3-2007; 2-14-2008; 11-13-2008;
2-12-2010;
5-20-2010; 11-10-2011;
1-12-2012; 1-28-2012; 2-12-2012; 3-22-2012;
7-29-2012; 8-18-2012; 10-18-2012;
5-16-2013; 6-26-2013; 7-22-2014; 11-30-2014; 5-2-2015; 10-9-2015;
2-13-2018; 8-15-2020;
AUTHOR:
James Park is a writer
with deep interest in end-of-life issues.
He is a strong advocate of the right-to-die in all forms,
when careful safeguards are employed.
See the Right-to-Die Portal:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/P-RTD.html
And more information about the author
will be found on his website, linked below.
The above discussion of how to have open and public
safeguards
(which are fulfilled in
completely private ways)
has become Chapter 22
of How
to Die:
Safeguards for Life-Ending Decisions:
"Open Safeguards Kept
Private:
End-of-Life Medical Decisions Should Never Become Public
Information".
Go to
the beginning of this website
James
Leonard Park—Free
Library