Most people would agree that unrelieveable
physical
suffering
would be a legitimate reason for choosing a voluntary death or a
merciful death,
but not as much agreement would apply to purely psychological suffering.
Psychological suffering would include
any torment
happening within the mind of the patient,
which does not have any physical component that can be treated.
Grief would be one form of psychological suffering.
However, normally grief is self-limiting: after a few years at the most,
the grief at the loss of a loved one has diminished enough
to allow the person who was grief-stricken to return to a more or less
normal life.
Other forms of mental suffering do not automatically
fade with time.
And sometimes no treatments prove effective
in overcoming the demons that torment some patients.
If every day is another day of fearing dangers that do not exist,
if every day is another day of harming oneself for unintelligible
reasons,
and if no amount of treatment has been able to alleviate this
suffering,
then a voluntary death or a merciful death might be the best solution.
Such a conclusion should be reached only after
the most exhaustive attempt to relieve the suffering
by every reasonable means available.
And such attempts must be well-documented before others will be
convinced
that death would be better than continued
mental suffering.
Also persons whose suffering is mainly mental or
psychological
sometimes have a questionable grasp on reality.
Part of the psychological problem might render them
incapable of making wise medical decisions.
Such capacity or incapacity should be determined by the psychological
evaluation,
which is another safeguard which should be used in close coordination
with this one.
When a patient is not able to make medical decisions
(for whatever reasons, including having a tentative grasp of reality),
then proxies should be officially appointed
to make medical decisions for that patient.
To whatever degree possible, the proxies should cooperate with the
patient,
attempting to determine the most rational wishes of the patient
while at the same time attempting to filter-out the irrational urges
that might be pushing the patient toward a harmful 'decision' for death.
Any decision for a merciful death should be taken
only by persons
whose thinking processes are beyond dispute.
For some mental patients, this will mean that the proxies
bear the legal responsibility for making any life-ending decisions.
HOW UNBEARABLE PSYCHOLOGICAL SUFFERING
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Irrational suicide is a real danger
for persons whose psychological suffering cannot be relieved.
This is why psychological experts must be consulted
before the proxies decide that a merciful death
would be better than forcing the patient to continue suffering every
day.
Proxies would have this power to decide
life-and-death
if the patient's suffering is so great
that it renders the patient unable to make wise medical decisions.
After the proxies have made all reasonable efforts
to find solutions to the patient's suffering,
and after they have documented their failures one-by-one,
then this medical record will stand as proof of their good-faith efforts
to help the patient recover from the psychological suffering.
If the proxies then decide for a merciful death,
it will not be an irrational
choice.
It will be in the best interest of the patient—a
benefit, not a harm.
It will be well-planned
in the sense that they have spent
months or years trying to find good alternatives.
And it will be a commendable
choice
because others who examine the same facts and opinions
would see the validity of the choice the proxies made.
The medical record itself would be sufficient proof
that this was not a premature death:
Given all of the facts and opinions collected
about this unbearable
psychological suffering, death now would be
better than forcing the patient to continue suffering
until death comes by some natural means.
created January 31, 2007; revised
2-9-2007; 3-15-2008; 4-3-2008