SPECIFICALLY-LICENSED
TERMINAL-CARE PHYSICIAN
AGREES TO PROVIDE LIFE-ENDING CHEMICALS
Note: This safeguard
is suggested as an alternative to the safeguard called PHYSICIAN
AGREES TO PROVIDE LIFE-ENDING CHEMICALS. As such, it incorporates
everything from that safeguard but adds that only a
special, licensed sub-set of physicians would be authorized to provide
life-ending chemicals to cause
death. A break indicates the beginning
of the new part added for this
safeguard. Both safeguards EE and FF end
with the same explanation of how physician-provided
lethal chemicals would prevent premature
death.
After the
primary-care physician has reviewed all
the medical facts and opinions
collected for planning death,
the doctor might approve a chosen
death.
This safeguard will normally be one of the last to
be
fulfilled
—after the opinions of the patient, family, proxies, ethics committee,
etc.
have all been properly gathered and distributed
to everyone legitimately involved in the death-planning process.
This approval by a terminal-care physician
has not
always been recognized as a safeguard,
because it was assumed to be so central to the process
as defined in laws permitting the giving of life-ending chemicals.
But it is important for at least
one
central professional to approve the
life-ending decision.
If this safeguard is not used, others become more important.
(Providing or authorizing life-ending chemicals
is a legal option in only a few locations on the planet Earth.
The Netherlands, Oregon, & Washington are three early examples.
Elsewhere the doctors might recommend and provide other means of
choosing death,
such as increasing pain-medication, inducing terminal coma,
disconnecting life-support systems,
or giving up water and other fluids.)
Exactly which chemicals should be used
to achieve a
peaceful and painless death
can be decided by the professionals
most centrally involved in the
life-ending decision.
But the purpose of the life-ending chemicals
should be plainly stated
for all
to
understand.
Therefore, to avoid even subtle or subliminal misunderstanding,
the chemicals to be used to cause death should
never
be described as "medication".
Especially if there might be translation problems
for patients and families for whom English is not the first language,
the chemicals should be described as "life-ending", "lethal", etc.
The purpose of these chemicals is not to medicate the patient
but to cause the immediate
death of the patient.
Every language has ways of discussing ending human life.
These are death pills or
liquids—not "medications".
The purpose of the life-ending chemicals must
be
fully
explained
to the patient, family members, and/or the proxies.
Everyone involved in planning this death
should be made aware that the life-ending chemicals
will first render the patient
unconscious
and then cause death within
a few hours at the most.
The intent of providing and taking the life-ending chemicals
is to cause the patient to
die a peaceful and painless death.
And the physician who provides the life-ending
chemicals
must make sure that everyone involved in the death-planning process
fully understands just how death will be caused by the lethal chemicals.
It might be helpful to give those who will observe the chosen death
some details about exactly how this death will occur.
Which bodily systems will be shut down by the gentle poison?
And where communication is especially difficult,
a video presentation of dying by this means
might make it clear to all concerned
just what will happen when the gentle poison is used.
Exactly how the lethal chemicals will be
administered
to the patient
and who will be present for this final scene
will be decided according to what seems wisest in each case.
The physician who provides the chemicals to cause death
might be present for the
death or not.
The following
are the new paragraphs added for this alternative safeguard:
Not all licensed physicians will provide life-ending
chemicals.
Only physicians with special training in terminal care,
who actually take care of patients in the last phases of their lives,
(and perhaps who are involved in hospice care)
will be authorized to provide life-ending chemicals
for the purpose of achieving a peaceful and painless death.
Licensed physicians who wish to have this additional
authority
will be required to apply for a special license,
which could be provided by the same licensing authority
that licenses all
physicians.
That licensing authority should establish the exact qualifications.
Or the qualifications could be specified in the law
that authorizes some
physicians to provide life-ending chemicals
for the purpose of achieving a peaceful and painless death.
Perhaps only 5% of all licensed physicians in any
jurisdiction
will apply for this special license to give lethal chemicals.
This means that the other 95% of doctors
will not be
associated with using lethal substances to bring death.
Other doctors who agree that a life-ending decision
is the best course of action under the circumstances
and who believe that gentle poison will be the best method of
dying
will have to refer
their patients to those terminal-care physicians
who are specifically trained and licensed to provide gentle poison.
This provides one additional level of professional approval.
Giving only specific physicians the power to provide
death pills
will also protect all physicians from the suspicion
that they
might be secretly planning for the patient's death.
Some physicians oppose right-to-die laws
because they fear that their patients will no longer trust them
if the patients know that all
doctors have the power to cause death.
