Completed
Life or Premature Death?
The Netherlands has taken another new initiative in
the right-to-die.
There is a popular movement to allow people over 70 years of age
to choose to end their lives even if they do not meet the criteria
established in Dutch law for assistance in dying from a physician.
If Dutch citizens decide that they are tried of life
or have completed everything
they want to do with their lives,
then they should be permitted to 'check-out'
before natural death.
Under current Dutch law, the patients must be suffering unbearably
before physicians are empowered to help them to die.
And generally, this means that they must be terminally-ill.
But this new movement of older people
seeks to permit other reasons
to be acknowledged
as valid reasons for
wanting to die.
In the United Kingdom, a similar movement has begun.
They use the name: SOARS: Society for Old Age Rational Suicide.
Here is their website, with much useful information and discussion:
http://www.soars.org.uk/
However, does this new 'completed life' movement
take into account the problem of
irrational suicide?
If society approves of people ending their own lives when it suits them,
how does this differ from condoning
irrational suicide?
This on-line essay will attempt to lay out some
reasonable methods
for separating wise
end-of-life choices
from foolish decisions that
will result in premature deaths.
I began the first draft of this essay when I was in the 70th year of my
life.
And I am now old enough to qualify for this new provision of Dutch or
English law if
enacted.
And everything in this essay applies to myself.
OUTLINE:
1.
IRRATIONAL SUICIDE NEAR THE END OF LIFE
2.
TERMINAL ILLNESS SHOULD NOT BE REQUIRED FOR VOLUNTARY DEATH
3.
DOES IT MATTER HOW MY DEATH WILL BE RECORDED?
4.
WORKABLE WAYS TO SEPARATE COMPLETED
LIFE FROM PREMATURE
DEATH
A. ADVANCE
DIRECTIVE
FOR MEDICAL CARE
B. REQUESTS
FOR
DEATH FROM THE
PATIENT
N. STATEMENTS
FROM FAMILY
MEMBERS
AFFIRMING OR QUESTIONING CHOOSING DEATH
D. PHYSICIAN'S
STATEMENT
OF CONDITION AND PROGNOSIS
E. INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
C. PSYCHOLOGICAL
CONSULTANT EVALUATES THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS
G. UNBEARABLE
SUFFERING
H. UNBEARABLE
PSYCHOLOGICAL SUFFERING
O. A MEMBER
OF THE
CLERGY
APPROVES OR QUESTIONS CHOOSING DEATH
P. RELIGIOUS
OR OTHER MORAL PRINCIPLES APPLIED TO THIS
LIFE-ENDING DECISION
U. WAITING
PERIODS FOR REFLECTION
5. HOW MANY PEOPLE WILL BE INVOLVED IN THESE END-OF-LIFE
DISCUSSIONS?
6. ARE MORE SAFEGUARDS NEEDED?
Completed
Life or Premature Death?
by
James Leonard Park
1. IRRATIONAL SUICIDE
NEAR THE
END OF LIFE
When we think of people killing themselves for
foolish 'reasons',
we often think of teen-agers:
When they have deep problems, it sometimes seems to them
that the only way out is to kill
themselves.
Some pregnant girls kill themselves rather than face their parents.
Sometimes deep disappointments related to 'love'
cause teens to end their own lives before they have really begun.
Angst is often
associated with the teen years.
And sometimes it gets so bad that the victims 'choose' irrational
suicide.
But much less attention has been paid to older
people killing themselves
for reasons that might be equally questionable.
An additional problem with some
older people
is that our minds are not working as well as they once did.
We might have more
difficulty forming
thoughts
and drawing
rational
conclusions from several factors.
When our thinking process becomes deeply dysfunctional,
then other (more rational) adults must decide for us.
If we are experiencing some forms of mental decline,
then we should not be trusted to make important decisions on our
own.
This includes, of course, any choices that would draw our lives to a
close.
On the other hand, if we have good reasons to
'check-out' from life,
then we can explain our
thinking to other reasonable people.
And if our reasons are genuinely wise and compassionate,
then others who embrace the right-to-die should agree with
us.
2. TERMINAL ILLNESS
SHOULD NOT
BE REQUIRED FOR VOLUNTARY DEATH
Under many concepts of choosing the best time to die,
terminal illness is often high on the list of required
conditions.
And most people can agree that being already on the way towards
death
would be a meaningful factor to consider in all end-of-life choosing.
But careful thought shows that there are many
end-of-life conditions
that do not qualify
as 'terminal illness' which would nevertheless
qualify as good reasons
for choosing to die now
rather than die later.
Alzheimer's disease would be a prime example:
If we lose most of the capacities that made us persons,
then what is the point in keeping our bodies alive?
As more people on the Earth reach advanced age,
there will be more patients suffering from various forms of dementia.
