Will
this Death be
a "Mercy-Killing"
or a "Merciful
Death"?
original
title:
FOUR DIFFERENCES BETWEEN MERCY-KILLING
& MERCIFUL
DEATH
SYNOPSIS:
The advent of medical technology that can keep a body 'alive'
for
months or even years after
the person is no longer there
necessitates
some new thinking and new terminology
for the process of deciding
to end the life of another individual
who can no longer decide for
himself or herself
and who might now have become a former
person.
This essay proposes to define and distinguish two concepts
that
might seem to be synonymous: mercy-killing
and merciful
death.
The
same four distinctions can be used to distinguish
irrational
suicide
from voluntary
death.
OUTLINE:
A.
SEPARATING MERCY-KILLING
FROM MERCIFUL
DEATH
1. Will this death be harmful or helpful to the patient?
2. Will this death be irrational or rational?
3. Will this death be capricious or well-planned?
4. Will this death be regrettable or admirable?
B. PRACTICAL
WAYS TO SEPARATE MERCY-KILLING
FROM MERCIFUL
DEATH
C.
MERCY-KILLING
SHOULD REMAIN A CRIME;
MERCIFUL
DEATH
SHOULD BE PERMITTED AND SUPPORTED
Will
this Death be
a
"Mercy-Killing"
or
a "Merciful
Death"?
by James Leonard Park
A.
SEPARATING MERCY-KILLING
FROM MERCIFUL
DEATH
1.
Will this death be harmful
or helpful
to the patient?
Mercy-killing is a well-known phenomenon in almost every culture.
It
happens when someone causes death in another individual
based on
the belief that death would be good
for the victim.
But when the facts come to light, almost everyone
agrees
that death was not
the best option under those circumstances.
For example, spouses sometimes kill their loved ones
under what
turns out to be the false belief that they had cancer.
When the
body was autopsied by the medical examiner,
sometimes no cancer
was found.
When such mistakes are made by well-meaning spouses,
in
retrospect even they agree that the death was a harm
to the victim.
Such cases are correctly called
"mercy-killings".
On the other
hand, there are situations in which the patient
really was
suffering an incurable and painful disease.
And when all the facts
became known,
even people who were initially against a chosen
death
agreed that death was a better option than meaningless
suffering.
Increasingly, due to modern
life-support systems,
the patient is unconscious or otherwise
unable to make medical decisions.
Then the proxies must collect
all of the relevant information
and explore all the remaining
medical options,
possibly concluding that death would be the best
course of action
for this person or former person.
When the facts and opinions point to death as the best choice,
then
this death might be called a "merciful death".
This is
parallel to a voluntary
death
which
could have been chosen by the patient himself or herself
if he or
she was still able to make medical decisions.
And often the
proxies will have asked themselves:
What would this individual
have chosen
if he or she knew everything that we know?
If the
patient would have chosen a voluntary death,
then the proxies are
justified in calling it a merciful
death
when
they
must make the life-ending decisions for the patient.
Laws should be re-written wherever necessary
so that proxies do in
fact have the same powers to choose death
for a patient who has
now lost decision-making capacity.
None of us should lose the
right-to-die
merely because we can no longer authorize
the
necessary actions (or withholding-of-actions) ourselves.
2.
Will this death be irrational
or
rational?
When other people examine a mercy-killing after the death has
occurred,
they determine that the reasons for death were
insufficient.
The person who committed the mercy-killing
probably
believed at the time that it was best for the victim.
But when
cooler heads examine all of the facts,
they decide that it was
really an irrational response
to a situation that was perhaps
misunderstood.
Often the relative of
someone who is suffering
has a limited understanding of medical
matters.
This can lead to false ideas about what is likely to
happen.
And such mistaken beliefs can lead to a
mercy-killing.
However, if the
duly-appointed proxies
for someone who has ceased to function as
a full person
have examined all the medical facts and
recommendations,
then if they make a wise choice for death,
it
might be called a "merciful death"—not
a "mercy-killing".
And there should be no punishment for
that life-ending decision.
