THE PROPER RECORDING OF
VOLUNTARY DEATHS AND MERCIFUL DEATHS


    The following section is reproduced
from the draft law against causing a premature death:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PREM-DTH.html

    Further discussion of these new categories for recording deaths
follows these 40 numbered lines.



1.    Section VI. Recording of Deaths

2.        The commissioner of health of this state,
3.    (or other authority responsible for keeping records of deaths)
4.    the medical examiner of each county,
5.    and the prosecuting authorities throughout this state
6.    shall establish three new statistical categories for deaths
7.    as defined by this law:
8.        (1) voluntary deaths (as distinct from irrational suicides),
9.        (2) merciful deaths (as distinct from mercy-killings), and
10.      (3) premature deaths (a form of homicide).

11.        Physicians responsible for filing death certificates with the state
12.    shall also conform to these definitions.

13.        If the medical examiner finds the death-planning record
14.    fulfills the definition of a voluntary death in this law,
15.    that death shall be recorded for all purposes
16.    as a voluntary death, not an irrational suicide.
17.    And if the death-planning record explains the reasons
18.    for the voluntary death to be a fatal disease, illness, or condition,
19.    that fatal disease, illness, or condition
20.    shall be recorded as the primary cause of death,
21.    with the additional notation
22.    that the patient chose a voluntary death
23.    rather than waiting for the natural processes to kill him or her.  

24.        If the medical examiner finds the death-planning record
25.    fulfills the definition of a merciful death in this law,
26.    that death shall be recorded as a merciful death,
27.    not any form of homicide, including causing premature death.
28.    And if the death-planning record explains the reasons
29.    for the merciful death to be a fatal disease, illness, or condition,
30.    that fatal disease, illness, or condition
31.    shall be recorded as the primary cause of death,
32.    with the additional notation that the proxies chose a merciful death
33.    rather than waiting for the natural processes to kill the patient.

34.        No new statistical category need be established
35.    for recording deaths that result from
36.    the withholding or withdrawal of life-support systems.
37.    These deaths will automatically be recorded
38.    as caused by the underlying disease, illness, or condition.
39.    But the record should also show that a careful process was followed
40.    in reaching the decision to remove the life-support systems.



discussion of proper recording of deaths

    Most people do not worry about what will appear on their certificates of death.
After they are dead and gone,
such matters can only concern those who continue to live.
But it sometimes matters a great deal to us
to know how we will be remembered after we are gone.
And this might be especially important if we are blazing new pathways towards death.
For example, if we choose to shorten the process of dying
by choosing a gentle poison or choosing to give up eating and drinking,
we would want our friends and relatives to remember the way we left this life
in a more positive way than might be conveyed
by the words "suicide" or "dehydration".

    The draft legislation above creates some new categories
for the official recording of deaths.
If something like these new concepts are used,
it could affect the ways that we will meet our own deaths
and the kinds of life-ending decisions we will approve for the people we love.




    There might be a meaningful element of choice in about half of all deaths in the USA.
But it would make hash of all vital statistics to record these as "suicides".
And who would suggest that disconnecting life-supports is a form of suicide?
100% of us will die
and our death-certificates will record the causes of our deaths.
And the fact that there will be some element of choice at the end of our lives
should not require any changes in the basic causes of death as recorded and added up.
A certain percentage of us will die from heart and circulatory problems.
Some of us will die from cancers growing on various parts of our bodies.
And some of us will die from a variety of degenerative diseases at once.
Before careful statistics were created,
these would have been known as deaths from "old age".

    But now that most of us will die in hospitals under medical care,
it would be a conceptual error to name only the most immediate cause of death.
For example, if we were being sustained by respirators supporting our breathing,
then respiratory failure should be recorded as the cause of death
and not the fact that someone turned off the respirator
when it became obvious that we would never recover.

    When someone needs to know the full account
of every medical treatment used in the last year of our lives,
such facts will be contained in our medical records.
But the certificate of death need only name the main causes of death,
which would normally be the underlying disease or condition
for which we were receiving medical care.
Terminating useless treatments is not the cause of death.