At least if we have clearly expressed our wishes to
die
if we 'lose our minds' before natural death,
we should be granted the merciful deaths we request.
In most cases, dementia
cannot be classified as a terminal illness,
since we could live for several years in mental decline.
Another essay
explicitly addresses this question:
"Life-Ending
Decisions for Alzheimer's Patients".
What degree of
decline would justify choosing death?
Terminal illness is usually defined as having less
than 6 months to live.
Sometimes 'terminal illness' means likely to die within one year—or
more.
But, as we all know, such predictions by doctors are
always imprecise.
And only a few of the people who are now dead
ever had an official
declaration of terminal illness in their
medical records.
3. DOES IT MATTER HOW MY
DEATH
WILL BE RECORDED?
I know nothing of the Dutch language.
But every language should have separate
expressions
for what in English we call IRRATIONAL SUICIDE
distinguished from
VOLUNTARY DEATH.
And 'vital statistics' should also
separate these two phenomena.
Perhaps in Dutch the expression for "suicide" is not very negative.
But most of us who are considering wise end-of-life
medical choices
would never want "suicide" to appear on our death-certificates.
In English, "voluntary death" would be more
acceptable.
And with careful continued use,
we should be able to get the recording laws changed
to create a new category for the statistics of death:
A certain percentage of us will die by choosing
a "voluntary death".
There are more irrational suicides than voluntary
deaths.
Perhaps there are 10 or 20 irrational suicides for every voluntary
death.
These numbers might be somewhat different for people of advanced
age.
But even the elderly have more irrational suicides than voluntary
deaths.
Exactly how to draw the line between these two forms
of chosen death
is explained in the following on-line essay:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"?
http://www.tc.umn.edu/~parkx032/CY-IS-VD.html
Briefly, this essay asks four open-ended questions:
Was this death a harm
or a benefit to the
person now dead?
Was this death foolish
(irrational) or wise
(reasonable)?
Was this death capricious
or well-planned?
Was this death admirable and
commendable or tragic
and regrettable?
Since I myself intend to choose a voluntary death,
I hope that the laws of my state can be changed by that time
to allow my death to be correctly
recorded as a voluntary death.
Who wants to be lumped together with regrettable irrational suicides?
4. WORKABLE WAYS TO
SEPARATE COMPLETED
LIFE FROM PREMATURE
DEATH
What methods should we apply to resolve this
question:
When is the best time for this life to end?
The following safeguards have been selected from
the complete list of 26 recommended
safeguards for all life-ending
decisions.
And they
retain the letters used in that original list.
Each safeguard is linked to a more complete explanation on the
Internet.
Here these safeguards are listed beginning with those that are most
relevant
for separating completed life
from premature death.
These 11 practical safeguards are not just
thought-experiments.
Each will result in at least
one written document.
The patient will explain why his or her life has been completed.
Then several other people will offer their opinions.
A. ADVANCE
DIRECTIVE
FOR MEDICAL CARE
When we create our own Advance Directives for
Medical Care,
we are considering how we
will spend the last year of our
lives.
Writing comprehensive Advance Directives empowers us to explain
our settled values with respect to living and dying.
If we consider the remaining years of our lives,
when would we say that
our lives have been completed
and fulfilled?
Another on-line essay—Choosing Your Own
Pathway Towards Death—
offers 18 specific Questions to help plan the last year of our lives.
While we still have all of our mental powers,
we can describe our settled
values with respect to life and death.
We can be as explicit as we please about our own medical ethics,
including our own choices
concerning the right-to-die.
If so moved, we can even wax lyrical about
the
meanings of our lives.
What have we sought to achieve with our hours on Earth?
To what degree have we fulfilled the meanings we selected for ourselves?
And (perhaps regretfully) we can name the goals we never achieved.
Maybe no human life is ever completely fulfilled.
But we can explain in our Advance Directives
the ways we might evaluate progress toward our life-purposes.
Probably the physical limitations of our bodies
will
ultimately call a halt to our pursuit of meaning.
And in this sense, every human death will be premature:
There was always something more we might have achieved.
But when we accept the facts of our physical or mental limitations,
we might be content for our lives to end
without labeling our deaths 'premature'.
When we come to the last phase of our lives,
we might have good reasons to update
our Advance Directives,
so that we can take into account the emerging conditions
that might lead us to choose voluntary death.
There might be new medical facts to take into account.
The more recently we have reaffirmed our settled values,
the more convincing our Advance Directives will be,
especially to more distant critics who might question
the relevance of documents created years before.
Our plans for the last year of our lives can now be
put into action
—with all
appropriate modifications as required by new
circumstances.
When we are drawing our lives to a close,
it will be especially important to have the support
of the people who are closest to us at that time.
