PROTECTING PATIENTS FROM
BEING PUT TO DEATH
WITHOUT AUTHORIZATION
Critics of the right-to-die as practiced in the
Netherlands
often point out that a certain percentage of deaths facilitated by
doctors
are recorded as "without explicit request".
This could be interpreted to mean that Dutch doctors
are taking it upon themselves to decide
which patients should be given lethal injections
and which patients should not.
And if there are a few cases of patients in a coma
being given drugs that will cause death,
such cases should be investigated more deeply.
Perhaps some premature deaths were caused by these physicians.
If death is achieved without proper authorization,
then a crime has been committed under almost any country's law.
And where such crimes are happening,
better safeguards are needed to bring unauthorized deaths to an end.
Other countries are not required to follow the
pattern of Holland.
If there are problems created by the Dutch system,
then these can be corrected when other countries
(or any states of the United States or Australia)
create new laws concerning the
right-to-die.
However, what was most likely happening
under this category of "without explicit request"
was that patients had already discussed their desire to die
if and when there was no hope of recovery.
But the patients waited too long:
When they had already passed into a semi-conscious state
or a completely unconscious state,
they could no longer give explicit permission for their own deaths
at the exact moment of that their death were to be achieved.
Also, the family members of these patients
were probably also consulted to see if they agreed
that a peaceful death achieved by drugs given by the physician
would be better than letting nature take its (sometimes long) course.
Perhaps Dutch law does not explicitly allow such proxy decision-making,
but we can all see the value of allowing such decisions
under safeguards that make sure that no harm
is being inflicted upon the patient who will soon be dead.
Especially when the patient has given explicit prior
authorization,
there should be no barrier to the duly-authorized proxies giving their
approval
if the patient has slipped past the point
of being able to make a meaningful life-ending decision.
The worry here seems to be that some doctors or
government bureaucrats
will decide that certain patients should die.
They look at a list of patients and mark some of them for death.
This would be the most basic meaning of
'putting patients to death without authorization'.
The way to prevent such behavior is to make clear
exactly who has the authority
to make life-ending decisions.
Several safeguards for life-ending decisions
explicitly address this question of making decisions at bed-side.
A good set of safeguards would prohibit all
unauthorized decisions for death
while at the same time setting forth procedures
by which patients and/or their proxies can make wise life-ending
decisions.
PROTECTING PATIENTS FROM BEING PUT TO DEATH WITHOUT AUTHORIZATION
The following 22 safeguards make sure that the
proper decision-makers
are identified and empowered to make the life-ending decisions.
And they exclude people who should not have any power to put
strangers
to death.
These safeguards are arranged
with the most powerful and meaningful at the beginning.
These are the best ways to prevent patient from being put to death
without proper authorization.
KEEPING
GOVERNMENT OFFICIALS, THE MEDIA,
& OTHER
STRANGERS OUT OF THE LOOP
ADVANCE
DIRECTIVE FOR MEDICAL CARE
REQUESTS FOR
DEATH FROM THE PATIENT
INFORMED
CONSENT FROM THE PATIENT
UNBEARABLE
SUFFERING
UNBEARABLE
PSYCHOLOGICAL SUFFERING
THE PATIENT
MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
HOSPITAL OR
HOSPICE ENROLLMENT
STATEMENTS
WRITTEN BY HOSPITAL OR HOSPICE STAFF
MEMBERS
PALLIATIVE CARE
TRIAL
CERTIFICATION
OF TERMINAL ILLNESS OR CONDITION
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
REQUESTS FOR
DEATH FROM THE PROXIES
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING THE CHOSEN DEATH
STATEMENTS
FROM
ADVOCATES FOR
DISADVANTAGED GROUPS
IF INVITED BY
THE PATIENT AND/OR THE PROXIES
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
A
MEMBER OF THE CLERGY APPROVES OR QUESTIONS THE CHOICE FOR DEATH
RELIGIOUS OR
OTHER MORAL PRINCIPLES
APPLIED TO THIS
LIFE-ENDING DECISION
REPORT TO THE
PROSECUTOR BEFORE THE DEATH TAKES PLACE
CIVIL AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH