How to Die:
Safeguards for Life-Ending Decisions

by James Leonard Park

TABLE OF CONTENTS
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Introduction: Suicide Prevention and the Right-to-Die


PART ONE:  PERMITTING CHOSEN DEATH:
                            WORRIES, PROBLEMS, ABUSES & MISTAKES

Chapter 1  Protecting Patients from Greedy Relatives

Chapter 2  Protecting Patients from Family Pressure to Die

Chapter 3  Protecting Patients from Health-Care Administrators Who Must Save Money

Chapter 4  Protecting Vulnerable Patients from Discrimination

Chapter 5  Certain Lives Are Worthless

Chapter 6  Protecting Patients from Being Put to Death Without Authorization

Chapter 7  If We Permit Helpful Deaths, Harmful Deaths Will Follow:
                     That Slope is Too Slippery

Chapter 8  Preventing Mercy-Killing   

Chapter 9  Suicide Is a Sin and other Religious Objections

Chapter 10  God Will Decide When Life Will End: We Should Not 'Play God'

Chapter 11  Controlling Free-Lance 'Angels of Death'

Chapter 12  Preserving Good Doctor-Patient Relations: Will My Doctor Decide to Kill Me?

Chapter 13  Preventing Doctors from Misusing
                       their Prescribing-Power to Cause Premature Death

Chapter 14  Discouraging Teen-agers from Killing Themselves



PART TWO:  DEFINING TERMS FOR THE RIGHT-TO-DIE

Chapter 15  Would We Ask our Doctors to Help us "Commit Suicide"?

Chapter 16  Could "Gentle Death" Replace "Euthanasia"?

Chapter 17  Could "Timely Death" Replace "Hastened Death"?

Chapter 18  Are You Handing me "Medication" or "Gentle Poison"?

Chapter 19  Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Chapter 20  Will this Death be a "Mercy-Killing" or a "Merciful Death"?



PART THREE:  26 RECOMMENDED SAFEGUARDS FOR LIFE-ENDING DECISIONS

Chapter 21  Nine Characteristics of Good Safeguards for Life-Ending Decisions

Chapter 22  Open Safeguards Kept Private:
                       End-of-Life Medical Decisions Should Never Become Public Information

Chapter 23  Keeping Government Officials, the Media, & other Strangers Out of the Loop

Chapter 24  Family Use of Safeguards for Life-Ending Decisions

SAFEGUARD A  Advance Directive for Medical Care

SAFEGUARD B  Requests for Death from the Patient

SAFEGUARD C  Psychological Consultant Evaluates the Patient's Ability to Make Medical Decisions

SAFEGUARD D  Physician's Statement of Condition and Prognosis

SAFEGUARD E  Independent Physician Reviews the Condition and Prognosis

SAFEGUARD F  Certification of Terminal Illness or Incurable Condition

SAFEGUARD G  Unbearable Suffering

SAFEGUARD H  Unbearable Psychological Suffering

SAFEGUARD  I   Palliative Care Trial

SAFEGUARD J  Informed Consent from the Patient

SAFEGUARD K  Requests for Death from the Proxies

SAFEGUARD L  Enrollment in a Hospital or Hospice

SAFEGUARD M  Statements from Hospital or Hospice Staff Members

SAFEGUARD N  Statements from Family Members Affirming or Questioning Choosing Death 

SAFEGUARD O  A Member of the Clergy Approves or Questions Choosing Death 

SAFEGUARD P  Religious or other Moral Principles Applied to this Life-Ending Decision

SAFEGUARD Q  An Institutional Ethics Committee Reviews the Plans for Death

SAFEGUARD R  Statements from Advocates for Disadvantaged Groups
                                If Invited by the Patient and/or the Proxies

SAFEGUARD S  Report to the Prosecutor Before the Death Takes Place

SAFEGUARD T  Civil and Criminal Penalties for Causing Premature Death

SAFEGUARD U  Waiting Periods For Reflection

SAFEGUARD V  Opportunities for the Patient to Rescind or Postpone the Life-Ending Decision
  
SAFEGUARD W  Physicians Review the Complete Death-Planning Records

SAFEGUARD X  Complete Recording and Sharing of All Material Facts and Opinions

SAFEGUARD Y  The Patient Must Be Conscious and Able to Achieve Death

SAFEGUARD Z  The Death-Planning Coordinator Organizes the Safeguards

SAFEGUARD AA   Information about Palliative Care and other Alternatives to Death

SAFEGUARD BB   Notify Family of Life-Ending Decision

SAFEGUARD CC   Family Members Discuss the Level of Personhood in the Patient

SAFEGUARD DD  The Patient Must be an Adult Resident of the State

SAFEGUARD EE  Physician Agrees to Provide Life-Ending Chemicals

SAFEGUARD FF  Specifically-Licensed Terminal-Care Physician
                                  Agrees to Provide Life-Ending Chemicals

Chapter 25  The Number of People Reviewing a Life-Ending Decision
                       Using the 26 Recommended Safeguards

Chapter 26  Safeguards Embraced by Critics of the Right-to-Die

Chapter 27  Safeguards Embraced by the Right-to-Die Movement



PART FOUR: PLANNING OUR OWN DEATHS

Chapter 28   Advance Directives for Medical Care:
                        24 Important Questions to Answer

Chapter 29  One Million Chosen Deaths per Year?

