SAFEGUARD U FOR LIFE-ENDING DECISIONS

WAITING PERIODS FOR REFLECTION

     In order to prevent mistakes that might occur in any rushed process, 
appropriate waiting periods should be observed
for each way of choosing death. 

1. WITHDRAWING MEDICAL TREATMENTS AND LIFE-SUPPORTS.

     For the withdrawal of all medical treatments and life-supports,
the waiting period might be one week,
beginning with the first written request for the withdrawal of supports.   
(Comfort-care will continue, to make the death as easy as possible.)
For patients already in a terminal coma without chance of recovery,
and whose coma has already continued for several weeks,
the case is so obvious no additional waiting period would be helpful.

     One week is short compared to the other suggested waiting periods.
But people dependent on life-support systems to prevent them from dying
often have no chance of surviving their disease or condition. 
So the only decision is the best time for their lives to end

     Once a request for withdrawal of all life-supports 
has been put into writing by the patient and/or the proxies,
then all persons concerned will be informed immediately,
in case anyone has new information or opinions
that might have a bearing on this life-ending decision. 

     In most cases, all concerned persons
will already be well aware of the grave condition of the patient. 
This notification merely sets a definite date for the withdrawal,
after which immediate death is expected.

     In cases where it might be wise to notify the prosecuting authority
before the withdrawal of life-supports,
the law should require the prosecutor to act
within 5 business days or never thereafter to raise any objections.
But because the withdrawal of medical treatments is so common,    
it seems most likely that the prosecuting authority
will not become involved unless someone close to the case
suspects that some harm will be done to the patient
by the withdrawal of all curative treatments and life-supports.
If the patient is going to be harmed by withdrawal,
a crime is on the verge of being committed. 
And the prosecuting authority might be able to prevent any such harm.  
Usually everyone agrees that withdrawal will not harm the patient.
Painful and useless treatments might be more harmful  
than ending all life-support measures
and allowing the patient to have a peaceful death.

     Eventually the other forms of chosen death will become so routine
that the review by the prosecuting authority will become a formality
merely looking for obvious signs of fraud. 
The staff of the prosecutor's office might come to trust
the doctors and consultants often involved in withdrawing life-supports. 

2. VOLUNTARY DEATH.

      The waiting period for a voluntary death might be 12 months.
This waiting period begins with the creation of the first written,
signed, and witnessed request for death from the patient.
During each month of this
process of planning for death,
the patient might reaffirm in writing (properly dated and witnessed)
his or her choice of voluntary death. 

    This long period for reflection will allow a complete examination
of all facts and opinions that have a bearing on this end-of-life plan.
But if the choice of voluntary death is truly rational, based on facts,
thoughtfully and compassionately planned, & admired by others,
then taking 12-months to prepare will demonstrate more clearly
that voluntary death was the wisest choice under the circumstances. 

     12 months should provide plenty of time
to reconsider the decision to choose a voluntary death.  
Something might change during this planning process,
causing the patient to push back the proposed date of death. 
If we choose to end our lives rationally and voluntarily,
we are free to choose the best timing of our deaths
so that we end our lives at the ideal time for all concerned.
If our health improves, we might want to live for a few more weeks.

     If, on the other hand,
the patient becomes incompetent during this waiting period,
the months already passed since the first request for death
will count toward the waiting period for merciful death, discussed below. 

     Waiting periods make sure that the patient
is not being rushed into death prematurely.
The patient's physical or mental conditions might improve. 
If so, the doctors should issue
new statements of condition and prognosis,
which supersede all previous ones. 

     Old friends or relatives might turn up
as a result of announcing the plans for death,
who will have new information, new offers of support,
or new perspectives to give,
causing the patient to reconsider the choice of a voluntary death.

     During the waiting period, the patient might have a change of heart
Something new might emerge in his or her interpersonal, mental,
or spiritual life to modify the decision for voluntary death.

     There might even be a new treatment for the underlying condition
that caused the patient to choose voluntary death in the first place. 
The patient can decide to try any new treatments
without interrupting the waiting period for a voluntary death. 
If new treatments succeed, the patient can always postpone death
If the new treatments fail, the original date for death can be kept. 

     Is 12 months is too long to wait for death?
It is better to err on the side of caution than to be reckless
And simultaneous with the first application for voluntary death
the patient and proxies should agree
on which medical treatments will be tried or continued
and which treatments will be omitted or discontinued.
The patient and proxies might agree to Do-Not-Resuscitate orders,
so that there will be no efforts to revive the patient
if death comes from natural causes during the waiting period. 
They should also exclude medical procedures
that might merely prolong the process of dying.
Since at least a tentative date has been set for this death, 
the patient will agree to forgo surgery or other treatments
that would be appropriate for someone with an indefinite life-span. 

     The 12-month waiting period for voluntary death
will give ample opportunity for those who care about the patient
to complete their business with that person,
to express all of their love and caring,
and perhaps even to begin to grieve for the loss
they will experience when the patient dies.
Those who are taking an active part in preparing for this death
—for instance, by writing statements supporting the decision
will be much more prepared for this death
if it comes suddenly from natural causes during the waiting period. 

     The purpose of these waiting periods for choosing death
is not to impose additional burdens on the patient and/or the family.
If the patient is suffering, then the waiting period could be shorter. 
And those responsible for reporting the fulfillment of this safeguard
should explain any reasons for a shorter waiting period. 
Each death is a very individual matter. 
And we should not impose rigid rules on such personal decisions. 
Let reason and compassion guide our application of all safeguards.

