NINE
CHARACTERISTICS
OF
GOOD SAFEGUARDS
FOR LIFE-ENDING DECISIONS
drafted
9-29-2006 by James Park,
revised 9-30-2006, posted on the Internet 10-2006
revised 10-11-2006, 11-24-2006, 1-3-2007; 2-24-2007; 5-3-2007; 8-22-2007
1. The safeguard must be simple,
clear, & straight-forward.
The best safeguards will be easy to grasp even from
the name of
the safeguard.
There will be no hidden or technical procedures easily concealed in the
details.
Laypersons must be able to understand and apply the safeguard.
2. The safeguard must be possible
to fulfill with a few hours of work.
When laypersons read thru a list of safeguards for
life-ending
decisions,
they must not first experience an urge to avoid the safeguards
because they take too much time.
For example, a safeguard that calls for a second
professional
opinion
should allow all reasonable time for the second doctor
to review the medical record and to examine the patient.
A long series of committees reviewing lengthy
documents
would not be a
reasonable safeguard.
Opponents of the right-to-die will propose 'safeguards'
that are really intended to delay each death for as long as
possible.
3. The safeguard must be open to
reasonable exceptions.
Sometimes a particular safeguard will not be
applicable
because of some special circumstance.
For example, it is impossible to get a statement from someone in a coma.
And if the safeguard asks for a statement from the patient,
the record can simply show that this was not possible
because the patient has been in a coma or in a persistent vegetative
state
for a specific length of time and is not expected to awaken enough
to make a valid statement of medical preferences.
When a particular safeguard does not apply,
it is sufficient to explain briefly why it cannot be fulfilled.
The other safeguards become more important
when one or two safeguards
cannot be fulfilled because of special circumstances.
4. The safeguard does not require
excessive paperwork.
One page of documentation should be enough to prove
that a particular safeguard has been fulfilled.
Multiplying pages of documents
would probably not improve the
death-planning process.
And when too much paperwork is required,
people tend to take short-cuts to avoid
the extra (and they believe
unnecessary) work.
5. The safeguard must seem
reasonable and workable on first exposure.
When laypersons read a safeguard, they should be
able to say:
"Yes, I can fulfill that safeguard."
"Yes, that does seem a reasonable way to prevent mistakes and abuses."
Unreasonable
safeguards will immediately arouse
opposition:
"How can we get around this safeguard?"
"This safeguard should not apply to us because we are good people."
Unworkable
safeguards will arouse the following
responses:
"This requirement would take many more hours than we can devote right
now."
"This 'safeguard' is merely intended to prevent us from claiming the
right-to-die."
"We would have to hire a lawyer to fulfill this safeguard."
6. The safeguard has real
potential to prevent premature death.
Some unwise decisions that would result in premature
death
will be prevented when
patients and/or proxies proceed to fulfill this
safeguard.
Whenever a 'right-to-die' is affirmed,
there are possibilities for mistakes and abuses to take
place
under any new system of certifying voluntary deaths or merciful deaths.
For example, a second professional opinion
should contain the real
possibility that the second doctor
will discover some facts or present some opinions
that will reverse the
original decision to seek a short-cut toward
death.
If those who originally proposed an early death
were acting primarily from their own greed
or from a desire to be relieved of the burden of caring for the dying
person,
then one or two of the safeguards should have the potential
of discovering such an abuse of the right-to-die.
If the 'right-to-die' has become the 'duty-to-die',
will this safeguard uncover that distortion?
For example, when a clergy-person speaks privately
with the patient,
that patient might say that he or she does not really want to die
but is feeling pressure from the family to shorten the process of dying.
If the patient is not entirely free in making the life-ending decision,
then some safeguards should be designed
to discover such coercion
and
manipulation.
When put into practice,
will this safeguard save
some people from premature death?
7. Safeguards should take into
account the reasonable fears of special
groups of people,
such as racial or ethnic
minorities and people with
disabilities.
On first reading, at least one safeguard should
address the fears
of special groups.
For example, disabled persons should be able to request that their cases
be reviewed and approved by some individual or group
that is well aware of the special concerns of patients with
disabilities.
It would be unreasonable to propose a safeguard
that would prevent any disabled person from choosing the right-to-die.
Likewise, it would be unreasonable to propose a
safeguard
that prevented any persons of color from asserting the right-to-die.
Careful safeguards can prevent even the appearance
of bias against
any group
while still permitting individuals of all sorts and descriptions
wisely to choose their best pathways toward death.
8. Safeguards should make serious
efforts to prevent irrational suicide.
Advocates of the right-to-die do not generally favor
irrational
suicide.
Therefore, safeguards should be proposed that genuinely and easily
separate those people who
are planning an irrational suicide
from those people who have
wise reasons for choosing a voluntary death.
Some suicidal people will try to use the
right-to-die philosophy
and language
as a way of disguising their irrational wish to die.
In fact, there are many more irrational
suicides than there are
voluntary deaths.
What are the most straight-forward safeguards
that will immediately say to all who read them
that these safeguards would discourage their teen-agers
from killing themselves for
any foolish 'reasons'?
To separate irrational suicide from voluntary death,
see:
"Four
Differences between Irrational Suicide and Voluntary Death".
9. Some safeguards could be
offered as optional rather than mandatory.
When state laws requires certain safeguards to be
fulfilled
before a voluntary death or a merciful death will be certified,
the same law could also suggest some additional safeguards
that might be fulfilled if the people who are planning the death
decide that they want to create even more complete proof
showing that death now
is better than death later.
For example, a family preparing for a
voluntary death
might take it upon themselves to create a recording
of the patient explaining in his or her own words
just why he or she is choosing death at this time.
This could be either an audio-recording or a video-recording.
And the whole family might be included,
since that will show more convincingly than anything else
that everyone involved fully understood what is being proposed
and that they agree with the plan for a timely death
—death now
rather than death later.
Another example might be the suggestion of having a
member of the clergy
review the request for death and the recommendations of others.
If the patient and/or the family have no strong religious connections,
this safeguard could be omitted.
Bringing in religious views that are actually irrelevant to this patient
would only unnecessarily complicate the the
death-planning process.
In all secular countries of the world,
the views of religious authorities are optional.
The patient and/or the proxies should decide how deeply to seek
religious opinions.
Additional characteristics of good safeguards
can be added to this list at any time.
Send your suggestions to the webmaster:
James Park: e-mail: PARKx032@TC.UMN.EDU.