PROTECTING
VULNERABLE PATIENTS
FROM DISCRIMINATION
When we are dying, we are more vulnerable
than any time since we
were born.
We are often completely incapable of doing anything for
ourselves.
Others must feed us, clean us, keep us warm, etc.
And
sometimes merely omitting to do something
necessary for
our survival will result in our deaths.
In
addition to all such normal vulnerabilities,
some patients at the
end of their lives are even more vulnerable
because they lack
strong advocates to protect their interests.
We hope that most
of us will have close family and friends
who will watch out for us
when we are in the last year of our lives.
But we might come to
the end of our lives
after many of our friends and relatives have
already died
and when our remaining family members are distant and
uninvolved.
Another kind of vulnerability
arises when the patient
comes from a different social group than
the care-givers.
Sometimes the doctors and nurses cannot easily
relate to the patient
because the patient speaks a different
language,
belongs to a different racial or ethnic group,
or has
a very limited education and/or low intelligence.
Will patients with whom the staff cannot identify
get the same
level of care as given to patients
who are very similar to the
professionals providing the care?
Do doctors give the best care to
other doctors like themselves?
This is how we feel about close family members.
We
'naturally' want to do the best for the persons we love.
And if
this means that someone down the hall gets less attention,
that is
not our problem.
We demand the very best for the people we care
about.
And all the other patients do not matter as much to us.
All
medical care-givers are subject to the same feelings,
even tho
they are trained to give the same care to all patients in
need.
When it comes to life-ending
decisions,
doctors and nurses might favor patients of their own
ethnic group.
At least this is a valid question raised by members
of minority groups.
Since minorities have fewer people
in the health-care professions,
they might worry about inferior care
from people they have sometimes seen as
oppressors.
Even if such tribal thinking is absent from the minds
of the care-givers,
minority-group patients and their families
might still be concerned.
And even baseless worries should be
taken into account.
PROTECTING
VULNERABLE PATIENTS
Several safeguards would be helpful in protecting those patients
who
worry that they might be subject to discrimination for any
reason.
Here are 13 safeguards, beginning with the most effective
for protecting vulnerable patients.
Clicking the blue
title
will lead to a complete explanation of that safeguard.
The red
comments
explain how that safeguard protects vulnerable patients.
REQUESTS
FOR DEATH FROM THE PATIENT
If the
patient himself or herself has
clearly requested death,
without
any pressure from anyone else,
then this is strong reason to
believe
that death at this time would not
be an example
of giving worse care to this patient for any
non-relevant reasons.
INFORMED
CONSENT FROM THE PATIENT
If the patient
is giving fully-informed consent,
who could claim that the patient
is being treated differently?
If there are any valid doubts about
the consent,
then the other procedures should resolve such
questions.
Vulnerable patients might need more information and
explanation
before they are informed enough to make wise end-of-life decisions.
UNBEARABLE
SUFFERING
The patient's
suffering
rather than any discrimination
is
the reason for considering a chosen death.
And the level of
suffering must be carefully evaluated
for patients who cannot communicate very well.
For example, has
the suffering been confirmed
over a sufficiently long period of
time?
Have meaningful efforts been made to relieve the
suffering?
THE
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
If the patient himself or herself is making the final decision
and
actually using his or her own hands to bring death,
who could
claim that the patient was being put to death
because it was more
convenient for other people?
If there is any doubt about the level
of consciousness,
let additional experts evaluate the
decision-making process
and let additional witnesses be present at
the end
to make sure that the patient is really choosing to
die.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE
PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
When the patient's decision-making capacity is in doubt,
a
psychological professional should evaluate this
patient.
This
psychologist or psychiatrist should be capable of
evaluating the
possibly-increased vulnerability of this patient.
And if the
patient has limited capacity to make end-of-life decisions,
this psychological professional will make sure
that this
vulnerable patient is protected in all reasonable ways.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
The physician's medical statement sets forth the objective facts
and
the professional evaluation of the doctor.
The
physician should protect the best interests of the
patient.
And
if discrimination might be present,
the
physician should take that worry into account.
Everyone who reads
the physician's summary
should look for
any signs of giving a lower level of care
because this patient is
especially vulnerable.
REQUESTS
FOR DEATH FROM THE PROXIES
The proxies
for the patient are also in good position
to raise any doubts
about possible discrimination.
If they also request death based on the gathered facts and opinions,
then this life-ending
decision is probably not inferior terminal care.
One of the
primary functions of carefully-selected proxies
is to protect
vulnerable patients who cannot protect themselves.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING
OR
QUESTIONING CHOOSING DEATH
Other
family members should also review the plans for death.
If
they suspect that their dying relative is receiving inferior care,
they should challenge
the plans for death.
But if the people who are closest to the
dying patient
approve the plans for a timely death,
this will
also be strong
evidence that this death was properly chosen,
even
if the patient was in a very vulnerable condition at the end of
life.
Merely being
especially vulnerable should not cancel the right-to-die.
STATEMENTS
FROM ADVOCATES FOR DISADVANTAGED GROUPS
IF
INVITED BY THE PATIENT AND/OR THE PROXIES
If the patient belongs to a group that has suffered
discrimination,
then a special advocate drawn from that
group
might be asked to review the plans for death.
And if this
special advocate looks for signs of discrimination
and
agrees that death at this time is the best course of action,
others
who are more distant and perhaps more skeptical
might be reassured
that a timely death was wisely chosen.
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
Ethics committees are also able to protect vulnerable patients.
They
are aware of how social factors might affect the
judgment
of other people involved in planning this death.
And
especially when they know this patient is particularly
vulnerable,
they should exercise extra
care
to make sure the
plans for death are appropriate for this patient.
A
MEMBER OF THE CLERGY
APPROVES
OR
QUESTIONS CHOOSING DEATH
Ministers, priests, rabbis, or other religious leaders
might also
be asked for their opinions about the proposed death.
If they agree that this life-ending decision is wise,
then
more distant doubters can be more assured
that the rights of a
vulnerable patient have been protected.
REVIEW
BY THE
PROSECUTOR (OR OTHER LAWYER)
BEFORE
THE DEATH
TAKES PLACE
And all people working in the prosecutor's office
will also be
aware of the possibility of discrimination
against patients who
are vulnerable for any reason.
They will review the death-planning
record
to make sure that the
safeguards were applied with special care
because
this patient was very vulnerable at the end of
life.
CIVIL
AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
The law protects the
vulnerable.
Anyone who might be tempted to provide inferior care
will be
careful to fulfill several safeguards
to prove that this
vulnerable patient received appropriate care.
In very difficult cases, additional
safeguards might be needed
to
resolve any doubts about the wisdom of any proposed death.
created
February 23, 2007; revised 3-9-2007; 8-30-2008; 11-14-2008;
1-5-2009;
2-4-2010; 2-26-2011; 12-21-2011;
1-26-2012; 2-18-2012; 3-25-2012;
5-29-2012; 9-11-2012;
3-17-2013; 6-20-2013; 7-16-2014; 10-10-2014;
3-11-2015; 5-6-2015; 7-3-2015; 11-18-2017; 6-28-2018; 8-16-2018;
6-17-2020;
This
review of the best safeguards to protect vulnerable patients
has
now become Chapter 4 of How
to Die: Safeguards for Life-Ending Decisions:
"Protecting
Vulnerable Patients from Discrimination".
Go
to other dangers,
mistakes, & abuses of the right-to-die.
Go to
the beginning of this website
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