Just as the patient could have reached
the same conclusion
if he or she were still able to weigh medical
facts and opinions
and reach a wise decision about how to
proceed,
so the proxies for the patient have thought long and
hard
about all the possible courses of action
and have
reluctantly decided that death
is the best option.
There can always be disagreements about just what is rational,
but
at least the principle
can be applied to each specific situation.
When the patient can no
longer decide,
what is the wisest course of action for the proxies
to take?
If the patient makes a foolish choice for death,
that
is called "committing irrational suicide".
If someone
else make a foolish choice for death, that is called "mercy-killing".
This
is the same irrational/rational distinction
that separates
irrational
suicide from
voluntary
death.
(See
the companion on-line essay:
Will this Death be an "Irrational
Suicide" or a "Voluntary
Death"?
http://www.tc.umn.edu/~parkx032/CY-IS-VD.html
)
3.
Will this death be capricious
or well-planned?
Usually what we later call a mercy-killing was basically a capricious
act,
taken on the spur of the moment, not carefully planned and
organized.
The man who wants to shoot his wife to end her
suffering
does
not share this plan
with anyone else
because he fears on some level that others will
not agree
with him
and will take action to prevent
him from shooting his wife.
And if he is delayed by other people
or circumstances,
he probably will have had second thoughts about
killing his wife.
Good medical information might have assured
him
that death
today is not the wisest course of action.
In contrast, when the proxies are planning the death of their
patient,
they will complete an exhaustive search for the best
medical treatments
before
they conclude that no
cure is possible.
They
might consult a variety of medical people
before they move toward
a "merciful death".
The process of planing for a
merciful death could
take up to one year
—especially
in cases of complex diseases with several possible outcomes.
Just as a person who is considering his or her own medical care
will
pursue all meaningful options before deciding to accept death,
so
the proxies for someone who has lost decision-making capacity
will
analyze all the facts and collect all relevant medical
opinions
before possibly deciding that death is the best option
available.
And as each of us retains the power to choose a
voluntary death
while we still have all our wits about us,
so
our proxies should be duly authorized to
choose death for us
after we have lost consciousness permanently
or otherwise
become unable to make medical decisions.
As a voluntary
death can
be well planned by the patient,
so
a merciful
death can
be well planned by the proxies
for the patient.
4.
Will this death be regrettable
or admirable?
When a distraught relative has committed a mercy-killing,
everyone
who knows about this tragedy regrets
that result.
We wonder what we could have done to prevent this
needless death.
And some premature deaths have
been prevented
when
others learned of a foolish plan to commit mercy-killing.
These evaluations often must be made after the death has
occurred.
But if we know of any plans to kill a vulnerable
person,
we can take the necessary steps to prevent such a
regrettable crime.
However, if a mercy-killing has already taken
place,
we should let the justice system examine the case.
On the other hand, when a merciful
death is
planned,
no crime will be committed and the justice system will
not become involved.
It is a wise and admirable plan to draw this
life to a close
at the best time—not
too soon
and not
too late.
If
the patient had been able to participate in the decision for
death,
he or she would have agreed that death is the wisest
course.
Then if others must carry forward the plans for death,
it
will be called a wise, merciful death.
Again, the proxies should
have the same full powers to decide
as held by a patient with full
capacity to make medical decisions.
Law
and medical practice will have to change in some degree
to make
this distinction between mercy-killing
and merciful
death
effective in the real world.
But the basic tests can be
understood by anyone
who knows the differences between:
(1)
harming or helping;
(2) being irrational or rational;
(3)
acting capriciously or cautiously; &
(4) a death we regret or
a death we admire.
Mercy-killings will
still take place.
And they will have to be dealt with by law
enforcement:
the police, the prosecutors, the courts, & the
prisons.
But the new
concept of merciful death
can be put into practice
under the supervision of the medical
profession.
They can recommend a life-ending decision to the
proxies
when the facts of the case suggest
that death is the
best choice for this patient.
Often the death will come about
as
the result of disconnecting life-support systems,
which has long
been recognized
as a valid and reasonable way to draw life to a
close.
