Advantages
of the Premature-Death Approach to the Right-to-Die
Brings Underground Chosen Deaths
Above Ground
UNDERGROUND
CHOSEN DEATHS IN OREGON
When we note that
only 1 death in 1,000 in Oregon
has been reported as using the Oregon Death with Dignity Act,
it seems that there must be many
more chosen deaths
that are remaining
underground.
The people of Oregon voted twice to create their
right-to-die law.
So at least half of
the people who have died in Oregon in the last
decade
voted in favor of the Oregon Death with Dignity Act.
So, what happened to them at the end of their lives?
Perhaps it was sufficient for them to affirm the
right-to-die.
And when it came time for their own deaths,
they decided to go ahead with a planned death
but they decided not to
bother with the paperwork
required by the Oregon Death with Dignity Act.
They and their doctors just conspired to avoid the law
and keep this death outside the reporting required
under the Oregon Death with Dignity Act.
Calling these "underground deaths" does not imply
that they were wrongly decided.
Good safeguards might have been used in making these life-ending
decisions.
But if there was some
aid-in-dying,
it was not correctly reported to the Oregon Department of Health.
The element of choice was not mentioned on the death certificate.
These death certificates merely name the underlying disease or
condition,
omitting any mention of the decision to shorten this process of dying.
That is the way all deaths are handled
when life-supports systems sustain the patient's life toward the end.
The withdrawal of life-supports is not recorded as a cause of death.
If we were to look at the medical record,
we would learn exactly which medical measures were in use
and which changes in medical orders occurred just before death.
But it did not seem relevant to mention these facts on the certificate
of
death.
When the life-support machines, etc. were turned off or unplugged,
the death that was predestined to happen took its natural course.
And cancer (or whatever) was recorded as the cause of death.
In Oregon patients and doctors are finding other
ways to bring death
than applying for the complex protocol
prescribed by the Oregon Death
with Dignity Act.
Most of these deaths are probably not caused by life-ending chemicals
prescribed by the physician.
Rather, other, more readily-available means are chosen,
perhaps involving giving up some forms of medical treatment
that was keeping the patient alive.
Maybe life-ending chemicals will not be a popular
means
to achieve
death.
Doctors can more easily increase
the pain medication that is already being
used.
And the process of dying will be shortened as a result.
Doctors can even order terminal sedation,
which will keep the patient unconscious until death.
Terminal sedation will probably be coupled with giving up food and
water,
since an unconscious patient cannot eat or drink normally.
Or perhaps the patient and/or the proxies decided to
stop food and water.
But even voluntary
death by dehydration
might not be recorded as such on the certificate of death.
The death certificate will probably name the underlying disease or
condition
that led the patient and/or the proxies to choose death by dehydration.
BRINGING MORE CHOSEN DEATHS INTO THE OPEN
In the Netherlands, where shortening the process of
dying
has been well accepted for many years,
about 5% of all deaths
are achieved with the help of a physician.
This would seem to be a reasonable goal for other advanced cultures.
As noted at the beginning, in Oregon only one death in a thousand
is reported as having used the Oregon Death with Dignity Act.
Here are the easy-to-remember numbers for the first ten years:
About 300,000 Oregonians died.
Only 300 chose the official Death-with-Dignity pathway toward death.
Why so few?
If the Dutch pattern prevailed,
50 times as many Oregonians would be choosing timely deaths
rather than following the patterns of standard terminal care.
Probably more
than these 300 citizens of Oregon
chose timely deaths,
but for reasons unknown they did not choose
to apply for the right-to-die under the Oregon Death with Dignity Act.
If the Netherlands proportions hold in Oregon,
for each person who
followed the official route,
there were 50 others
who kept their chosen deaths underground.
Over ten years, this amounts to about 15,000 underground chosen
deaths.
As said before, when chosen deaths remain
underground,
there is no certainty that they were wisely chosen
because no public safeguards
were used in the process of choosing death.
There are about 10 different
safeguards embodied in Oregon's Death
with Dignity Act.
Perhaps there are some changes that should be
incorporated
in other right-to-die laws that follow the pattern set in Oregon
so that more people who are
choosing timely deaths
will take advantage of the right-to-die
and have their deaths correctly recorded.
A fifty-fold increase in applications for voluntary death
would mean that the deaths of many more people
would come under the
safeguards for life-ending decisions
that are intended to prevent premature death.
When laws are written that most people avoid,
it means that patients and their families will not benefit
from the public safeguards embodied in those laws.
LAWS AGAINST CAUSING PREMATURE DEATH MIGHT BE MORE WIDELY HONORED
The other approach to the right-to-die suggested here
puts the public safeguards into the homicide section of the laws.
People who are giving secret aid-in-dying now
know that there is a remote chance
that they will be caught helping others to die
and be charged with some form of homicide.
And some desperate relatives resort to mercy killing
because the medical system seems to offer no relief.
When laws against causing premature death are
enacted,
underground aid-in-dying and mercy killings might largely disappear.
Doctors, nurses, patients, & relatives will know what safeguards to
fulfill
in order to prevent anyone from being charged with causing a premature
death.
And desperate family members
who might otherwise have been tempted to commit mercy
killings
will decide that there are better ways to make life-ending decisions.
The safeguards embodied in the law
will tell them just what steps they should take
to make certain that they are making wise life-ending decisions.
The law tells everyone involved in death-planning process
exactly how to defend themselves
against the charge of causing a premature death:
If they follow the safeguards, they will not be causing a premature
death.
And there will be no danger of prosecution.
Right now, people who give aid-in-dying
are opening themselves to criminal prosecution.
Free-lance, underground aid-in-dying
is now subject to prosecution as 'mercy killing',
which will be charged as some form of homicide.
The jury will be asked to decide whether a crime was committed.
And even tho the jury does not approve of the behavior
of the one who
caused the death,
they can sympathize with the thinking behind it.
So they refuse to send the perpetrator to jail.
At least one juror votes for acquittal.
And the one who caused a questionable death is not punished.
When the law explicitly allows such life-ending
choices,
then people can fulfill whichever of the specified safeguards
seem most relevant for the life that is now coming to an end.
And later they might have to take their chances with the
criminal-justice system.
The most careful families will do the best jobs of fulfilling the
safeguards.
And when their present
their fulfilled safeguards to the prosecutor,
the prosecutor will see immediately
that there is no chance of winning a conviction
before a jury of peers of the family that chose the merciful death.
This form of laws gives the defendants explicit
permission to
present evidence
that supports the conclusion that it was a wisely-decided death.
Under murder laws, such evidence is often excluded.
So the jury does not know what went thru the minds of the family.
The jury is only allowed to hear evidence of what the family did.
The jury knows nothing about the medical condition of the patient.
This is what sank the last case of Jack Kevorkian.
The family was not able to testify that they also agreed
that it was a wise choice for Thomas Youk to end his life
when he decided he could no longer tolerate his suffering due to ALS.
The fact that Thomas Youk could not take the fatal action himself
should not have sent Jack Kevorkian to prison.
Under laws against causing premature death,
Jack Kevorkian would have known exactly what safeguards to fulfill.
And the judge and/or jury would have decided
that it was a wisely-chosen voluntary death
—not
second degree murder.
In fact, if specified safeguards had been fulfilled in advance,
the prosecutor would never have thought
to bring the charge of causing a premature death.
The fulfilled safeguards would have proved
that Thomas Youk did not die
too soon.
Jack Kevorkian wanted to bring underground chosen
death into the open.
But the law of Michigan was not yet ready to recognize
the validity of making life-ending decisions
by means of fulfilling meaningful safeguards
that would prevent premature deaths.
When Michigan—or
any other state or country—
enacts a law against causing premature death,
then everyone will know just
what safeguards might be fulfilled
in order to prove to any prosecutor, judge, or jury
that the life-ending decision
was a wise and ethical choice under the circumstances,
not any crime that should be punished.
Those who help others to die under meaningful
safeguards
are providing compassionate help
to the patients, not harming
them.
And it seems entirely possible that laws against
causing premature death
will be taken into account by more people involved in planning death.
And thus the safeguards embodied in the law
will be applied much more
broadly
than under life-ending-chemical laws,
which, as we have seen, are widely
unused.
Is it a success to apply public safeguards to only one death in a
thousand?
Created March 30,
2007; revised 3-31-2007; 2-1-2008; 2-28-2008