The first evaluation of the patient's abilities to make medical choices
will be made by the family members who are closest to the patient.
The family or proxies along with the doctors involved in terminal care
will probably have no difficulty in determining
whether or not the patient still has the mental capacities
to make meaningful medical decisions.
In most cases, the answer will be obvious:
Is the patient still operating in all four capacities of personhood:
consciousness, memory, language, & autonomy?
Or is the patient unconscious most of the time?

     If anyone questions whether the patient is capable of deciding,
it is best for a professional to evaluate the patient's mental capacities
and/or state-of-mind when considering death.
If the person who makes this professional judgment
has known the patient for some years, so much the better.
If not, a doctor can suggest a psychological consultant to evaluate the patient.

     This psychological consultant must be open-minded enough
to believe that (sometimes, at least) it is rational to choose death.
Perhaps 90-95% of all persons who kill themselves
commit suicide for irrational 'reasons'. 
But this consultant must be open to the 5-10%
who choose voluntary death for good reasons,
which can be understood and approved by others.

     The psychological consultant will   
read the patient's explanation of the reasons for choosing death 
and interview the patient to determine his or her state-of-mind.
Besides certifying that the patient is of sound mind,
the consultant should make sure that the patient
(1) has considered all the reasonable alternatives to death,
(2) is making a fully informed choice to end his or her life,
(3) is not being coerced into making a life-ending decision,
(4) is not depressed by some bio-chemical imbalance,
(5) is not being influenced by any mood-altering substances,
(6) is not suicidal in the sense of irrationally rushing into death, &
(7) is not suffering from an eating disorder that might lead to death.
A trial of anti-depressant drugs or psychotherapy might be needed
to make sure that the 'reasons' for choosing death
are not really bio-chemical or based on irrational feelings. 
But coming to the end of life should be expected to be depressing
for good psychological reasons.

     If the psychological consultant finds the patient
not able to make a wise decision about death,
then the provisions of the Advance Directive come into force.
Every Advance Directive for Medical Care explains   
what to do in case the patient becomes unable to make decisions.
If we can no longer make medical choices,
our proxies or Medical Care Decisions Committees (MCDCs)
are empowered to make the necessary decisions for us. 

     And if there is any question or doubt about the capability
of any proxy or any member of the Medical Care Decisions Committee,
then a similar professional evaluation could confirm or disconfirm
such proxy capacity to make medical decisions for their patient.

     No matter what the results, let the professional evaluation
of this psychological consultant be put into writing
so that it can become a permanent part of the death-planning record.


     Family members and friends might easily know
whether the patient has any suicidal tendencies.
And if they have any questions about the mental status of the patient,
they will cooperate in any needed psychological evaluations.

    The psychological consultant might be in the best position
to determine any tendency toward suicidal thinking in the patient.
Psychiatrists and psychologists are trained to recognize
the many forms of irrational thinking that can lead to suicide.

    Likewise, if there is some pressure from family members
to choose a premature death because that would benefit the family
either financially or psychologically,
these are also poor reasons for choosing death.
The psychological consultant must interview the patient
in a setting where it would be possible for the patient to say
that he or she feels pressured into 'choosing' a premature death.
In other words, the patient must be interviewed separately
—away from the possibly-manipulative relatives.

    Because the psychological consultant can take a broad, human view
of the whole process of choosing the best time to die,
he or she would be well-situated to uncover
any problems in the process of making end-of-life choices.
All such problems and doubts should be resolved
before any final steps are taken towards choosing death.

    If such psychological consultants do their jobs well,
some premature deaths will be prevented.

created January 17, 2007; revised 2-5-2010; 5-9-2010; 9-9-2010; 5-27-2011; 8-2-2011; 12-14-2011;
1-29-2012; 2-22-2012; 3-22-2012; 8-1-2012; 8-19-2012;
5-22-2013; 6-26-2013; 7-24-2014; 5-16-2015; 12-27-2016; 1-21-2018; 10-24-2018;

This explanation of the possible need for a psychological evaluation
is Safeguard C in How to Die: Safeguards for Life-Ending Decisions
"Psychological Consultant Evaluates the Patient's Ability to Make Medical Decisions".

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