PROTECTING
PATIENTS FROM
BEING PUT TO DEATH WITHOUT AUTHORIZATION
Critics of the right-to-die as practiced in the Netherlands
often
point out that a certain percentage of deaths facilitated by
doctors
are recorded as "without explicit request".
This
could be interpreted to mean that Dutch doctors
are taking it upon
themselves to decide
which patients should be given lethal
injections
and which patients should not.
And if there are a few cases of patients in a coma
being given
drugs that will cause death,
such cases should be investigated
more deeply.
Perhaps some premature deaths were
caused by physicians.
If death is achieved
without proper authorization,
then a crime has been
committed under almost any country's laws.
And where such crimes
are happening,
better safeguards are needed to prevent any further
unauthorized deaths.
Other countries need
not follow the early pattern of Holland.
If there were problems
created by the original Dutch system,
then these can be corrected
when other countries
(or any states of the USA or Australia)
create new laws concerning the right-to-die.
However, what was most likely happening
under this category of
"without explicit request"
was that patients had already
discussed their desire to die
if and when there was no hope of
recovery.
But the patients waited too long:
When they had
already passed into a semi-conscious state
or had become completely
unconscious in a coma,
they could no longer give explicit
permission for their own deaths
at the exact moment that their
deaths were to be achieved.
Also, the
family members of these patients
were probably also consulted to
see if they agreed
that a peaceful death achieved by drugs given
by the physician
would be better than letting nature take its
(sometimes long) course.
Perhaps Dutch law does not explicitly
allow such proxy decision-making,
but we can all see the value of
allowing such decisions
under safeguards that make sure that no
harm
is being inflicted upon the patient who will soon be
dead.
Especially when the patient has given
explicit prior authorization,
there should be no barrier to
the duly-authorized proxies
giving their approval if the patient
has slipped past the point
of being able to make meaningful
end-of-life decisions.
The worry here seems
to be that some doctors or government bureaucrats
will decide that
certain patients should die.
They review a list of patients and
mark some of them for death.
Is this the meaning of 'putting
patients to death without explicit request'?
The way to prevent such behavior is to make clear
exactly who
has the authority to make life-ending decisions.
Several
safeguards for life-ending decisions
explicitly address this
question of making decisions at the bedside.
Good safeguards would prohibit all unauthorized decisions for
death
while at the same time setting forth careful
procedures
by which patients and/or their proxies can make wise
end-of-life choices.
PROTECTING
PATIENTS FROM BEING PUT TO DEATH
WITHOUT
AUTHORIZATION
The following 22 safeguards make sure that the proper decision-makers
are identified and empowered to make the life-ending
decisions.
These safeguards exclude people who should not
hold life-and-death power.
These 22
safeguards to protect patients are arranged
with the most
powerful and meaningful at the beginning.
The blue
title links to a complete explanation of that safeguard.
The
red comments explain how that safeguard
prevents
the patients being put to death
without proper authorization.
<>
KEEPING
GOVERNMENT OFFICIALS, THE MEDIA,
&
OTHER STRANGERS OUT OF THE LOOP
Because
life-and-death choices are private and personal matters,
strangers
should be kept as far away as possible.
Our medical records
should be kept completely private.
Government officials, media
employees, & nosy neighbors
who have no right to review private
medical records
should have no
role in making life-ending decisions
—and
no
role in trying to prevent private end-of-life choices.
ADVANCE
DIRECTIVE FOR MEDICAL CARE
The patient
whose death is being considered is the central decider.
An Advance
Directive for Medical Care allows the patient to explain
the
appropriate values and principles to be applied at the end of
life.
As completely as possible, the patient spells out
the
conditions under which death would be the best choice.
In short,
an Advance Directive authorizes wise life-ending decisions.
When
the prescribed conditions are met,
carrying forward the plans for
drawing the patient's life to a close
will not result in a
premature
death.
REQUESTS
FOR DEATH FROM THE PATIENT
And when the
patient makes an explicit request for death
under the terminal
conditions as they have emerged,
then there is even less reason to
believe
that this death might be decided without proper
authorization.
INFORMED
CONSENT FROM THE PATIENT
When the
patient gives informed consent for his or her death,
could
anything be more obvious?
The patient takes part in planning for death and fully approves.
UNBEARABLE
SUFFERING
The patient might have described the suffering
that is leading him or
her to choose a specific pathway towards death.
UNBEARABLE
PSYCHOLOGICAL SUFFERING
And
psychological factors are also relevant for the patient to use
in
deciding when would be the best time to die.
When the patient has
explained these reasons
for choosing death
now
rather than death
later,
he
or she authorizes the life-ending decisions.
THE
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
And if the patient remains conscious to the last moment of life
and
able to take any necessary life-ending actions,
this would be
dramatic proof that at least at that last moment
the patient
really wanted to die.
The
authorization comes from the patient
—not
from anyone else, anywhere.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
When a physician creates a written statement
of
the medical problems and prospects for the patient,
this
is the medical background for all future decisions.
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
And
when an independent physician also recommends death,
this
should overcome any worries
that
this patient might be put to death inappropriately.
