DISCOURAGING TEEN-AGERS FROM KILLING THEMSELVES


    One worry sometimes raised in objection to talk of the 'right-to-die'
is that such discussion will devalue human life
and lead more people to commit irrational suicide.
Does talk of the 'right-to-die' create a culture of death?
Teen-agers are known to be especially at risk for irrational suicide.

    Permitting the right-to-die is probably not a significant factor
encouraging teen-agers to kill themselves.
We now have the example of the state of Oregon,
where the right-to-die has been available for many years.
As far as I know, there has been no measurable increase
in the rate of irrational suicides—among any age-group.
Has Oregon created a culture that encourages premature death?

    We know that the citizens of Oregon are well aware of the right-to-die.
They voted twice in public referenda on this question.
So there is no citizen who lived thru those media campaigns of the 1990s
who has remained unaware of the right-to-die.
And there is probably no teen-ager who grew up in Oregon
who remains unaware that Oregonians have this specific right-to-die.
But has the Death with Dignity Act created a 'culture of death' in Oregon?
It does not seem so.

    Nevertheless, we proponents of the right-to-die
should consider possible negative results of discussing the right-to-die.
We should explore our right to make wise end-of-life choices
with an eye to preventing as many irrational suicides as possible.
When we propose a new 'right-to-die',
we should worry about people with suicidal urges
who might seize upon such talk of a 'right-to-die'
as support for their irrational, self-destructive plans.

    Opponents of the right-to-die sometimes think that having
the right to choose a timely death
(which opponents call a "hastened death")
will devalue the lives of everyone living.
Our lives will lose meaning if we become casual about ending them.
According to some opponents, making the exits too readily available
will cause some unstable people to choose death
rather than stay alive to deal with their problems.
When wise life-ending decisions are socially approved,
does this create a social climate
in which teens are more likely to commit irrational suicide?

    We must acknowledge that teen-suicide is a major social problem.
Teens irrationally kill themselves for a wide variety of 'reasons'.
And we should seek good ways to prevent irrational suicide.
But public policies to discourage teens from killing themselves
should never prevent dying patients from choosing a timely death.

    In other words, we should be able to create safeguards
that permit behavior that we approve (wise life-ending decisions)
while at the same time discouraging behavior we disapprove
(irrational suicide and other forms of premature death).



SAFEGUARDS TO DISCOURAGE IRRATIONAL SUICIDE

    Each of the 30+ safeguards proposed
has a discussion of how that safeguard discourages irrational suicide
—and other forms of premature death.
Here is the complete catalog of possible safeguards:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-CAT.html

    But some of these safeguards would be more effective than others
in discouraging the self-harming behavior we want to avoid.
Here are the eight safeguards
that would be most effective in preventing irrational suicide,
beginning with the safeguards that would be most beneficial
in discouraging people from killing themselves for foolish 'reasons'.
The blue title links to a complete explanation of that safeguard.
The red comments explain how that safeguard would discourage
troubled teens (and others) from committing irrational suicide.


PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    Most teens who kill themselves are not terminally ill.
So if they have any reason to consult a doctor,
they will not be given a terminal prognosis.
And if a doctor is consulted, the physician will not give
any support for an irrational suicide for a troubled teen-ager.
Any doctor consulted might help to prevent an irrational suicide.

HOSPITAL OR HOSPICE ENROLLMENT

    Likewise, teen-agers are almost never enrolled in hospice programs,
since they are not likely to have less than 6 months left to live.
And if they are receiving treatment in a hospital,
the staff will be careful not to encourage irrational suicide.
If there is any known danger of suicidal thinking,
the hospital can create a 'suicide watch'.

PSYCHOLOGICAL CONSULTANT EVALUATES
           THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

    Having teens discuss their problems with psychological professionals
is probably the most we can do to prevent irrational suicides.
Such consultations might even result in involuntary commitment
to institutions specifically created to prevent teen-suicide.
And psychological consultants will not certify
that suicidal teen-agers are capable of making wise medical decisions.

WAITING PERIODS FOR REFLECTION

    When waiting periods are required before choosing death,
this might turn an unstable teen-ager away from irrational suicide.
The temporary problem that was pushing toward suicide
might be resolved either by actual changes in the teen's life
or by being able to re-think the problem during any waiting period.
Most suicidal urges are temporary.
And if the plan to kill oneself persists,
the waiting period will give time to seek meaningful help
to prevent any foolish self-killing.

STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

    When family members are asked to approve any proposed death,
they will almost always reject suicide as a solution to anything.
If a troubled teen asks for written statements from family members,
those relatives can take effective action to prevent irrational suicide.

ETHICS COMMITTEE REVIEWS THE LIFE-ENDING DECISION

    Likewise, if an ethics committee is asked to review the case,
the troubled teen will not be able to convince these strangers
who deal with life-and-death decisions as their normal work
that death would be the best solution to the problems at hand.
Consulting an ethics committee will prevent an irrational suicide.

A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING DEATH

    Also, it will be extremely difficult (perhaps impossible)
for a troubled teen-ager to get the approval of a member of the clergy
for what would be an irrational suicide.
Any clergy-person consulted would take steps to prevent suicide.

RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    If anyone asked for a written statement
showing how religious and/or moral principles
apply to this proposed death,
the conclusions would almost certainly be that
there is no moral or religious justification for this death.


