SAFEGUARD
FOR LIFE-ENDING DECISIONS
THE DEATH-PLANNING COORDINATOR
ORGANIZES THE SAFEGUARDS
Whenever the death-planning process involves the
creation
of more than a few written documents proving that safeguards have been
fulfilled,
some individual must take charge of organizing the paperwork.
Physicians are usually not the appropriate persons to do this
coordination.
The doctors will be in charge of their own medical records
and of fulfilling the specific safeguards for which they are
responsible.
Lawyers would not be appropriate persons to coordinate the safeguards
because they are trained to follow stereotyped pathways
and to create documents that are as similar to old documents as
possible.
Lawyers are likely to present pre-printed forms for people to sign.
Collecting signatures is not a meaningful way to make life-ending
decisions.
The death-planning coordinator should not be a public official,
since public officials are often subject to political pressure:
Advocate of one pathway toward death or another
will attempt to use public officials to support their choices.
Death-planning should never become a bureaucratic process.
Each safeguard asks for the personal or professional opinion
of someone who is close to the patient or knowledgeable about the case.
Since the primary decider for every life-ending
decision
is either the patient himself or herself or proxies appointed by the
patient,
the death-planning coordinator should work under the direction
of the patient and/or the duly-authorized proxies for the patient.
The death-planning coordinator will probably have to be private
contractor,
employed by the patient or the estate of the patient.
If the patient is using a hospice service,
then that hospice service might have developed a system of coordinators
who will do the paperwork involved in a careful death-planning process.
If the patient is being cared for in a hospital,
then some special contractor associated with the social services
department
might be hired to be the death-planning coordinator for the patient.
The primary function of the death-planning
coordinator
is to make sure that all appropriate safeguards are fulfilled.
The DPC will collect and circulate statement from the patient,
proxies,
doctors,
psychological consultant, family members, ethics committee,
clergy-persons, etc.
—everyone
who is asked to fulfill some safeguard.
And when people respond to the other written statements,
their responses should also be shared
with everyone involved in the death-planning process.
(Care should also be taken by the death-planning coordinator
to make sure that none of these documents gets into the hands
of people who have no legitimate right to know what they
contain.)
The death-planning coordinator will make sure that
all appropriate persons
receive copies of each document created in the death-planning process.
And complete records of who received what documents and when
shall also be maintained by the death-planning coordinator.
In some cases, it might be wise to ask for written acknowledgment
that certain persons have received and read the safeguard documents.
When some persons involved in the death-planning process
read the views of others, they might want to revise their own
statements.
The last revised statement from any participant
becomes the final and permanent safeguard created by that person.
This function could be performed by electronic means,
if all or most of the people who need the documents
can receive and respond to them by e-mail or some other electronic
means.
Those who do not have electronic means of communication
will have to be kept in the death-planning process by communications on
paper.
The final records can be kept either way—either
electronically or on paper—
as
long as the storage method is secure and permanent.
The death-planning coordinator will also be
responsible for proving
that the appropriate waiting
periods have been observed
between the various requests for death.
Even when there are verbal requests for death from the patient and/or
the proxies,
these are to be recorded in writing by the persons present,
who are witnessing that the requests were made appropriately
—that
is, not under any coercion, duress, or manipulation.
Of course, written requests for death signed by the patient and/or
proxies
will also contain the date on which the requests were made.
And the death-planning coordinator will issue a summary statement,
showing when all
requests for death were made.
Similarly, when other safeguards must be fulfilled
in a certain order,
the death-planning coordinator will certify that
everyone received the documents as needed
and that they responded appropriately.
This coordinating function will probably involve
reminding various participants of their responsibilities
and getting them to complete their examinations of the facts and
opinions
before they issue their own statements.
Whenever the death-planning process requires a legal
notification,
the death-planning coordinator can fulfill this process
—and
certify that it was accomplished at the time and place indicated.
The death-planning coordinator shall also be
responsible
for creating a complete and accurate summary of the whole
death-planning process.
This will be provided to all participants in the process
both in draft-form
during the death-planning process
and in final form
once the death has taken place.
If and when the death-planning record will be reviewed by an
ethics committee,
the death-planning coordinator will create
a summary of the case and
the safeguards fulfilled.
And the death-planning coordinator should be present
in the meetings of the institutional ethics committee.
In all cases where a report to the
prosecuting authority would be appropriate,
the death-planning coordinator would be the person
to make a summary of the case and the safeguards already fulfilled
to send to the law-enforcement authority
that would be responsible for prosecuting any violations of law.
For legal purposes, the death-planning coordinator
is the single person who maintains the official record
of all documents created for fulfilling the safeguards.
And after the death has taken place,
the death-planning coordinator will notify everyone involved
of the the permanent storage place for these documents.
If any legal problems arise during or after the
death-planning process,
this summary of all of the safeguards will be the first place
law-enforcement officials will look
in asking whether or not any law has been violated.
Thus the final summary should show that all relevant safeguards were
fulfilled,
which will then demonstrate that this death was a wise choice
based on all the facts and opinions gathered in the death-planning
process.
HOW THE SERVICES OF THE DEATH-PLANNING COORDINATOR
DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
The death-planning coordinator will be in the best
position
to notice anything going wrong in the death-planning process.
If the patient is really planning an irrational suicide,
this should emerge when others are asked to approve the life-ending
decision.
Because the death-planning coordinator will develop
skills and experience
in dealing with all forms of death-planning,
he or she will be able to notice any distortions of the process
that would lead to a hidden
or disguised premature death.
Step-by-step over a period of several weeks or months,
the death-planning coordinator will be asking
several different people to fulfill their
safeguards.
If anyone legitimately involved in the death-planning process
has any doubts about what is happening,
they should alert the death-planning coordinator,
who knows how to delay or
halt
the process
so that deeper investigations can be completed.
The basic purpose of all the safeguards is to
prevent premature death.
And the death-planning coordinator will be examining
how well each safeguard accomplishes this goal.
If all goes well, a wise decision will be reached.
And a meaningful death will be achieved
—at
the best time
for all concerned and by the best
means.
Created January 26,
2007; revised 3-9-2007; 8-26-2007;