WILL
MY DOCTOR PRESCRIBE
AN OVERDOSE OF DRUGS?
All systems of organized medicine give special powers to doctors
to
prescribe pain-killing medications.
If the
patient is already receiving drugs
to treat the pain
of the disease or condition,
then the doctor decides just
how much to prescribe.
Increasing any pain-medication already
in use
is always within the authority of the doctor.
But what
is to prevent the doctor from ordering too much
pain-medication?
Perhaps the doctor and the family will
conspire to cause a premature death
by means of administering an
overdose of pain-medication.
Another
common medical practice is to order terminal
coma.
Here
the doctor orders that sufficient drugs be given continuously
so
that the patient will never wake up.
The purpose is to save
the patient from any further suffering
by keeping the
patient asleep for the rest of his or her life.
When
terminal coma is induced, it is usually accompanied
with
orders to abandon life-support systems
and to abandon
all forms of feeding and providing water to the patient.
All
such steps are part of a set of decisions
that acknowledge
that the patient is dying.
And some of these steps will
shorten the process of dying.
In
some places on the Earth,
doctors are permitted to prescribe
lethal doses of drugs
with the explicit purpose
of
bringing the patient's life to a peaceful and painless end.
What
prevents the doctor from abusing this power?
Do some doctors cause premature death
using their power to
prescribe lethal amounts of drugs?
Because
all doctors are also people, they can make mistakes.
Thus, because
the doctor has the power to control drugs,
the doctor can say "yes" or "no" to death caused
by drugs
---or to a process of dying shortened by the use
of drugs.
Some safeguards are needed
to prevent doctors from
abusing their prescribing-power.
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SAFEGUARDS
TO DISCOURAGE
THE MISUSE OF
DRUGS TO CAUSE PREMATURE DEATH
The following are the most powerful safeguards
for preventing any
abuses of the doctor's authority to prescribe drugs.
These
safeguards are organized beginning with the most effective.
The
blue
title
links to a complete explanation of that safeguard.
The red
comments
explain how that procedure or review
prevents doctors from abusing their
prescribing power.
REVIEW
BY THE
PROSECUTOR (OR OTHER LAWYER)
BEFORE
THE DEATH
TAKES PLACE
Sharing the death-planning process with the prosecutor
—including
the amounts of specific drugs planned—
should
prevent any
premature death
caused by the doctor prescribing too much
pain-medication.
The doctor will explain his reasons for
prescribing the drugs.
If the doctor knows that his or her
prescribing activities
can be reviewed by the legal
authorities,
he or she will
be careful not to abuse this power.
CIVIL
AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
When the doctor knows the possible penalties for making a bad
decision,
he or she will think twice about doing anything that
might harm
the patient.
The doctor will have a vested interest in making
certain
that all of the relevant safeguards have been
fulfilled.
Is death
at this time
the best choice for the patient?
Fulfilling the other safeguards
will be a process
aimed at reaching the best possible end-of-life
choices.
If the death-planning record shows that this death was
wisely chosen,
no civil or criminal penalties would even be
considered.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE
PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
When the patient approves the end-of-life use of
drugs,
then
it would be relevant to make sure
that
the patient is still able to make wise medical decisions:
The
patient is mentally able to approve the suggested level of
medication.
And the patient does request the appropriate
amount of drugs.
REQUESTS
FOR DEATH FROM THE PATIENT
When the patient has requested the proposed
drugs,
it is less likely that the resulting death will be
premature.
The patient states that he or she is ready to die
and
approves a method of dying that involves the use of drugs.
When
the patient is requesting death,
induced terminal coma might be the
most appropriate choice.
UNBEARABLE
SUFFERING
And
when the patient has explained his or her specific suffering,
this
is direct testimony about the need for pain-killing drugs.
The
patient is giving informed consent for additional
pain-killers,
recognizing that the drugs will probably shorten the
process of dying.
Or the patient is requesting to be kept
unconscious until death comes.
If the suffering is intolerable,
then being kept asleep continuously will prevent any further
suffering.