     This long process of explaining one's reasons for wanting to die
and getting agreement from doctors, clergy, & significant others
will show that the patient is truly getting ready for death.  
The patient can arrange his or her practical affairs
and complete any projects that should be done before death. 

    Having set at least a tentative date for death
will enable all of the people who care about the patient
to begin preparing themselves for this death to occur. 

     This  process of
planning for death might stimulate the planners
to consider how they would like to meet their own deaths.
And the medical care-givers will abandon their automatic responses
—which are always to keep the patient alive,
no matter what burdens this puts on the patient, family, & friends.
The doctors and nurses will be ready to let the patient die
because this patient has carefully and rationally chosen death.

3. MERCIFUL DEATH.

     The waiting period for a merciful death should be 6 months.  
This period of waiting begins from the first application for either
voluntary death (written by the patient while still capable)
or merciful death (written by the proxies for an incapable patient).
During each month of this waiting period,
the proxies should reaffirm in writing their decision for merciful death.
 
     And (as said above in reference to voluntary death),
simultaneous with the application for a merciful death,
the proxies should decide which medical treatments to continue
and which to discontinue.
They should make sure that a Do-Not-Resuscitate order is written
so that the patient will not be 'saved' by medical interventions
if he or she should die of natural causes during the waiting period.

     In the case of a merciful death,
the patient can no longer participate in the decision-making process,
but if the patient wrote an Advance Directive before becoming incapable,
that document stands as the best expression of the patient's wishes. 
And the duly-authorized proxies will be responsible
to carry forward the decision for merciful death.  
When the patient can no longer participate in the decision for death,
all of the other safeguards become more important.
And if most safeguards are fulfilled, everyone should be assured
that the chosen pathway was the best way for this life to end.  

     The waiting period for a merciful death
might also be shortened for good reasons, such as the fact
that the patient has already been in a coma for several months.
The person reporting on this safeguard should include any documents
showing that the process of planning for this death was not rushed.

AVOID RIGID RULES ABOUT WAITING PERIODS

    Some right-to-die laws have elaborate requirements
for paperwork related to waiting periods.
For example, they require some requests for death to be verbal
and some to be written, with specific waiting periods between requests.

    However, this puts the emphasis in the wrong place.
The purpose of waiting before death
is to make sure that death is really a wise choice.
Thus, the waiting periods should be used to examine options.
What additional medical treatments should be considered?
Is the patient being given physical and emotional care
so that the decision for death is not premature?
Do distant friends and relatives wish to visit the patient before death?
What new medical facts and professional opinions might appear
that would change the plans for death?

    The process of fulfilling other safeguards takes time.
And seeking the opinions of others who care about the patient
will be more meaningful than proving that a certain length of time
has passed between the various required requests for death.

    No one should be punished because of incomplete paperwork.
But if the patient was really rushed prematurely into death,
then that harm to the patient might warrant some legal sanction.

    Instead of just waiting for a certain number of days to pass,
spend each additional day working to fulfill meaningful safeguards.
We do not merely want to delay death.
We want to make sure that this death is being wisely decided
.




HOW WAITING PERIODS DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH


    Whenever significant waiting periods are observed before
removing life-supports, choosing voluntary death, or granting a merciful death
possible mistakes and abuses of such life-ending decisions are prevented.

    In the situation of choosing a voluntary death,
the monthly reaffirmations of this choice will prevent irrational suicide
—the self-harming, foolish, capricious, & regrettable taking of one's own life. 
Suicidal persons will not be able to explain their reasons 
in order to convince others to cooperate.
And their irrational urges to die will probably not last for 12 months.
When written plans for death (including 'reasons' for wanting to die)
are shared with members of the family and perhaps with friends,
others might see different solutions to the problems
that are leading the patient to choose death.

    The 6-months waiting period for merciful death serves a similar function:
If someone is plotting a mercy-killing—harmful to the patient,
not based on real-world facts, sudden, & regrettable—
the long waiting period will allow ample time to discover the evil intent
and to prevent the mercy-killing.
Creating documents to fulfill the other safeguards will be specific ways
to uncover any conspiracy to cause a premature death.

     Requiring one week notice for withdrawing life-supports
will permit all concerned to review their thinking about this life-ending choice.
If there are other realistic options,
the announced date of death will bring out the other possible solutions.
And occasionally, waiting will prevent a premature death.



Created January 2007; revised Feb. 2007; 3-2-2007; 1-20-2008; 3-22-2008; 7-16-2008;
2-10-2010; 5-9-2010; 9-9-2010; 5-27-2011; 12-16-2011; 2-1-2012 name changed;
2-10-2012; 2-23-2012; 3-23-2012; 8-2-2012; 8-23-2012;
3-5-2013; 6-28-2013; 2-11-2015; 7-9-2015; 12-28-2015; 4-20-2016; 1-17-2018; 11-8-2018; 12-12-2019

 
Go to the Catalog of Safeguards for Life-Ending Decisions



Go to the list of 26 recommended safeguards.



  Slowing down the process of deciding about death
is Safeguard U in How to Die: Safeguards for Life-Ending Decisions:
"Waiting Periods for Reflection".



Go to the index page for the Safeguards Website.



Go to the Right-to-Die Portal.



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