SUICIDE-MODEL
RIGHT-TO-DIE versus MEDICAL MODEL END-OF-LIFE
CARE
by James Leonard Park
1.
The Suicide-Model for Ending Life
Almost all of the early right-to-die laws were based on the suicide-model.
This means that these laws were implicitly or explicitly grounded
on the inherent right to
give up one's own life:
Each person's life belongs only to that one individual.
Therefore that person has a right to end that life.
This feature of most right-to-die laws
can be found in the requirement that the dying patient
must be capable and
competent up until the last moment of life.
The final act that brings death
must be performed by the person who is choosing death,
not by anyone else—no
matter how authorized or qualified.
Using the concept of suicide as the basis for
the
right-to-die, no proxy can act on
behalf of the person whose life is ending.
If the chosen method of dying is a lethal injection,
the injection must be authorized at the last moment by the patient.
2. The Medical Model for
End-of-Life Care
The medical model for taking
care of dying patients
is based on the authorized practice of medicine.
Wherever scientific medicine is practiced,
being a doctor is a licensed and controlled profession.
Only certain trained, tested, & licensed persons
are authorized to practice medicine.
By law, only licensed physicians may
offer certain named and described medical procedures.
Anyone else who does such procedures without being licensed
is "practicing medicine without a license",
which is a criminal offense.
Medical doctors are authorized by law to prescribe controlled
substances for their patients.
And with this prescribing-power comes the authority
to increase or decrease any such drugs.
Giving or withdrawing (or withholding) drugs
can lead to the patient's death.
The patient gives informed consent to any such drugs.
(Or the patient makes an informed
refusal for any drug.)
If and when the patient can no longer give consent or refusal,
then proxies for the patient have authority to make these changes.
Also, sometimes doctors are involved in decisions
about life-supports,
including providing food and water to the patient by means of tubes.
Life-sustaining treatments or supports can also be
discontinued
when recommended by the doctors
and agreed to by the family or official proxies for the patient.
Whenever the patient is still conscious
and able to
make medical decisions,
the patient will be the first person asked
about any change of medical
care.
But usually at the end of life,
the patient's thinking has become so
diminished
that the official deciding-authority has already shifted to the
proxies.
All such loss of mental capacity on the part of the
patient
does not diminish in any way the right to choose a peaceful death. The proxies have all of the
same authority and powers
once possessed by the patient.
This is in sharp
contrast to the suicide-model
right-to-die.
Under that understanding of the end-of-life powers,
only the patient himself or herself has the authority to choose
death.
Here are the four most common methods of managing
dying
that might be recommended and/or approved by a licensed physician:
In a few places on the planet Earth,
licensed physicians are also authorized to prescribe chemicals
that are intended for no other purpose than to cause the patient to
die.
In some places the doctor can give a lethal injection.
And sometimes the patient is expected to take the deadly substances
using his or her own hands and mouth.
When the medical
model for end-of-life care is being
used,
it does not matter exactly who authorizes the life-ending action.
And it does not matter who take the final actions that cause death.
Safeguards are used to make certain this is a wise end-of-life
decision.
For example, frequently everyone agrees that the
life-supports
are doing the patient no good.
The patient and/or the proxies agree to have life-supports
discontinued.
And usually the nurse is the actual medical person
who turns off the machine and disconnects the tubes.
A doctor must examine the body of the deceased
patient
and certify that death has occurred.
The doctor will announce the time of death.
And the doctor will fill out the death-certificate,
indicating the primary cause
of death and any secondary factors.
All such procedures are well within the normal
practice of medicine.
And even without the enactment of any new right-to-die laws,
doctors will continue to recommend these first four methods of
dying.
But new laws are needed to authorize the giving of
lethal chemicals
for the purpose of causing the patient to die.
Safeguards should apply to all life-ending
decisions.
And usually these safeguards are affirmed by the medical profession.
But when new methods of dying are approved by law —such
as giving lethal substances to cause death—
then some additional safeguards might be wise.
In 2014, the Canadian province of Quebec
passed a
new law for medical care at the end-of-life,
which falls fully within the medical model. An
Act
Respecting End-of-Life Care
authorizes doctors to help their patients to die in three ways:
1. disconnecting and discontinuing any medical treatment,
2. beginning continuous palliative sedation, &
3. medical aid in dying.
All three of these life-ending actions
are
authorized by licensed physicians.
The law specifically says that when providing (3) 'medical aid in
dying',
the physician must remain with the patient until death occurs.
And nowhere in the law is the patient required
to be conscious and competent to the very end
to authorize the life-ending decisions,
which would have been required under any suicide-model
legislation.
The patient must have given informed
consent to the plans for death,
but such consent can be affirmed in an Advance Directive.
Other
provinces
of Canada might follow the example set by Quebec.
And they could explicitly include two additional methods of dying: comfort-care
only and medical
dehydration.
And each province will decide exactly
what safeguards
must be fulfilled before any life-ending decisions can be made.
France
also created a new
end-of-life medical care act in 2016.
This one falls entirely within the normal practice of medicine
as found everywhere in the advanced world.
And it carefully avoids any mention of
'euthanasia' or 'physician-assisted suicide'.
The Netherlands
has the longest history
of allowing patient to choose death.
In 2002, Holland updated its rules and regulations allowing doctors
to administer "euthanasia" and "physician-assisted
suicide"
---and the required reporting of all such deaths.
The patient's considered judgment is uppermost
in making such life-ending decisions.
Plans for death can also be made in advance.
The Netherlands also allows the other medical
methods
of managing dying,
which are all considered normal parts of medical care.
Such life-ending decisions do not require any special reporting.
And the deaths are recorded as having natural causes.
In 2002, Belgium
undated
its right-to-die law.
This law basically authorizes a physician to perform "euthanasia"
when the specified safeguards have been fulfilled.
When the patient can no longer participate in the life-ending decisions,
proxies are authorized to make the final choices.
Causing
Premature Death is another model for the right-to-die.
This proposed law falls within the laws against murder.
And it lays out 26 specific safeguards by which doctors and
proxies
can prove that their patient had a timely death, not a premature death.
A Facebook Group has been established for Right-to-Die
Legislators.
When any
member of a law-making body anywhere on Earth
has created a proposal for a new right-to-die law
or regulations that permit more choices at the end of life,
a link can be offered to this Facebook Group.
26
recommended
safeguards for life-ending decisions.
Lawmakers could include at least the best of these safeguards
in any new right-to-die or end-of-life legislation.
Each safeguards is explained in a page or two on the Internet.
Whenever lawmakers authorize new (or existing) methods of managing
dying,
they might also consider adding a new line to certificates of death:
Beyond giving a full explanation of the causes of death an additional line might explain any medical methods of managing dying
or life-ending decisions
that were the final medical orders
that led to this patient's death. Expanding
Death-Certificates to include end-of-life medical decisions.