UNBEARABLE
PSYCHOLOGICAL SUFFERING
If
the patient is suffering emotionally,
this would be relevant
to consider
as a reason for shortening the process of dying
by
using reasonable amounts of drugs.
Or the unbearable psychological
suffering
could be completely prevented by terminal
coma,
since psychological or emotional suffering
is
impossible when the patient is unconscious.
PALLIATIVE
CARE TRIAL
Using comfort-care drugs experimentally could establish
the
exact level of benefit and burden from each level of
pain-control.
This
will be good background for deciding to increase
pain-medication
with
the knowledge that it will probably shorten the process of dying.
And
if the palliative-care trial shows that
no
level of pain-killers
is sufficient to control the pain,
then
inducing terminal coma might be a wise alternative.
INFORMED
CONSENT FROM THE PATIENT
The
power of doctors to recommend any medical procedure
is tempered by
the informed consent of the patient.
Carefully consulting the patient will make sure that the patient
has fully understood and
approved of the use of drugs.
Exactly what level of medication
does the patient want?>
AN
INSTITUTIONAL ETHICS COMMITTEE
REVIEWS
THE PLANS FOR DEATH
An ethics committee will be familiar with the practices in
question.
They will know appropriate times to use drugs
to control pain
and even to create permanent unconsciousness.
An
ethics committee can review the possible excesses of
doctors.
Given the condition and prognosis of the patient,
is
the doctor suggesting too
much
or too
little
pain-controlling medication?
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
When an independent physician has reviewed the end-of-life drug-plan,
this will be strong evidence that it was
a
reasonable medical choice.
The second physician might also create
a written statement
explaining why the patient's condition
justifies a specific level of medication.
This will be a check on
the first physician's recommendations.
HOSPITAL
OR HOSPICE ENROLLMENT
When the drugs are administered within a medical institution,
the
amounts and timing of the drugs will be well recorded.
This
should give any renegade doctors second thoughts
about
committing a crime under the color of medical practice.
If any
harm has been visited upon the patient,
the hospital or hospice
records should show
exactly how that harm was
committed.
COMPLETE
RECORDING AND SHARING
OF
ALL MATERIAL
FACTS AND OPINIONS
When
all of the steps towards death are documented
and shared with
everyone who has a legitimate right to know,
then the end-of-life
use of drugs will also be recorded and shared.
This complete
openness will give renegade doctors pause
before they break the
law to prescribe overdoses of deadly drugs.
Does the record show the doctors have followed careful safeguards
intended to separate foolish decisions from wise choices?
THE
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
And if the
death-planning coordinator
collects and
organizes all of the fulfilled safeguards,
this will be strong
evidence
that this death was wise and timely---not premature.
Several responsible persons—professionals and laypersons—
knew about the end-of-life drug-plan
and they approved those life-shortening or life-ending decisions.
If these 13
safeguards do not seem sufficient
to discourage any
premature death caused by a doctor
abusing his or her authority
to prescribe drugs to shorten the process of dying,
there
are 22
more
listed in the complete catalog of
safeguards:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAT.html
Each
of these descriptions contains a few paragraphs
explaining how
that procedure will discourage
all forms of premature death.
Created
July 16, 2008; Revised 7-23-2008; 7-31-2008; 8-27-2008; 11-12-2008;
2-1-2009; 3-29-2009; 4-8-2009;
1-17-2010; 1-31-2010; 2-25-2011;
12-29-2011;
1-27-2012; 2-21-2012; 3-28-2012;
7-18-2012; 9-12-2012;
5-3-2013; 6-21-2013; 7-31-2013;
7-17-2014; 10-10-2014;
5-5-2015;
7-2-2015; 12-21-2017; 9-5-2018; 5-28-2020;
This
worry that some doctors might prescribe
an overdose of drugs to cause
premature death
has become Chapter 13 of How
to Die: Safeguards for Life-Ending Decisions:
"Will My
Doctor Prescribe an Overdose of Drugs?"
Go
to other dangers,
mistakes, & abuses of the right-to-die.
A closely-related
worry is explained here:
Preventing
Mercy-Killing.