Will this Death be
a
"Mercy-Killing"
or a
"Merciful Death"?

original title:
 FOUR DIFFERENCES BETWEEN
MERCY-KILLING & MERCIFUL DEATH

SYNOPSIS:


    The advent of medical technology that can keep a body 'alive'
for months or even years
after the person is no longer there
necessitates some new thinking and new terminology
for the process of deciding to end the life of another individual
who can no longer decide for himself or herself
and who might now have become a
former person.

    This essay proposes to define and distinguish two concepts
that might seem to be synonymous:
mercy-killing and merciful death.
The same four distinctions can be used to distinguish
irrational suicide from voluntary death.

OUTLINE:

A.  SEPARATING
MERCY-KILLING FROM MERCIFUL DEATH

1.  Will this death be harmful or helpful to the patient?

2.  Will this death be irrational or rational?

3.  Will this death be capricious or well-planned?

4.  Will this death be regrettable or admirable?

B.  PRACTICAL WAYS TO SEPARATE MERCY-KILLING FROM MERCIFUL DEATH

C.  MERCY-KILLING SHOULD REMAIN A CRIME;
     
MERCIFUL DEATH SHOULD BE PERMITTED AND SUPPORTED




Will this Death be
a "Mercy-Killing"
or a "Merciful Death"?


by James Leonard Park


A.  SEPARATING MERCY-KILLING FROM MERCIFUL DEATH

1.  Will this death be harmful or helpful to the patient?


    Mercy-killing is a well-known phenomenon in almost every culture.
It happens when someone causes death in another individual
based on the belief that death would be
good for the victim.
But when the facts come to light, almost everyone agrees
that death was
not the best option under those circumstances.

    For example, spouses sometimes kill their loved ones
under what turns out to be the false belief that they had cancer.
When the body was autopsied by the medical examiner,
sometimes no cancer was found.
When such mistakes are made by well-meaning spouses,
in retrospect even they agree that the death was a
harm to the victim.
Such cases are correctly called "mercy-killings".

    On the other hand, there are situations in which the patient
really was suffering an incurable and painful disease.
And when all the facts became known,
even people who were initially against a chosen death
agreed that death was a better option than meaningless suffering.

    Increasingly, due to modern life-support systems,
the patient is unconscious or otherwise unable to make medical decisions.
Then the proxies must collect all of the relevant information
and explore all the remaining medical options,
possibly concluding that death would be the best course of action
for this person or former person.

    When the facts and opinions point to death as the best choice,
then this death might be called a "merciful death".
This is parallel to a
voluntary death
which could have been chosen by the patient himself or herself
if he or she was still able to make medical decisions.
And often the proxies will have asked themselves:
What would this individual have chosen
if he or she knew everything that we know?
If the patient would have chosen a voluntary death,
then the proxies are justified in calling it a
merciful death
when
they must make the life-ending decisions for the patient.

    Laws should be re-written wherever necessary
so that proxies do in fact have the same powers to choose death
for a patient who has now lost decision-making capacity.
None of us should lose the right-to-die
merely because we can no longer authorize
the necessary actions (or withholding-of-actions) ourselves.





2.  Will this death be irrational or rational?

    When other people examine a mercy-killing after the death has occurred,
they determine that the reasons for death were insufficient.
The person who committed the mercy-killing
probably believed at the time that it was best for the victim.
But when cooler heads examine all of the facts,
they decide that it was really an irrational response
to a situation that was perhaps misunderstood.

    Often the relative of someone who is suffering
has a limited understanding of medical matters.
This can lead to false ideas about what is likely to happen.
And such mistaken beliefs can lead to a mercy-killing.

    However, if the duly-appointed proxies
for someone who has ceased to function as a full person
have examined all the medical facts and recommendations,
then if they make a wise choice for death,
it might be called a "merciful death"
not a "mercy-killing".
And there should be no punishment for that life-ending decision.
Just as the patient could have reached the same conclusion
if he or she were still able to weigh medical facts and opinions
and reach a wise decision about how to proceed,
so the proxies for the patient have thought long and hard
about all the possible courses of action
and have reluctantly decided that
death is the best option.

    There can always be disagreements about just what is rational,
but at least the
principle can be applied to each specific situation.
When the patient can no longer decide,
what is the wisest course of action for the proxies to take?
If the patient makes a foolish choice for death,
that is called "committing irrational suicide".
If someone else make a foolish choice for death, that is called "mercy-killing".  

  
  This is the same irrational/rational distinction
that separates
irrational suicide from voluntary death.
(See the companion on-line essay:
Will this Death be an "Irrational Suicide" or a "Voluntary Death"?
http://www.tc.umn.edu/~parkx032/CY-IS-VD.html )





3.  Will this death be capricious or well-planned?

    Usually what we later call a mercy-killing was basically a capricious act,
taken on the spur of the moment, not carefully planned and organized.
The man who wants to shoot his wife to end her suffering
does not share this plan with anyone else
because he fears on some level that others
will not agree with him
and will take action to
prevent him from shooting his wife.
And if he is delayed by other people or circumstances,
he probably will have had second thoughts about killing his wife.
Good medical information might have assured him
that
death today is not the wisest course of action.