When we first created our Advance Directives for Medical Care,
we got the cooperation of our families and our proxies.
And when we create our more specific requests for death,
do the people closest to us at the end of our lives
agree with our plans
for death?
When we have mentioned specific new circumstances
that are leading us to choose a timely death,
the people closest to us can include their own evaluations
of any and all new conditions and thinking
in their statements
of understanding and support.
Statements from people who know us well would be especially important
if we are losing our mental powers toward the end of our lives.
The people who love us, will not endorse irrational
suicide.
They do not want us to harm ourselves, even if we have stopped caring.
Input from other people will help us to make our deaths
admirable and commendable
rather than tragic and
regrettable.
And if we were on the verge of
choosing a foolish death,
the people who have been closest to us
can help us to avoid harming ourselves.
Perhaps they will suggest postponing
our deaths for a few more months.
And their statements could include new conditions
that would cause them to change
their minds
about finally approving a chosen death.
Such evaluations from those who are close to us at
the end of life
will help to separate completed
life from premature
death.
B. REQUESTS
FOR
DEATH FROM THE
PATIENT
When we believe that we have completed our lives,
when we are ready
to select our date of death,
we should put our plans for death into a short written statement.
It might be helpful to list the things that
we have accomplished.
Can we describe 10 goals we have fulfilled?
If we begin with the positive achievements of our lives,
such requests for death will not seem like suicide notes.
We want to convince others that we have
completed our lives
and that our end-of-life decisions are as rational as they can be.
We might present all of the
factors that are leading us
to the
decision to choose a voluntary death now
rather than waiting for the natural processes of death to take us.
Some of our reasons for choosing death
might be medical facts.
And herein our requests for death can refer to the doctors' statements.
See Safeguards D & E below.
But many of our reasons for choosing voluntary death
will be more personal and subjective.
If the meaningful purposes of our lives have been completed,
if we can no longer pursue our basic goals,
or if no more values can be achieved,
we can explain in our own
words why we are ready to die.
N. STATEMENTS
FROM FAMILY
MEMBERS
AFFIRMING OR QUESTIONING CHOOSING DEATH
Once we have started the death-planning process,
it will be wise to begin to collect written statements from family
members
and others who know us well at the end of our lives
either supporting or questioning our proposed deaths.
When other people agree with our reasons for choosing death,
we can have our own thinking validated.
Our friends and family might even comment
on each of our
reasons for
choosing death.
If we have created a list of factors favoring
voluntary death,
our family members can give their own evaluations of each factor.
Do they agree that all of the facts add up to a completed life?
Do they agree that we can no longer pursue our life-meanings?
Or if they have valid doubts about choosing death at this
time,
their written statements would be an excellent place to raise those
questions.
Do family members believe that this death would be premature?
Perhaps they would never
approve a freely-chosen death.
If so (and if we affirm our right-to-die), such views can be
discounted.
And open-minded statements questioning the plans for death
should specify what new
developments would reverse
the recommendation.
When the patient and the family members all agree
that the proposed death would be a wise end-of-life decision,
they can all cooperate to create a dignified end for this completed
life.
D. PHYSICIAN'S
STATEMENT
OF CONDITION AND PROGNOSIS
As said at the beginning, 'completed life' is not a
medical category.
But in some cases, our physical condition will be very important
in deciding just when would be the best time to die.
The written statement of our primary-care physician
should explain as completely as possible
our physical condition and its likely next stages.
If we have a progressive disease or some degenerating condition,
then that can be explained by the doctor in charge of our care.
Does our physical or mental condition and prognosis
explain why we can no longer pursue our life-meanings?
But if our basic reasons for choosing a voluntary
death
are personal rather
than medical,
then the doctor has no veto
power over our choice.
Our doctors are our medical
advisors, not the
dictators of our lives.
E. INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
Especially when medical fact are a major reason for
choosing death,
it might be wise to obtain a second written medical opinion.
This will either confirm the first doctor's professional opinion
or mention new factors or options beyond the first doctor's
statement.
We should always have a clear grasp of the medical facts
before we proceed with our plans for death.
C. PSYCHOLOGICAL
CONSULTANT EVALUATES THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS
Especially if our mental powers might decline toward
the end of our lives,
it would be a wise precaution to consult with a
psychological professional.
At least a statement from this additional professional
should reassure more distant doubters that this death was wisely chosen
—that
it was not the result of distorted thinking or family pressure.
A therapist can help us review our reasons for
choosing death.
How valid is our conclusion that we have completed our lives?
Would the psychological professional regard this death as premature?
If we ourselves can no longer make our own
life-ending decisions,
perhaps this psychological professional can evaluate our prior
thinking
that led to this decision to die
now rather than die
later.
And this professional consultant can support the proxies
as they carry forward the plans-for-death decided earlier.
