When the patient can no longer make reliable medical decisions,
the power to make medical choices—including life-ending choices—
passes to the legally-authorized proxies
who were chosen to act on behalf of the patient in just such circumstances.

    The proxies might have to take over the medical decisions
after the patient has already made one or more requests for death.
If so, the reasons for choosing death now rather than death later
should be clear from the patient's requests for death.
The proxies will also be guided by the Advance Directive for Medical Care
created by the patient while he or she was clearly able to make decisions.

    The proxies will strive to carry forward the medical ethics of the patient,
especially as they are articulated in the Advance Directive.
And the proxies might have further insights into the views of the patient
because of their long association with the now-incapable person. 

    The proxies will probably be called upon to make medical choices
after the patient has declined towards death to such a degree
that the patient can no longer be expected to make wise decisions.
And the proxies might know more about the likely causes of death
than the patient knew before he or she lost decision-making capacity.

    The proxies will review all of the medical records
and the other statements already created for planning this death.
They will pay special attention to the doctors' statements
about the current condition and prognosis of the patient.

    When the proxies consider making a request for death,
they should re-state in their own words
exactly how they understand the condition and prognosis of the patient.
Then if there is any misunderstanding (or incomplete grasp of the facts),
the doctors can explain all of the medical facts and recommendations
until the proxies are satisfied that they fully understand
what is going to happen to the patient under each option worth considering.

    To make certain that these requests for death are carefully-considered,
they should be in writing as well as verbally stated for everyone.
Also waiting periods will allow everyone to review their thinking.
And when considering a life-ending decision,
everyone involved wants to be sure that all options have been explored
and that death now is better than any of the other possibilities.
All written requests for death from the proxies should be signed and dated.
This will make clear just who is authorizing the life-ending decision.

    In some cases, it will be appropriate for the proxies to state explicitly
their reasons for choosing death at this time.
The proxies might know something about the patient
that is not contained in the medical records
and might not be known to others involved in the death-planning process.
For example, has the patient completed meaningful life-goals?
Is the patient a member of the One-Month-Less Club?


    Once the power to decide has passed from the patient to the proxies,
all talk of irrational suicide is no longer relevant
because the patient has lost the ability to decide
and carry forward any plans for death—whether rational or irrational.

    But the proxies should be wary of causing a premature death.
A death that comes too soon harms the patient.
Do the proxies completely understand the medical situation?
Are they deciding because of a sudden decline in the patient's condition?
Are they making a rash decision before all options have been considered?
Will their choices result in a premature death they will later regret?

    Once the proxies have considered all of these ways
in which they might err on the side of death rather than life,
then they can be more confident that they have really weighed the options
and they have chosen a merciful death for the patient,
based on the patient's own settled values,
which were expressed when the patient was
fully in control of his or her own destiny.
If the proxies must now decide for the patient,
they will ask themselves whether they are carrying forward the decision
that would have been made by the patient
if the patient still had enough mental capacity to make the needed decision.

    To make the proxies' request for death more formal and official,
it might be wise to have their written request witnessed by others
who have no vested interest in any particular course of action.

    The goal of this safeguard is not merely to get more signatures on paper
but to facilitate a thoro discussion of the pros and cons
of any particular pathway towards death.
And if the choice would lead to a premature death
as perceived by any of the neutral observers and witnesses,
then they should not support that request for death.
If the request for death is not rational, not based in well-established facts,
then this is an opportunity for any observer to prevent a premature death.

Created January 24, 2007; revised 4-13-2007; 3-15-2008; 4-23-2008; 2-6-2010; 5-21-2010;
5-27-2011; 12-15-2011; 1-29-2012; 2-11-2012; 3-23-2012; 8-2-2012; 8-22-2012; 11-15-2012;
5-22-2013; 6-27-2013; 2-19-2015; 2-12-2018;

Once the power to make medical decisions has been officially taken over by the proxies,
then they also have the authority to request death for their patient.
This is Safeguard K in How to Die: Safeguards for Life-Ending Decisions:
"Requests for Death from the Proxies".

Would you like to join a Facebook Seminardiscussing this book-being-revised?
See the complete description for this seminar:

Go to the Catalog of Safeguards for Life-Ending Decisions

Go to the list of 26 recommended safeguards.

Go to the index page for the Safeguards Website.

Go to the Right-to-Die Portal.

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