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 life of the person has come
to an end
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 cyber-sermon proposes to define and distinguish
two concepts
that initially might seem to be synonymous: mercy-killing
and merciful death.
And the same four distinctions can be used to distinguish
irrational suicide from voluntary death.
OUTLINE:
A. FOUR
DIFFERENCES BETWEEN MERCY-KILLING & MERCIFUL DEATH
1. Is the
proposed death harmful or helpful to the patient?
2. Is the proposed death
irrational or rational?
3. Is the proposed death
capricious or well-planned?
4. Is the proposed death
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
FOUR DIFFERENCES BETWEEN
MERCY-KILLING & MERCIFUL
DEATH
by James Park
A. FOUR DIFFERENCES BETWEEN MERCY-KILLING
& MERCIFUL DEATH
1. Is the proposed death 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
with some belief that the death would be good for the victim.
But when the facts come to light, 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 have cancer.
When the body is autopsied by the medical examiner,
sometimes no cancer is found.
When such mistakes are made by well-meaning spouses,
in retrospect even they probably 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 become known,
even people who were initially against a chosen death
agree that death was a better option than continuing the meaningless
suffering.
Increasingly, due to modern life-support systems,
the patient is unconscious or otherwise unable to make medical
decisions.
Then the proxies must gather all of the relevant information
and explore all the remaining medical options
before concluding that death would be the best course of action
for this person or former person.
When the facts and opinions add up to death being
the wisest course of action,
then this death should 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 decision 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 that power to decide for himself or
herself.
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. Is the proposed death 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 in the best interest of the
victim.
But when cooler heads examine all of the facts,
they decide that it was really an irrational response
to a situation that might not have been correctly understood.
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 these mistaken beliefs can lead to a mercy-killing.
However, if the proxies for someone who has ceased
to function as a full person
have examined all the medical facts and opinions,
then if they make a wise choice for death,
it should be called a "merciful death"—not a "mercy-killing".
And, of course, there should be no punishment for such a decision for
death.
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 and irrational,
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 cyber-sermon:
"Four Differences between Irrational Suicide & Voluntary Death"
http://www.tc.umn.edu/~parkx032/CY-IS-VD.html )
3.
Is the proposed death capricious or well-planned?
Usually what we later call a mercy-killing was
basically a capricious act,
taken on the spur of the moment rather than carefully planned thru.
The man who shoots his wife to end her suffering
did not share this plan
with anyone else
because he feared on some level that others would not agree with him
and would take action to prevent
him from carrying out the mercy-killing.
If he has been delayed by other people or circumstances,
he probably would have had second thoughts about killing his wife.
Good medical information could have assured him
that death today was
not the best choice.
In contrast, when the proxies are planning the death
of someone they love,
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 decide upon what will then be called a "merciful death".
The process of planing for a merciful death could take up to a year
—especially in cases of complex
diseases that could have several
possible outcomes.
Just as a person who is thinking thru 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 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
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. Is the proposed death regrettable
or admirable?
When a distraught relative has committed a
mercy-killing,
everyone who knows about this tragedy regrets that it turned out
this
way.
We wonder what we should 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 event.
However, if a mercy-killing has already taken place,
we can only stand back and let the law-enforcement authorities
do what they need to do.
On the other hand, when a merciful death is planned,
then there will no need for calling the police.
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 out the last acts to bring death,
it will be called a wise merciful death.
Again, the proxies should have the same full powers to decide
that each of us has
while we are still able to make our own 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 that is regrettable or a death that is admirable.
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 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 the 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
Now that we have 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. Living
Will and/or other Request for Death from the Patient.
2. Psychological Consultant Certifies
that the Patient was 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 Before Death is Permitted.
10. Complete Reporting of all Material Facts.
As might be obvious from these ten safeguards,
they can be used in 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 more active means of drawing life to a close might be
appropriate.
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, for
example.
Our advance directives and any other documents created by others
should still be valid
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 fulfilling these
safeguards
should be assumed to be acting in good faith,
watching out for the best interest 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 cyber-sermon:
Fifteen
Safeguards
for Life-Ending Decisions
:
http://www.tc.umn.edu/~parkx032/CY-10SG.html
This cyber-sermon 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
in that the victim was believed by the perpetrator to be dying anyway.
Thus it should be prosecuted under a new section of any homicide laws.
This new section should also include the possible crime
of prematurely disconnecting life-support systems,
another new means of killing people that our forefathers never thought
about.
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 recorded as a voluntary death if chosen by the
patient.
The death will be recorded as a merciful death if chosen by proxies for
the patient.
Each state or country will have to modify his 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
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/
Here are a few related cyber-sermons also by James
Park: