SAFEGUARD
FOR LIFE-ENDING DECISIONS
THE
PATIENT MUST BE CONSCIOUS
AND
ABLE TO ACHIEVE DEATH
Some systems for enabling a patient to
choose a
voluntary death
require the patient to be conscious until the last moment before death.
Moreover, the patient must be physically able to perform
whatever actions are necessary to bring about his or her own death.
The thinking behind this safeguard emphasizes
patient autonomy.
The patient (and no one else) is making the life-ending decision.
The patient should be allowed to change his or her mind
up until the very last moment of life.
This is one way to assure that the patient's choice
is the basis for the life-ending action.
Taking this safeguard a step further is the
requirement
that the patient be physically able to take an action to bring death:
to take a lethal drug, to push a button that starts a death-delivering
device,
to throw a switch that turns off the flow of a life-sustaining drug,
or to pull a plug on a machine that is keeping him or her alive.
The action taken by the hands of the patient (or some other voluntary
action)
will start a physical process that will cause death within a few minutes
—or
a few hours at the most.
HOW REQUIRING CONSCIOUSNESS AND ABILITY TO PERFORM
WILL DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE
DEATH
This safeguard requiring that the patient be
conscious and able
will not stop most irrational suicides,
since people who kill themselves for foolish reasons
must also remain conscious and able up until the last moment.
If they lose consciousness of if they lose the ability to pull the
trigger,
then they will not be able to commit irrational suicide.
At least, they will not be killing themselves foolishly at that time.
But if this safeguard requires others to observe the
final moment of life,
then it does have some potential of saving patients from premature
death.
The observers might notice something that was missed by the patient.
New information might suddently become relevant to the life-ending
decision.
If other people are present to the very end,
then they have some duty to prevent the patient from choosing death
if this does not appear to be the best course of action at the time.
And if the patient is required to perform a
death-dealing action,
which is clearly known to the patient to be an action that will end his
or her life,
then all who observe will have to agree that the patient
took full responsibility for his or her own death.
To the best of their ability, any observers should make sure
that no coercion or manipulation was applied
to make the patient choose death prematurely.
They will witness the offer to
change the plan for death
and to opt to live for a longer period of time.
If the patient refuses the final offer to take a different course,
then the patient will be permitted to take the action that brings death.
An extensive argument against this safeguard will
be found here:
"Do I Lose
the Right-to-Die when I Lose Consciousness?"