SAFEGUARD
FOR LIFE-ENDING DECISIONS
SPECIFICALLY-LICENSED TERMINAL-CARE
PHYSICIAN AGREES TO PROVIDE
LIFE-ENDING CHEMICALS
(Note: This safeguard
is suggested as an alternative to the safeguard called
PHYSICIAN
AGREES TO PROVIDE LIFE-ENDING CHEMICALS .
As such, it incorporates everything from that safeguard
but adds that only a special, licensed sub-set of physicians
would be authorized to provide life-ending chemicals for the purpose of
causing
death.)
After the primary care physician has reviewed all
the medical facts and opinions,
he or she shall decide whether a voluntary death or a merciful death is
a wise course of action
given everything that has been collected in the death-planning process.
This safeguard will normally be one of the last to
be
fulfilled,
after the opinions of the patient, family, proxies, ethics committee,
etc.
have all been properly gathered and distributed
to everyone legitimately involved in the death-planning process.
This approval by the primary care physician
has not
always been recognized as a safeguards,
because it was assumed to be so central to the process
as defined in laws permitting the giving of life-ending chemicals.
But it is important for at least
one
central professional to approve the
life-ending decision.
If this safeguard is not used, the others become more important.
Exactly which chemicals should be used to achieve a
peaceful and painless death
can be decided by the professionals most centrally involved in the
life-ending decision.
But the purpose of the life-ending chemicals should be plainly stated
for all
to
understand.
Therefore, in order to avoid even subtle or subliminal misunderstanding,
the chemicals to be used to cause death
should never
be described as "medication".
Especially if there might be translation problems
for patients and families for whom English is not the first language,
the chemicals should be described as a "life-ending".
Every language has ways of discussing the end of human life.
The purpose of the life-ending chemicals must be
fully
explained
to the patient, family members, and/or the proxies.
Everyone involved in planning this death
should be made aware that the life-ending chemicals
will first render the patient
unconscious
and then cause death within
a few hours at the most.
The intent of providing and taking the life-ending chemicals
is to cause the patient to die a peaceful and painless death.
It is the responsibility of the physician who provides the life-ending
chemicals
to make sure that everyone else involved in the death-planning process
fully understands just how death will be caused by the life-ending
chemicals.
It might be helpful to give those who will observe the chosen death
some details about exactly how this death will occur.
Which bodily systems will be shut down by the life-ending chemicals?
Exactly how the life-ending chemicals will be
administered
to the patient
and who will be present for this final scene
will be decided according to what seems wisest in each case.
The physician who provides the life-ending chemicals
might be present for the
death or not.
(The following
are the new paragraphs added to this alternative safeguard:)
Not all licensed physicians will be authorized to
provide life-ending chemicals.
Only physicians with special training in terminal care,
who actually take care of patients in the last phases of their lives,
and perhaps who are involved in hospice care
will be authorized to provide life-ending chemicals
for the purpose of achieving a peaceful and painless death.
Licensed physicians who wish to have this authority
will be required to apply for a special license,
which will be provided by the same licensing authority
that licenses all physicians.
That licensing authority will establish the exact qualifications.
Or the exact qualifications could be specified in the law
that authorizes some
physicians to provide life-ending chemicals
for the purpose of achieving a peaceful and painless death.
Perhaps only 5% of all licensed physicians in any
jurisdiction
will apply for this special license to give life-ending chemicals.
This means that the other 95% of doctors
will not be associated with the practice of providing life-ending
chemicals.
Other doctors who agree that voluntary death or merciful death
is the best course of action under the circumstances
and who believe that life-ending chemicals will be the best means
will have to refer their patients to those terminal-care physicians
who are specifically licensed to provide life-ending chemicals.
This will further protect the patients
because an additional level of professional approval will be required.
Giving only certain physicians the power to provide
life-ending chemicals
will also protect all physicians from the suspicion
that they might be privately planning for the patient's death.
Physicians have been among the strongest opponents
of some proposed right-to-die laws
because they fear that their patients will no longer trust them
if the patients know that the doctors have the power to cause death.
Many medical associations have also taken official stands
against what used to be called "physician-assisted suicide"
because they say that doctors
must not kill.
Using this specific safeguard should go a long way
toward
relieving the fears of both physicians and their patients
that doctors might be involved in causing death
without the proper authorization.
Ordinary doctors would not be authorized to
provide life-ending chemicals.
They would have to discuss the possibility of voluntary death or
merciful death
with the patient and/or the proxies
before referring the patient to a terminal-care doctor
who has a specific license to provide life-ending chemicals.
Non-reporting or voluntary deaths and merciful deaths
would become less common
because the terminal-care physicians who are authorized to give
life-ending chemicals
would be the ones required to submit reports of such means of achieving
death.
And because they have asked to be licensed to provide life-ending
chemicals,
they will not worry about getting a 'bad reputation'.
All other doctors could continue to affirm
that they are only involved in those forms of medical care
that are intended to cure
the patient
or at least to ease the
passage into death without using life-ending chemicals.
HOW A DOCTOR PROVIDING LIFE-ENDING CHEMICALS
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
As said before in connection with other safeguards,
suicidal people are not likely to pursue the elaborate processes
required for a voluntary death or a merciful death.
These many safeguards were created
specifically to prevent
people from killing themselves irrationally.
But great care must be taken after the life-ending
chemicals have been obtained
that they not taken by some
other member of the household
for the purpose of committing irrational suicide.
Having a bottle of life-ending chemicals in the household
is more dangerous than having a loaded gun available.
Some suicidal people will be deterred
by the violence involved in a suicide by handgun.
But the same reluctance would not apply to taking a life-ending
chemical.
Whenever a physician provides life-ending chemicals
for
a patient,
this physician is acting as a gate-keeper.
The physician names
the patient when providing the life-ending chemicals.
If and when this patient takes the chemicals,
the resulting death will not
be premature
in the professional opinion of the physician who provides the
life-ending chemicals.
(When any death is caused by a means not under the control of the
physician,
then the physician is not as direct a participant in the death-process.)
When life-ending chemicals provided by a physician
for a
specific patient are used,
then all should know that the physician who provides the life-ending
chemicals
is taking professional responsibility for causing the resulting death.
In the professional judgment of the physician,
this death is at the best
time for the named patient.
Given all of the gathered medical facts and opinions
and all the assembled personal facts and opinions,
a voluntary death or a merciful death at this time
is the best course of action.
So the terminal-care physician provides life-ending chemicals,
which will soon bring the patient's life to a peaceful and painless
end.
(A
note on language:
These two similar safeguards have carefully and intentionally avoided
the following words:
"drugs", "medication", "prescription", & all related terms.
This is intended to avoid any confusion that might arise
because physicians are also authorized to prescribe drugs for curing
diseases, etc.
And the provided chemicals need not be obtained from a licensed
pharmacy.
Thus, the laws regarding prescriptions should not apply.
Some laws using this safeguard will continue to refer to the chemicals
as "drugs", "medication", or "prescription",
but to allow the future functioning of such laws to be more open,
such terms from the practice of medicine and pharmacy should be
avoided.)
Created September 26,
2007 (incorporating everything from the earlier safeguard referred to
at the beginning);
revised 10-3-2007;