SAFEGUARD
FOR LIFE-ENDING DECISIONS
AN INSTITUTIONAL ETHICS COMMITTEE
REVIEWS THE PLANS FOR DEATH
If the patient is already in a
hospital or nursing home,
there might be an established institutional
ethics committee,
with a regular procedure for reviewing life-ending decisions.
If so, the documents already completed for the death-planning record
should be reviewed by that ethics committee.
The careful documentation should be quite impressive,
since they usually only get a recommendation from a doctor.
If the committee does not agree with the plans for death,
it should make its doubts known so they can be resolved
by collecting further facts and opinions if need.
The final report of the ethics committee
should list all documents in the death-planning process
which it has reviewed and found satisfactory.
If possible, the ethics committee should meet with
the patient and/or the proxies.
This will help the ethics committee to assess the validity
of the reasons for choosing death at this time.
And if a life-ending decision would not be wise,
the ethics committee
should say so.
If and when the committee is finally satisfied with
the life-ending
decision,
it should add its written conclusions to the death-planning record.
If there is no ethics committee in the
hospital or nursing home,
then the patient and/or the proxies should seek out
a private consultant in medical ethics.
Eventually, as the right-to-die is more widely accepted,
some consultants might specialize in life-ending decisions.
These people might be called "death-planning consultants".
And if there is no one else to gather and distribute the documents,
the death-planning consultant can take this administrative role.
[See
another safeguard called:
Death-Planning
Coordinator Organizes the Safeguards.]
Ethics committees and death-planning consultants
have given considerable thought to the medical ethics surrounding death.
While they must not impose their own values
on the real decision-makers—the patient and/or the proxies—
they can clarify issues the laypeople are facing for the first time.
These ethical consultants should not be
expected
to make any decisions
concerning the proposed death,
but they can help the decision-makers to examine all the options
and gather all the opinions relevant to the end-of-life choices.
The ethics committee or death-planning
consultant
can make sure that all of the proper safeguards have been fulfilled
and that all the documents have been gathered
and distributed to everyone who needs them.
If an institutional ethics committee has no
formal guidelines
for reviewing life-ending decisions,
it might consider adopting some modification
of the safeguards discussed on this website
to become the official policy of the institution.
And any such policies should be made known
to all potential patients and their proxies,
in case they might want to exercise their right-to-die in that
institution.
HOW REVIEW BY AN INSTITUTIONAL ETHICS COMMITTEE
OR OTHER ETHICAL
CONSULTANT
COULD DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Most people who are thinking of killing themselves
for foolish 'reasons'
will never consider asking an ethics committee to review the decision
for death.
But if some conspiracy has been hatched by doctors
and/or family members
to bring the patient's life to an end prematurely,
then an ethics committee should be able to detect
any such plot to
cause a premature death.
This ethics consultation should
not simply approve decisions already
made by others.
Rather, all of the facts and opinions gathered to support the
life-ending
decision
should be probed and questioned.
The institutional ethics committee should have clearly in mind
exactly what it means for them to prevent a premature death.
And if an ethical consultant or committee
joins in a conspiracy to cause a premature death
or approves of a life-ending decision that turns out to have been
premature,
then they should be liable to the same prosecution
and penalties
that will be used against any others who cause premature death.
Created January 23,
2007; revised 3-21-2008; 6-17-2008