    If these 8 safeguards do not seem sufficient
to discourage irrational suicides by teen-agers,
there are several more listed in the complete catalog of safeguards:
http://www.tc.umn.edu/~parkx032/SG-CAT.html.
Each of these descriptions contains a few paragraphs
explaining how that procedure will discourage
irrational suicide and other forms of premature death.


Created February 24, 2007; revised 3-9-2007; 2-1-2009; 3-29-2009; 4-19-2009; 2-4-2010;
2-26-2011; 12-29-2011; 1-27-2012; 2-22-2012; 3-28-2012; 9-12-2012;
3-28-2013; 6-21-2013; 7-18-2013; 7-28-2013; 7-17-2014;10-10-2014; 7-4-2015;
1-17-2018; 9-5-2018; 5-28-2020; 


This discussion of 8 ways to prevent teen suicide
has become Chapter 14 of How to Die: Safeguards for Life-Ending Decisions:
"Discouraging Teen-Agers from Killing Themselves".


The following 16 paragraphs summarize Part One of
How to Die: Safeguards for Life-Ending Decisions.

Each chapter number links to that chapter on the Internet.

Summary of Part One

How Careful Safeguards Prevent Abuses and Mistakes


    Whenever the right-to-die is discussed,
opponents think first of the problems that might arise.
They sometimes claim that abuses are so likely
that we should not even consider allowing patients to choose death.
They imagine vulnerable patients having their lives shortened
for the benefit of everyone else:
greedy relatives who want to get their hands on their inheritance sooner,
family members who are tired of taking care of the dying relative,
health-care administrators who must shed excess patients to save money,
over-zealous 'angels of death' who have a quick solution,
doctors who too-easily agree to provide sleeping pills,
teen-agers so overwhelmed by problems they wish their were dead.

    For each of the 14 identified problems or abuses of the right-to-die,
we have considered a specific set of safeguards to prevent that mistake.
Instead of loose talk of the 'right-to-die' creating a 'culture of death'
that encourages people to kill themselves to solve their problems,
we should carefully apply the most relevant safeguards
to prevent each possible abuse of the right-to-die.

    1.  If there is any danger of greedy relatives favoring an early death,
alerting the prosecutor before the death takes place should abort the plot.
Is death being proposed because of an objective medical condition?
Has a member of the clergy approved the plan for death?

    2. If some members of the family want the patient dead,
or if there might be some kind of 'suicide pact' between spouses,
asking for legal advice or religious input would counteract foolish plans.
What kinds of suffering is the patient experiencing?
Have medical professionals evaluated each patient?

    3. Whenever there is some danger of 'pulling the plug' to save money,
we need a doctor's statement of the patient's condition and prognosis.
Civil and criminal penalties should cause any plotters to reconsider.
Is the patient himself or herself really giving informed consent to death?
Has an ethics committee reviewed the whole situation?

    4. Especially when the patient is unusually vulnerable at the end of life,
careful safeguards will prevent a premature death:
We will make certain that the request for death comes from the patient.
Is the patient making a conscious and wise choice to die?
Has a psychological consultant affirmed that the patient can decide?
And is it relevant to get the opinion of a clergy-person?

    5. When there might be a tendency to devalue the life of the patient,
the official proxies and family members become important.
Do two physicians agree that the condition of the patient warrants death?
Has a psychological professional evaluated the plans?
Has an advocate from the patient's identity-group approved this death?

    6. Especially when the patient is in a coma,
there might be danger of choosing death without proper authority.
Fulfilling the patient's Advance Directive, would death be the best choice?
Did the patient give consent while still able to request death?
Has the plan for death been reviewed by the relevant legal authorities?

    7. How do we prevent obvious cases from affecting marginal cases?
Does the family agree with the life-ending plans?
Have two doctors issued statements supporting the plans for death?
Has a psychiatrist or psychologist endorsed the plans?
Has the patient given explicit authorization and consent?

    8. How can we prevent mercy-killing?
Doctors' statements, hospital enrollment, Advance Directive,
proxies, clergy, ethics committee, & prosecutor
all can discourage any premature ending of life.

    9. According to some religious beliefs, would this death be a sin?
A member of the patient's clergy could clarify the situation.
Do family members agree that this death would not be a sin?
How do religious and moral principles apply to this situation?

    10. Should we wait for God to decide that life is over?
Is the patient suffering unbearably and pleading for death?
Does the religion of the patient and/or proxies allow life-ending decisions?

    11. Is there a danger of 'angels of death' choosing death prematurely?
This danger could be controlled by an evaluation by the public prosecutor.
Does a psychological consultant and an ethics committee support the plans?
Have reasonable waiting periods been observed?
Does the family endorse the plans for death?  Do the doctors agree?

    12. Might the doctor too easily recommend death as the solution?
Has good palliative care been tried?
Is the Advance Directive of the patient being observed?
Has the patient been given opportunities to change the plans for death?

    13. Could the doctor too easily prescribe an overdose of drugs?
Does the prosecutor agree that no crime will be committed?
Is the request for death really coming from the patient?
Does the ethics committee agree that death is the best option?

    14. Teen-agers are especially vulnerable to suicidal urges.
A professional psychological consultant could evaluate the plans.
Do family members and a clergy-person agree with the plans for death?
See all 14 dangers, mistakes, & abuses of the right-to-die.

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James Leonard Park—Free Library