TERMINAL CARE--DECISION MAKING---when unbearable psychological suffering is the main reason for choosing death

    Most people would accept unrelievable physical suffering
as a legitimate reason for choosing death,
but how many would agree that purely psychological suffering
might be sufficient for choosing death?

    Psychological suffering would include
any torment happening within the mind of the patient,
which does not have any physical component that can be treated.
Grief would be one form of psychological suffering.
However, normally grief is self-limiting: After a few years at the most,
the suffering caused by someone's death has diminished enough
to allow the person who was grief-stricken to return to normal life.

    Other forms of mental suffering do not automatically fade with time.
And sometimes all treatments prove ineffective
in overcoming the demons that torment some patients.
If every day is another day of fearing dangers that do not exist,
if every day is another day of harming oneself for unintelligible reasons,
and if no amount of treatment has been able to alleviate this suffering,
then a chosen death might be the best solution.

    Such a conclusion should be reached only after
the most exhaustive attempts to relieve the suffering
by every reasonable means available.
And such efforts should be recorded to convince others
that death would be better than continued mental suffering.

    Also persons whose suffering is mainly mental or psychological
sometimes have a questionable grasp of reality.
Part of the psychological problem might render them
incapable of making wise medical decisions.
Such incapacity should be explored by psychological evaluation
—another safeguard to use in close coordination with this one.

    Especially when psychological suffering is a reason for dying,
more than one professional medical opinion might be needed.
Each additional evaluation by a psychiatrist should be documented.
The medical record will show the various methods of treatment tried.
Keeping the patient medicated to reduce the psychological suffering
might be a useful interim method while new means of healing are tried.
But if full consciousness always means the return of suffering,
then open-minded psychological professionals might agree
that a chosen death could be better for this patient.
Will the psychiatrists put such recommendations into writing?

    When a patient is not able to make medical decisions
(for whatever reasons, including having a tentative grasp of reality),
then proxies should be officially appointed and empowered
to make medical decisions for that patient.
Whenever possible, the proxies should cooperate with the patient,
attempting to determine the most rational wishes of the patient
while at the same time attempting to filter-out any irrational urges
pushing the patient toward a harmful 'decision' for death.

    Choosing death for psychological reasons should be endorsed
only by persons whose thinking processes are beyond doubt.
For some mental patients, this will mean that the proxies
bear the legal responsibility for making all medical decisions
—including any life-ending decisions.

HOW UNBEARABLE PSYCHOLOGICAL SUFFERING
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH

    Irrational suicide is a real danger
for persons whose psychological suffering cannot be relieved.
This is why psychological experts must be consulted
before the proxies decide that death would be better
than forcing the patient to continue suffering every day.

    Proxies would have this power to decide life-and-death
if the patient's suffering is so great
that it renders the patient unable to make wise medical decisions.

    After the proxies have made all reasonable efforts
to find solutions to the patient's suffering,
and after they have documented their failures one-by-one,
then this medical record will stand as proof of their good-faith efforts
to help their patient recover from the psychological suffering.
If the proxies then choose death,
it will not be an irrational choice.
It will be in the best interest of the patient—a benefit, not a harm.
It will be well-planned in the sense that they have spent
months or years trying to find good alternatives.
And it will be a commendable choice
because others who examine the same facts and professional opinions
would see the validity of the choice the proxies made.

    The medical record itself would be sufficient proof
that this was not a premature death:
Given all of the facts and opinions collected
about this unbearable psychological suffering,
when does the point come when death now
would be better than forcing the patient to continue suffering?

created January 31, 2007; revised 2-9-2007; 3-15-2008; 4-3-2008;
2-6-2010; 5-9-2010; 9-9-2010; 5-27-2011; 12-15-2011;
1-29-2012; 3-22-2012; 8-1-2012; 8-19-2012;
5-22-2013; 6-27-2013; 2-19-2015;
2-27-2016; 10-19-2016; 11-9-2017; 10-24-2018; 2-23-2019; 3-11-2020;

An evaluation of the patient's continuing psychological suffering
could be relevant for making end-of-life decisions.
This is Safeguard H in How to Die: Safeguards for Life-Ending Decisions:
"Unbearable Psychological Suffering".

Patients who have an uncertain grasp of reality and of their own lives
might need the most careful protection from their own impulses.
Here is a set of safeguards to protect all vulnerable patients:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-VUL.html

Go to the Catalog of Safeguards for Life-Ending Decisions