G. UNBEARABLE
SUFFERING
Deciding that our lives have come to a good
stopping-place
does not necessarily mean that we are suffering at the end of our
lives.
But if there is any suffering involved,
we can strengthen our case for choosing death
if we explain in our own words
exactly what kinds of suffering we are experiencing.
We alone are responsible for evaluating our degree of suffering.
But some medical testimony might also be useful here.
If the future holds for us only more suffering,
that might be a good reason to decide that meaningful life is over.
H. UNBEARABLE
PSYCHOLOGICAL SUFFERING
And if our suffering has components beyond medical
measurement,
this would also be very relevant for choosing the best time to die.
Perhaps several attempts at healing have brought no relief.
If so, then voluntary death might be the best choice.
We should explain our inward suffering as fully as we can.
But even if we have not completed our lives
according to
our own criteria,
psychological suffering could tip the balance toward choosing death.
O. A MEMBER
OF THE
CLERGY
APPROVES OR QUESTIONS CHOOSING DEATH
If we have any religious connections at the end of
our lives,
we might find it wise to consult with our religious advisors
concerning the best time to die.
(Some religious leaders will
automatically say: Live as long as
possible.
Such advice would be useless for making any life-ending decisions.)
Enlightened leaders of liberal religions will be able to separate
foolish plans for irrational
suicide from wise
plans for voluntary death.
And most
religious/ethical leaders should be able to separate
completed
lives from premature
deaths.
P. RELIGIOUS
OR OTHER MORAL PRINCIPLES APPLIED TO THIS
LIFE-ENDING DECISION
And if the specifics of any proposed death call for
deeper analysis,
then some religious or ethical authorities might be called upon
to apply their established moral principles to the situation at
hand.
Once again, religious leaders and written moral principles
have no veto power
over our end-of-life decisions,
but such additional principles should help our
deliberations.
U. WAITING
PERIODS FOR REFLECTION
It is always wise to allow plenty of time for
discussion and re-thinking.
Some new facts or opinions might come to light.
When we are asking if our lives are now complete,
a few more weeks of thinking might help us see new possibilities.
If we had rushed ahead when we first thought about voluntary death,
we might have chosen death prematurely.
Waiting periods to review past thinking
are more likely to benefit
everyone involved than to harm
anyone.
5. HOW MANY
PEOPLE WILL BE INVOLVED IN THESE END-OF-LIFE DISCUSSIONS?
Beyond the patient himself or herself,
fulfilling these 11 safeguards will mean collecting the opinions
of at least 7 additional people.
Others will have no veto
power over the final life-ending
decision,
but having consulted them will support the claim
that this was really a
completed
life rather than a
premature
death.
Several neutral observers examined the same facts and opinions
and came to the same conclusion:
For this person, death now
would be better than death
later.
6. ARE OTHER
SAFEGUARDS NEEDED?
If these 11 safeguards do not seem sufficient
to separate completed life
from premature death,
then there are several others included in the complete list of
recommended safeguards for life-ending decisions:
http://www.tc.umn.edu/~parkx032/SG-A-Z.html.
AUTHOR:
James Leonard Park is a long-time advocate of the
right-to-die.
But in his view, this fundamental right should be tempered with
wise and careful safeguards to help decide the best time to die.
Much more will be discovered about him on his
website:
An Existential Philosopher's Museum:
http://www.tc.umn.edu/~parkx032/
This exploritorium now has more than 1,000 rooms.
The most relevant rooms open from the Right-to-Die Portal:
http://www.tc.umn.edu/~parkx032/P-RTD.html
Here are
several related essays by James Park:
Choosing Your Date of Death:
How to Achieve a Timely Death
—Not too Soon,
Not too Late
The
One-Month-Less Club:
Live Well Now, Omit the Last Month .
One Million
Chosen Deaths per Year?
Taking Death in
Stride: Practical Planning .
Will this Death
be an "Irrational Suicide" or a "Voluntary Death"?
.
Will this Death
be a "Mercy-Killing" or a "Merciful Death"? .
Four Legal
Methods of Choosing Death .
The
Number of People Reviewing a Life-Ending Decisions
Using the 26 Recommended Safeguards .
Pulling
the Plug:
A Paradigm for Life-Ending Decisions .
Voluntary
Death
by Dehydration:
Why Giving Up
Water is Better than other Means of Voluntary Death .
Voluntary
Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice .
God Will Decide
When Life Will End:
We Should Not 'Play God'
Created
June 2, 2010; Revised 6-3-2010; 6-4-2010; 8-5-2010; 8-22-2010;
12-1-2010; 11-16-2011;
1-7-2012; 1-10-2012; 2-9-2012; 2-24-2012; 3-17-2012; 7-8-2012;
8-26-2012; 3-29-2013; 5-5-2013