Many medical associations have also taken official stands
against what used to be called "physician-assisted suicide"
because they say that doctors
must not kill.
Using this specific safeguard should relieve the
fears
of both physicians and their patients
that doctors might cause death without proper
safeguards.
Ordinary doctors would not be authorized to
provide gentle poison.
They would have to discuss the possibility of chosen death
with the patient and/or the proxies
before referring the patient to a terminal-care physician
who has a special license to provide life-ending chemicals.
Non-reporting of chosen deaths would become less
common
because the terminal-care physicians authorized to provide gentle poison
would be the ones submitting reports of such methods of achieving
death.
And because they have specifically
applied to provide lethal
chemicals,
they will not worry about getting a 'bad reputation'.
All other doctors could continue to affirm
that they are only involved in those forms of medical care
that are intended to cure
the patient
or to ease the
passage into death without
using life-ending chemicals.
HOW A DOCTOR PROVIDING LIFE-ENDING CHEMICALS
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
As said before in connection with other safeguards,
suicidal people are not likely to pursue the elaborate processes required
for choosing death with the assistance of a physician. These
many safeguards were created
specifically to prevent
people from killing themselves irrationally.
After the lethal
chemicals
has been obtained,
strict controls should be in place to make sure
that the lethal substances are not used
by some
other member of the household for the purpose of committing
irrational suicide.
Having a bottle of life-ending chemicals in the household
is more dangerous than having a loaded gun available.
Some suicidal people will be deterred
by the violence involved in a suicide by shooting themselves.
But the same reluctance might not apply to taking death-pills.
Whenever a physician provides life-ending chemicals
for
a patient,
this physician is acting as a gate-keeper.
The physician names
the patient when providing the lethal chemicals.
If and when these deadly chemicals are used by the qualified patient, the resulting death will not
be premature
in the professional opinion of the physician
who approved using gentle poison to cause death.
Because this gate-keeping function approves the timing of
death,
the physician who provides the life-ending chemicals
might decide in principle to
cooperate in this planned death some months or even years
before the best time for death.
The doctor might decide that some specific milestones
marking the inevitable decline towards death must be passed
before the lethal chemical will be provided.
It might even be wise to put
this agreement into writing,
so that everyone concerned will know
that the physician will provide the gentle poison
if and when the patient declines to the point
where a chosen death would be the wisest course of action.
Whenever
any death is caused by some means
NOT under the control of the
physician, then the physician is not as direct a
participant in that death.
When life-ending chemicals provided by a physician
are used,
then all should know that the physician who orders the gentle poison
is taking professional responsibility for causing the resulting death.
In the professional judgment of the physician,
this death is taking place
at the best
time for the named patient.
Given all of the gathered medical facts and recommendations
and all the assembled personal facts and opinions, a
chosen death at this time is the best course of action. So
the terminal-care physician provides life-ending chemicals,
which will soon bring the patient's life to a peaceful and painless
end.
A
note on language:
This safeguard has carefully and intentionally avoided the following
words:
"drugs", "medication", "prescription", & all related terms.
This is intended to avoid any confusion that might arise
because physicians are also
authorized to prescribe drugs for curing
diseases, etc.
And the provided chemicals need not be obtained from a licensed
pharmacy.
Thus, the laws regulating prescriptions
should not apply.
Some opponents of the right-to-die
will attempt to prevent voluntary death and merciful death
by means of controlling the prescribing power of doctors.
Some laws using this safeguard will continue to refer to the chemicals
as "drugs", "medication", or "prescription",
but to allow the future functioning of such laws to be more open and
honest,
such terms from the professions of medicine and pharmacy should be
avoided. See further
discussion of the misleading "medication"
terminology.
Created September 26,
2007
(incorporating everything from the earlier safeguard referred to
at the beginning);
revised 10-3-2007; 8-26-2008; 9-10-2008; 10-1-2008; 11-2-2008;
1-29-2009; 1-30-2010; 2-12-2010; 5-21-2010;
2-4-2012; 2-7-2012; 2-11-2012;
2-23-2012; 3-24-2012; 7-24-2012; 8-3-2012; 8-23-2012;
3-6-2013; 5-24-2013; 6-28-2013; 7-24-2014; 2-21-2015; 7-9-2015;
11-23-2017; 11-16-2018; 10-22-2019; 6-27-2020;
The above suggestion of licensing only
a few doctors to provide gentle
poison
is Safeguard FF in How
to Die: Safeguards for Life-Ending Decisions:
"Specifically-Licensed Terminal-Care Physician Agrees to Provide
Life-Ending Chemicals".
Go to the list of 26
recommended
safeguards.
The above safeguard is not
one of the 26 recommended safeguards.