HOSPITAL
OR HOSPICE ENROLLMENT
Deaths
that occur in hospitals and hospices are well-documented.
The
safeguards used in such institutions providing terminal care
should
assure any doubters
that the patient's death is being
correctly chosen and authorized.
STATEMENTS
WRITTEN BY HOSPITAL OR HOSPICE STAFF MEMBERS
And
when the staff people who are providing terminal care
voluntarily
add their own written statements,
this shows that they also
approve the life-ending decisions,
based on their day-to-day
knowledge of the condition of the patient.
Their cooperation shows
that this death is being
chosen wisely.
Death
is not
being imposed without proper authorization.
PALLIATIVE
CARE TRIAL
When
the patient has actually experienced the benefits of comfort-care,
this proves that terminal care was carefully provided.
There
was no rush to cause a premature death.
Death is chosen only after
palliative care proves no longer satisfactory.
CERTIFICATION
OF TERMINAL ILLNESS OR CONDITION
When
the physician certifies that the patient is dying,
this is strong
evidence that the basic reason for choosing death
is not some
abstract decision imposed by strangers.
PSYCHOLOGICAL
CONSULTANT
EVALUATES THE PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
A
careful evaluation of the patient's abilities to make medical
decisions
and the recording of the fact that the patient has
actually decided to die
should assure any and all distant
critics
that this will not
be an unauthorized, premature death.
REQUESTS
FOR DEATH FROM THE PROXIES
When
the patient can no longer decide,
any terminal-care decisions must
be made by the proxies.
Their recorded and witnessed requests for
death
—along
with their explanations of the need for death—
will be
direct evidence against any claim of an unauthorized
death.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING CHOOSING DEATH
In
addition to the request for death from the official proxies,
other
family members can also explain their reasons
for supporting the
life-ending decisions.
When
it is known that family members also approve choosing death,
what
basis might there be to claim an unauthorized death?
STATEMENTS
FROM ADVOCATES FOR DISADVANTAGED GROUPS
IF
INVITED BY THE PATIENT AND/OR THE PROXIES
And
when the patient belongs to an identifiable group
that has
sometimes suffered discrimination in the past,
a special advocate
might be appointed to review the plans for death.
If and when this
person appointed to protect against discrimination
also approves
the plans for death,
how can anyone suspect that the patient
might be put to death without proper authorization?
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
An
institutional ethics committee knows how to review plans for
death.
Precisely because they are not emotionally involved with
the patient,
they can be more objective about the reasons for
choosing death.
And they might notice any outside pressures
that
could be rushing
the patient into death.
A
MEMBER OF THE CLERGY
APPROVES OR
QUESTIONS CHOOSING DEATH
When
it is known that a member of the clergy
has reviewed the plans
for death and has reached the conclusion
that death
now
is better than death
later,
then
this should be strong evidence that this death was not
premature.
RELIGIOUS
OR OTHER MORAL PRINCIPLES
APPLIED
TO THIS LIFE-ENDING DECISION
And
when religious or other moral principles
have been explicitly
applied to this end-of-life situation,
any distant critics should
turn their attention to other cases.
This death is being chosen
with the most careful attention to morality.
And the resulting
written documents exist
just in case there might later be a
prosecution for any crime.
These documents exploring the morality
of this life-ending decision need never be made public,
but
the fact that they exist
might be disclosed if that seems to be wise.
REVIEW BY THE
PROSECUTOR (OR OTHER LAWYER)
BEFORE THE DEATH
TAKES PLACE
When
the people who are planning this death
have created a careful
written record of their planning process,
they can summarize their
thinking for the prosecutor.
This public official is responsible for bringing any criminal charges
if and when there is
good reason to believe
that some harm
has been committed against the patient.
Once again, the
death-planning record is not made public.
But it might be
disclosed that the prosecutor has reviewed the record
and decided
that there is no reason to object to the plans for death
or to
open a criminal investigation.
CIVIL
AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
And
if ever some criminal conspiracy
has slipped past all of the
above systems of prior review,
there is always the possibility of
opening an investigation
after
the death has taken place.
Civil and criminal penalties remain in
place
as sanctions against anyone who participates
in a
conspiracy
to put someone to death without proper authorization.
The
above 22 safeguards should be entirely sufficient to prove
that
a timely
death was wisely
chosen.
But
there might be some special situation
in
which one of the other 13 safeguards might be relevant to use.
See
the complete catalog of 35 safeguards for life-ending
decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAT.html
created
March 1, 2007; revised 3-22-2007; 11-12-2008;
1-22-2009; 1-31-2010;
2-25-2011; 12-21-2011;
1-27-2012; 2-21-2012; 3-25-2012;
5-29-2012; 9-11-2012;
3-17-2013; 6-20-2013; 7-16-2014; 10-10-2014;
7-3-2015;
2-12-2018; 8-18-2018; 5-26-2020;
This
discussion of 22 good ways to prevent premature death
has become
Chapter 6 of How
to Die: Safeguards for Life-Ending Decisions:
"Protecting
Patients from Being Put to Death Without Authorization".
Go
to other dangers,
mistakes, & abuses of the right-to-die.
Go to
the beginning of this website
James
Leonard Park—Free
Library