    In contrast, when the proxies are planning the death of their patient,
they will complete an exhaustive search for the
best medical treatments
before they conclude that
no cure is possible.
They might consult a variety of medical people
before they move toward a "merciful death".
The process of planing for a merciful death
could take up to one year
especially in cases of complex diseases with several possible outcomes.

    Just as a person who is considering his or her own medical care
will pursue all meaningful options before deciding to accept death,
so the proxies for someone who has lost decision-making capacity
will analyze all the facts and collect all relevant medical opinions
before possibly deciding that death is the best option available.
And as each of us retains the power to choose a voluntary death
while we still have all our wits about us,
so our proxies should be duly authorized
to choose death for us
after we have lost consciousness permanently
or otherwise become unable to make medical decisions.
As a
voluntary death can be well planned by the patient,
so a
merciful death can be well planned by the proxies for the patient.




4.  Will this death be
regrettable or admirable?


    When a distraught relative has committed a mercy-killing,
everyone who knows about this tragedy
regrets that result.
We wonder what we could have done to prevent this needless death.
And some premature deaths
have been prevented
when others learned of a foolish plan to commit mercy-killing.

    These evaluations often must be made after the death has occurred.
But if we know of any plans to kill a vulnerable person,
we can take the necessary steps to prevent such a regrettable crime.
However, if a mercy-killing has already taken place,
we should let the justice system examine the case.

    On the other hand, when a
merciful death is planned,
no crime will be committed and the justice system will not become involved.
It is a wise and admirable plan to draw this life to a close
at the best time
not too soon and not too late.
If the patient had been able to participate in the decision for death,
he or she would have agreed that death is the wisest course.
Then if others must carry forward the plans for death,
it will be called a wise, merciful death.
Again, the proxies should have the same full powers to decide
as held by a patient with full capacity to make medical decisions.




    Law and medical practice will have to change in some degree
to make this distinction between
mercy-killing and merciful death
effective in the real world.
But the basic tests can be understood by anyone
who knows the differences between:
(1) harming or helping;
(2) being irrational or rational;
(3) acting capriciously or cautiously; &
(4) a death we regret or a death we admire.

    Mercy-killings will still take place.
And they will have to be dealt with by law enforcement:
the police, the prosecutors, the courts, & the prisons.
But the
new concept of merciful death can be put into practice
under the supervision of the medical profession.
They can recommend a life-ending decision to the proxies
when the facts of the case suggest
that death is the best choice for this patient.
Often the death will come about
as the result of disconnecting life-support systems,
which has long been recognized
as a valid and reasonable way to draw life to a close.
When other methods are needed to shorten the process of dying,
these measures can be called "merciful death".




B.  PRACTICAL WAYS TO SEPARATE MERCY-KILLING FROM MERCIFUL DEATH


    Having outlined the philosophical and psychological differences
between the familiar phenomenon of
mercy-killing
and the less common practice of
merciful death,
we can ask for some
practical methods by which to separate these two.

    Here are ten definite steps that anyone can take
which will help to tell whether a proposed death
would be a
mercy-killing or a merciful death:

1.  Advance Directive and/or Requests for Death from the Patient.   

2.  Psychological Consultant Certifies that the Patient is Competent to Decide.

3.  Doctor's Summary of Condition and Prognosis.

4.  Independent Doctor Confirms the Condition and Prognosis.

5.  Significant Others Agree with the Life-Ending Decision.

6.  Member of the Clergy Approves the Life-Ending Decision.

7.  Ethics Committee Reviews the Life-Ending Decision.

8.  Criminal and Civil Penalties for Causing Premature Death.

9.  Waiting Periods for Reflection.

10.  Complete Reporting of all Material Facts.

    As might be obvious from these ten safeguards,
they can be used for all forms of life-ending decisions:
(1) while the patient is still capable of making the decision,
(2) after the decision-making power has passed to the proxies,
(3) in either case when considering withdrawing life-support systems, &
(4) when considering more active means of drawing life to a close.

    In cases of proposed merciful death,
the prior record of choices when the patient was still capable
of making decisions should still be honored.
We should not lose our right-to-die when we become unconscious.
Our advance directives and any other documents created by others
should still have legal and ethical force
unless there is some substantial change in the patient's condition
that would render the prior decisions invalid or irrelevant.

    Anyone who goes to the trouble of fulfilling these safeguards
should be assumed to be acting in good faith,
watching out for the best interests of the patient.
For example, someone who has an urge to commit a mercy-killing
is not going to consult the ethics committee of the hospital.
Proxies who
do ask for input from others
about the wisdom of
death now rather than death later
are much more likely to be planning
what will be called (after the fact) a
merciful death.

  
  The safeguards named above (and a few others)
are explained in further detail in another on-line essay:
Fifteen Safeguards for Life-Ending Decisions :
http://www.tc.umn.edu/~parkx032/CY-10SG.html

This essay is linked to an even more comprehensive list of safeguards.