    Likewise, if we are receiving pain-medication in our last year of life,
perhaps the drugs themselves will shorten the process of our dying.
For example, morphine is known to suppress respiration.
But it might still be prescribed by a physician
because the pain of the terminal disease might be worse
than the benefits of having a few additional days of life.
No matter what drugs are used in the last week of life,
the cause of death will be recorded as
the disease or condition for which we were receiving the drugs,
not the drugs themselves, even tho the pain-medication
might have shortened the process of dying.

    An even more extreme situation of end-of-life care might include terminal sedation.
Terminal sedation means that the doctor prescribes enough medication
to keep the patient continuously unconscious until death occurs from natural causes.
Along with ordering an induced terminal coma,
the doctor might also authorized the withdrawal of any other life-sustaining measures,
such as artificial nutrition and hydration
food and water by tubes.

    When the doctor writes the certificate of death,
none of the life-sustaining measures or curative treatments will be mentioned.
The doctor will merely name
the underlying disease or condition that led to the death of the patient
despite the best efforts of medical care to save the patient from death.

    When the life-support systems are switched off
and the feeding-tube is removed,
what sense does it make to say that this patient died of 'dehydration'?
The cause of death was some prior condition or disease,
which initially led to using the life-support methods.
The underlying disease or condition should be recorded as the cause of death,
not the fact that the life-supports were disconnected.




    So far, we have only described the standard ways of recording deaths.
Nothing controversial or novel is described in the paragraphs above.
However, when we turn to "suicide", some differences of opinion might arise.
And different doctors might handle such situations differently.
This is one reason for establishing public standards
for defining what would qualify as a voluntary death
as distinct from an irrational suicide.

    Before voluntary death became a common choice,
all self-caused deaths would have been lumped together as "suicides".

    And "suicide" will always be a valid category for death statistics.
No matter what we do to prevent people from foolishly killing themselves,
there will be some people every year
who decide they cannot tolerate their lives any longer.

    But as voluntary death
becomes more common among people
who are dying from well-known diseases,
we should not stigmatize them as "suicides".

    It should be possible for the certificate of death and the vital statistics
to say that this particular patient decided to follow a pathway towards death
that included a short-cut in order to avoid some unnecessary suffering.

    Here are the four basic ways to separate irrational suicide from voluntary death:
1. Was the chosen death harmful or helpful for the patient?
2. Was the chosen death irrational or reasonable?
3. Was the chosen death capricious or well-planned?
4. Was the chosen death regrettable or admirable?

    These questions might not be easy to answer in some difficult cases,
but in the vast majority of chosen deaths,
it should not be difficult to decide
whether it was an irrational suicide or a voluntary death.
Here is a fuller explanation of these differences:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"?
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-IS-VD.html

    A parallel situation arises when the patient
has lost the capacity to make medical decisions.
Then the family (or more formal proxies) must make all choices for the patient,
including any life-ending decisions.

    The same four questions will separate mercy-killing from merciful death:
1. Was the chosen death harmful or helpful for the patient?
2. Was the chosen death irrational or reasonable?
3. Was the chosen death capricious or well-planned?
4. Was the chosen death regrettable or admirable?
And another essay separates these phenomena more fully:
Will this Death be a "Mercy-Killing" or a "Merciful Death"?
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-MK-MD.html

    Whenever wise medical choices were made at the end of life,
the cause of death should always be recorded
as the underlying disease or condition
and not the fact that some medical decision was taken in the last week
that finally allowed the person to die.

    This is the intent of the legal language provided
at the beginning of this essay.
Does this language explain sufficiently how doctors, medical examiners, etc.
are supposed to fill out the certificates of death
so that the vital statistics are kept in reasonable categories
and so that the friends and relatives
will be able to remember the deceased
according to the most accurate description of the causes of death?



Created February 29, 2008; revised 5-13-2010; 2-23-2012; 5-16-2015; 6-15-2019; 5-26-2020;


DEATH CERTIFICATES:

ADDING
MEDICAL METHODS OF MANAGING DYING (MMMD)
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/DC-LED.html



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