Chapter 30  The One-Month-Less Club:
                       Live Well Now, Omit the Last Month
 
Chapter 31  Choosing Your Date of Death:
                       How to Achieve a Timely Death—Not Too Soon, Not Too Late

Chapter 32  Four Legal Methods of Choosing Death

Chapter 33  Choosing Your Own Pathway Towards Death

Chapter 34  Taking Death in Stride: Practical Planning

Chapter 35  Completed Life or Premature Death?

Chapter 36  Do I Lose the Right-to-Die when I Lose Consciousness?

Chapter 37  Voluntary Death by Dehydration:
                       Why Giving Up Water is Better than other Means of Voluntary Death

Chapter 38  Voluntary Death by Dehydration:
                       Safeguards to Make Sure it is a Wise Choice



PART FIVE: DECIDING DEATH FOR OTHERS

Chapter 39  Seeking Better Cooperation between the Hospice Movement and the Right-to-Die Movement

Chapter 40  Methods of Choosing Death in a Right-to-Die Hospice

Chapter 41  Safeguards for Making Life-Ending Decisions in a Right-to-Die Hospice

Chapter 42  Good Death Hospice: Creating the First Right-to-Die Hospice

Chapter 43  Pulling the Plug: A Paradigm for Life-Ending Decisions

Chapter 44  Losing the Marks of Personhood:
                       Discussing Degrees of Mental Decline

Chapter 45  Life-Ending Decisions for Alzheimer's Patients



PART SIX: CHANGING LAWS CONCERNING THE RIGHT-TO-DIE

Chapter 46  Two Approaches to Right-to-Die Laws:
                       Granting Permission or Banning Harms

Chapter 47  Interpreting Laws Against 'Assisting Suicide'

Chapter 48  Enlightened Prosecutors Can Lead the Way
                       toward Better End-of-Life Decision-Making

Chapter 49  A New Way to Secure the Right-to-Die:
                       Laws Against Causing Premature Death

Chapter 50  Causing Premature Death:
                       Draft of Legislation to Replace Laws Against 'Assisting Suicide'

Chapter 51  Advantages of the Premature-Death Approach to the Right-to-Die

A.  Applies to All Life-Ending Decisions,
      Not Just those Cases that Choose to be Covered by the Law.

B.  Creates Common Ground with Former Opponents of the Right-to-Die

C.  Makes Each Particular Safeguard Optional

D.  Encourages Advocates of the Right-to-Die to Embrace the Safeguards

E.  Requires Less Paperwork

F.  Brings Underground Chosen Deaths Above Ground

G.  Discourages Self-Appointed 'Angels of Death'

H.  Clarifies and Simplifies the Legal Status of Bedside Medical Decisions 

I.    Puts the Burden-of-Proof on the Prosecution: Presumed Innocent

J.   Prevents Attempts to Ban the Right-to-Die Using Drug-Laws

K.  Prevents Attempts to Ban the Right-to-Die Using Physician Licensing

L.   Focuses on Results rather than Procedural Details


Bibliographies

Preparing for Death

Advance Directives for Medical Care

Personhood

 Helping Patients to Die

Supporting the Right-to-Die

Opposing the Right-to-Die

Invitation to join a cyber-seminar discussing this book-in-progress

SAFEGUARDS FOR LIFE-ENDING DECISIONS


Additional Resources on the Internet

Books on Terminal Care
These books were not included in the six bibliographies printed in the book, 
but they might be of interest to readers.

Underground Aid-in-Dying Resists Reporting to the Prosecutor
This discussion explores the reasons why early advocates of the right-to-die
—especially those following the suicide-model for the right-to-die—
would never consider reporting their plans to the prosecutor.

26 Safeguards Suggesting No Prosecution for Murder, Manslaughter, or Assisted Suicide
This presentation discusses the 26 recommended safeguards,
showing how following these guidelines should prevent prosecution for any crime.

Fifteen Safeguards for Life-Ending Decisions
This presentation selects the 15 most important safeguards.

Voluntary Death by Dehydration: Questions and Answers
This Internet portal gathers information about the practical dimensions
of deciding to end one's life by voluntary dehydration.


Created December 30, 2011; Revised 1-7-2012; 1-10-2012; 1-11-2012; 1-18-2012; 1-19-2012; 1-27-2012; 2-9-2012; 2-21-2012; 2-28-2012; 3-4-2012; 3-8-2012; 3-9-2012; 3-10-2012; 3-15-2012; 5-29-2012; 8-17-2012; 9-7-2012; 1-2-2013; 1-3-2013; 1-26-2013; 4-10-2013

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