When other methods are needed to shorten the process of
dying,
these measures can be called "merciful death".
B.
PRACTICAL WAYS TO SEPARATE MERCY-KILLING
FROM MERCIFUL
DEATH
Having outlined the philosophical and psychological
differences
between the familiar phenomenon of mercy-killing
and
the less common practice of merciful
death,
we
can ask for some practical
methods
by which to separate these two.
Here are
ten definite steps that anyone can take
which will help to tell
whether a proposed death
would be a mercy-killing
or a merciful
death:
1.
Advance
Directive and/or Requests
for Death from the Patient.
2.
Psychological
Consultant Certifies that the Patient is Competent to Decide.
3.
Doctor's
Summary of Condition and Prognosis.
4. Independent
Doctor Confirms the Condition and Prognosis.
5.
Significant
Others Agree with the Life-Ending Decision.
6.
Member of
the Clergy Approves the Life-Ending Decision.
7.
Ethics
Committee Reviews the Life-Ending Decision.
8.
Criminal and
Civil Penalties for Causing Premature Death.
9.
Waiting
Periods for Reflection.
10. Complete
Reporting of all Material Facts.
As
might be obvious from these ten safeguards,
they
can be used for all forms of life-ending decisions:
(1)
while the patient is still capable of making the decision,
(2)
after the decision-making power has passed to the proxies,
(3) in
either case when considering withdrawing life-support systems, &
(4) when considering more active means of drawing life to a
close.
In cases of proposed merciful death,
the prior record of choices when the patient was still capable
of making decisions should still be honored.
We should not
lose our right-to-die when we become unconscious.
Our advance
directives and any other documents created by others
should still
have legal and ethical force
unless there is some substantial
change in the patient's condition
that would render the prior
decisions invalid or irrelevant.
Anyone who
goes to the trouble of fulfilling these safeguards
should be
assumed to be acting in good faith,
watching out for the best
interests of the patient.
For example, someone who has an urge to
commit a mercy-killing
is not going to consult the ethics
committee of the hospital.
Proxies who do
ask for input from others
about the wisdom of death
now
rather than death
later
are
much more likely to be planning
what will be called (after the
fact) a merciful
death.
The safeguards named above
(and a few others)
are explained in further detail in another
on-line essay:
Fifteen
Safeguards for Life-Ending Decisions
:
http://www.tc.umn.edu/~parkx032/CY-10SG.html
This
essay is linked to an even
more comprehensive
list of safeguards.
C.
MERCY-KILLING
SHOULD REMAIN A CRIME;
MERCIFUL
DEATH
SHOULD BE PERMITTED AND SUPPORTED
Mercy-killing is different from other forms of murder
because the
perpetrator believed the victim was already dying.
Thus it should
be prosecuted as a new
form of homicide.
This
new law should also include the possible crime
of prematurely
disconnecting life-support systems
—another
means of killing people that our forefathers never imagined.
Here is a draft of such a law, called Causing Premature
Death:
http://www.tc.umn.edu/~parkx032/PREM-DTH.html
This
draft embodies 26 safeguards.
If substantially all of the
safeguards are fulfilled, no crime was committed.
And the death
will be a voluntary
death if
chosen by the patient.
The
death will be a merciful
death if
chosen by proxies for the patient.
Each state or country will have to modify its own homicide laws.
But
looking ahead by 100 years,
we can be confident that such changes
will be common
and that irrational
mercy-killings
will continue to be prosecuted
whereas wise
merciful deaths
will be permitted and supported.
Created
October 30, 2005; revised several times, including: 11-13-2008;
6-5-2009;
3-2-2010; 6-10-2011; 11-4-2011; 12-31-2011;
1-22-2012;
2-1-2012; 2-22-2012; 3-30-2012; 7-11-2012; 9-13-2012; 10-17-2012;
5-4-2013; 6-25-2013; 7-18-2014;11-16-2014; 4-3-2015;
7-8-2015;
AUTHOR:
James Park is an independent existential philosopher
with deep
interest in medical ethics,
especially the many issues
surrounding the end of life.
Medical Ethics and Death are two of
the seven doors
to his website called "An Existential
Philosopher's Museum":
http://www.tc.umn.edu/~parkx032/
The above four
ways to separate mercy-killing from merciful death
is
also Chapter 20 of How
to Die: Safeguards for Life-Ending Decisions:
Will
this Death be a "Mercy-Killing" or a "Merciful
Death"?
If you find this line of thinking useful,
you might want to read
the whole book
and help make it better.
A Facebook Seminar is now reading and
discussing this book
one chapter or safeguard per week
and
make suggestions for improving How
to Die.
See the complete description for this
seminar:
http://www.tc.umn.edu/~parkx032/ED-HTD.html
Join our Facebook Group called:
Safeguards for Life-Ending
Decisions:
http://www.facebook.com/home.php#!/groups/107513822718270/
Here is the summary of Part Two of
How
to Die: Safeguards for Life-Ending Decisions.
Clicking the
chapter numbers will take you to each chapter on the Internet.
Summary
of Part Two
Careful
Use of Language will Advance the Right-to-Die
Advocates of the right-to-die have developed a set of conventional
terms
they use in discussing the end-of-life options with one
another.
But for historical reasons that are not obvious,
most
of the traditional terms have developed very negative
connotations.
Thus, it is time for a deep
revision
of the language used by supporters of the
right-to-die.
What advantage would be achieved by continuing to
use
"suicide" and "euthanasia" when we want
to convince people in the middle
to support wise end-of-life
medical choices?
Each chapter in this
section addresses one term, suggesting alternatives:
15.
Instead of referring to "assisted suicide" and "committing
suicide",
we could speak of "physician-assisted dying",
"voluntary death",
"aid in dying", or
"managed dying".
16.
Instead of the traditional term "euthanasia",
we could
refer to "gentle death", "good death", "chosen
death", etc.
Then opponents would tie themselves in knots
when they say that they oppose all forms of good death or gentle
death.
17.
"Hastening death" has not been much examined as a term of
art.
But we really do not advocate exiting from life as soon as
possible.
Rather, we want to choose reasonable and "timely"
deaths.
We seek the best time for death to come, not too soon and
not too late.
18.
Probably because the first law used this expression,
"medication"
has been the word for gentle poison
to be taken to achieve a
painless and peaceful death.
What about calling them "life-ending
chemicals"?
It would probably be better if we avoided any
possible confusion
with drugs used for treating disease or
alleviating symptoms.
19.
The right-to-die movement should never be confused with a suicide
cult.
At every opportunity, we should say that we do not advocate
people foolishly throwing their lives away.
With careful and
consistent use, we might be able to establish
"voluntary
death" by clearly distinguishing it from "irrational
suicide".
20.
Likewise, we should no longer seem to advocate "mercy-killing".
Rather, would it be possible to define and describe "merciful
death"
as an end-of-life choice that is helpful, rational,
well-planned, & admirable?
Some
related on-line essays and chapters:
Terminal Sedation:
Dying in Your Sleep—Guaranteed.
Losing
the Marks of Personhood:
Discussing Degrees of Mental
Decline.
Advance
Directives for Medical Care:
24 Important Questions to Answer
.
Fifteen Safeguards for Life-Ending Decisions .
Will this Death be an "Irrational Suicide" or a "Voluntary Death"? .
Will this Death be a "Mercy-Killing" or a "Merciful Death"? .
Four Legal Methods of Choosing Death .
Pulling
the Plug:
A Paradigm for Life-Ending Decisions .
VDD:
Why
Giving Up Water is Better than other Means of Voluntary Death .
Voluntary
Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice
.
Depressed?
Don't
Kill Yourself! .
FURTHER READING:
Best Books on Voluntary DeathBooks Opposing the Right-to-Die
Go to the Right-to-Die Portal.
Return to the DEATH page.
Go to the Medical Ethics index page.
Read
other free
books on the Internet.
Go to
other
secular sermons by James Park,
organized into 10
subject-areas.
Return
to the beginning of this website:
An
Existential Philosopher's Museum .