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.



<>
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.


Go to the beginning of this website
James Leonard Park—Free Library