C.  MERCY-KILLING SHOULD REMAIN A CRIME;
     
MERCIFUL DEATH SHOULD BE PERMITTED AND SUPPORTED


    Mercy-killing is different from other forms of murder
because the perpetrator believed the victim was already dying.
Thus it should be prosecuted as a
new form of homicide.
This new law should also include the possible crime
of prematurely disconnecting life-support systems
another means of killing people that our forefathers never imagined.

    Here is a draft of such a law, called Causing Premature Death:
http://www.tc.umn.edu/~parkx032/PREM-DTH.html
This draft embodies 26 safeguards.
If substantially all of the safeguards are fulfilled, no crime was committed.
And the death will be a
voluntary death if chosen by the patient.
The death will be a
merciful death if chosen by proxies for the patient.

    Each state or country will have to modify its own homicide laws.
But looking ahead by 100 years,
we can be confident that such changes will be common
and that
irrational mercy-killings will continue to be prosecuted
whereas
wise merciful deaths will be permitted and supported.



Created October 30, 2005; revised several times, including: 11-13-2008; 6-5-2009;
3-2-2010; 6-10-2011; 11-4-2011; 12-31-2011; 1-22-2012; 2-1-2012; 2-22-2012; 3-30-2012; 7-11-2012; 9-13-2012; 10-17-2012;
 5-4-2013; 6-25-2013; 7-18-2014;11-16-2014;



 AUTHOR:

    James Park is an independent existential philosopher
with deep interest in medical ethics,
especially the many issues surrounding the end of life.
Medical Ethics and Death are two of the seven doors
to his website called "An Existential Philosopher's Museum":
http://www.tc.umn.edu/~parkx032/

   
The above four ways to separate mercy-killing from merciful death
is also Chapter 20 of How to Die: Safeguards for Life-Ending Decisions:
Will this Death be a "Mercy-Killing" or a "Merciful Death"?

    If you find this line of thinking useful,
you might want to read the whole book and help make it better.
A Facebook Seminar is now reading and discussing this book
one chapter or safeguard per week
and make suggestions for improving How to Die.
  
    See the complete description for this seminar:
http://www.tc.umn.edu/~parkx032/ED-HTD.html

    Join our Facebook Group called:
Safeguards for Life-Ending Decisions:
http://www.facebook.com/home.php#!/groups/107513822718270/



    Here is the summary of Part Two of
How to Die: Safeguards for Life-Ending Decisions.
Clicking the chapter numbers will take you to each chapter on the Internet.

Summary of Part Two

Careful Use of Language will Advance the Right-to-Die


    Advocates of the right-to-die have developed a set of conventional terms
they use in discussing the end-of-life options with one another.
But for historical reasons that are not obvious,
most of the traditional terms have developed very negative connotations.

    Thus, it is time for a deep revision
of the language used by supporters of the right-to-die.
What advantage would be achieved by continuing to use
"suicide" and "euthanasia" when we want to convince people in the middle
to support wise end-of-life medical choices?

    Each chapter in this section addresses one term, suggesting alternatives:

    15. Instead of referring to "assisted suicide" and "committing suicide",
we could speak of "physician-assisted dying", "voluntary death",
"aid in dying", or "managed dying".

    16. Instead of the traditional term "euthanasia",
we could refer to "gentle death", "good death", "chosen death", etc.
Then opponents would tie themselves in knots
when they say that they oppose all forms of good death or gentle death.

    17. "Hastening death" has not been much examined as a term of art.
But we really do not advocate exiting from life as soon as possible.
Rather, we want to choose reasonable and "timely" deaths.
We seek the best time for death to come, not too soon and not too late.

    18. Probably because the first law used this expression,
"medication" has been the word for gentle poison
to be taken to achieve a painless and peaceful death.
What about calling them "life-ending chemicals"?
It would probably be better if we avoided any possible confusion
with drugs used for treating disease or alleviating symptoms.

    19. The right-to-die movement should never be confused with a suicide cult.
At every opportunity, we should say that we do not advocate
people foolishly throwing their lives away.
With careful and consistent use, we might be able to establish
"voluntary death" by clearly distinguishing it from "irrational suicide".

    20. Likewise, we should no longer seem to advocate "mercy-killing".
Rather, would it be possible to define and describe "merciful death"
as an end-of-life choice that is helpful, rational, well-planned, & admirable?




    Here are a few related on-line essays also by James Park:

Losing the Marks of Personhood:
Discussing Degrees of Mental Decline
.

Advance Directives for Medical Care:
24 Important Questions to Answer
.

Fifteen Safeguards for Life-Ending Decisions .

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 .

Pulling the Plug:
A Paradigm for Life-Ending Decisions
.

VDD:
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
.

Depressed?
Don't Kill Yourself! .



FURTHER READING:

Best Books on Voluntary Death

Best Books on Preparing for Death

Books on Terminal Care

Books on Helping Patients to Die

Books on the Right-to-Die

Books Opposing the Right-to-Die




Go to the Right-to-Die Portal.


Return to the DEATH page.


Go to the Medical Ethics index page.


Go to other secular sermons by James Park,
organized into 10 subject-areas.


Return to the beginning of this website:
An Existential Philosopher's Museum .




 

 






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