CONTROLLING
FREE-LANCE 'ANGELS OF DEATH'
Dr. Jack Kevorkian was the most famous 'angel of
death' in the late 20th century.
Before he was stopped by being put into prison,
he helped about 120 people to die.
The major criticism of his methods related to the
lack of proper safeguards
to make sure that the life-ending decisions were wisely made.
But in Dr. Kevorkian's defense, we can say that he was operating
under an extremely hostile legal environment.
He knew that he was stretching the law.
But he was willing to help people to die
because wanted to shorten their terminal suffering.
Jack Kevorkian's own informal safeguards
caused him to reject
more requests for death than he accepted.
The major safeguard that Dr. Kevorkian did use
was attempting to get informed consent
from the patients whom he helped
to die.
Without becoming entangled in any of the specific
cases
where Dr. Kevorkian provided aid-in-dying,
we can worry about other such self-appointed 'angels of death'
arising to fill the void created by Jack Kevorkian's removal.
We know that there is already a considerable
underground right-to-die movement.
Doctors, nurses, relatives, & friends are helping patients to end
their lives
without using any organized system of safeguards.
One informal safeguard often employed
is to make sure that the patient
really wants to die.
Is the patient giving wise informed
consent to death?
Has the patient really seriously considered the alternatives to
death?
But making sure that the patient really wants to die
is not sufficient,
because it does not take into account the urge toward irrational
suicide.
Everyone who commits irrational suicide 'wants to die' in some
sense.
But other persons can sometimes bring new perspectives
that will result in the suicidal person changing his or her mind.
When open, public
safeguards are employed,
secretive 'angels of death' will have to make their safeguards known.
Some of their informal safeguards
will closely correspond with the safeguards linked below.
But others guidelines will prove to be too personal and quirky.
For example, it is not sufficient for a nurse
to decide that a certain patient has 'suffered enough'.
When wise safeguards for life-ending decisions are
discussed
and when some of them are enacted into laws,
then people who have been 'angels of death' in the past
will find that they can work
within the new system of public safeguards.
And some people from the underground right-to-die movement
will be able to suggest meaningful safeguards that everyone can affirm.
In the meantime, societies all around the world
should continue to identify and prosecute underground 'angels of death'.
SAFEGUARDS TO DISCOURAGE FREE-LANCE 'ANGELS OF DEATH'
The following 13 safeguards call upon the considered
opinions
of a wide variety of neutral persons who can help
to separate wise life-ending
choices from foolish
decisions.
And even before such safeguards are embodied in new
laws,
free-lance individuals and agencies that help people to die
can decide which of
these safeguards
they want to include in their own decision-making process.
If they have in fact fulfilled several of these
safeguards,
it will do them no harm to
put everything into writing
—just in case a prosecutor decides to charge
someone with a crime.
The written death-planning record
will go a long way toward convincing the jury
that the voluntary
death or merciful
death was wisely chosen.
And even before a jury hears the evidence,
the prosecutor should review the documents
in order to decide whether a real
crime has been committed or not.
The whole society is slowly moving in the direction
of allowing people to make wise
life-ending decisions.
And even prosecutors are human beings,
who might at some later time wish to claim their right-to-die.
If the case before them shows all the signs
of being a wisely-decided life-ending choice,
then they will decide that no
prosecution is warranted.
With regard to the right-to-die,
public attitudes are usually ahead of changes in the law
—and changes in the practices of public
prosecutors.
But forward-looking prosecutors can still decide not to prosecute
when the facts suggest that good safeguards were employed.
Applying wise and meaningful safeguards like the
following 13
can change what might have been a premature death
into a death that took place at the best time and by the best means.
These safeguards to control free-lance 'angels of
death'
are arranged beginning with the
most powerful and effective.
The
blue title leads to a
complete explanation of that safeguard.
The red comments explain
how that safeguard
will control free-lance 'angels of
death'.
REPORT TO THE
PROSECUTOR BEFORE THE DEATH TAKES PLACE
Jack Kevorkian never reported his plans for death
until after the death had already taken place.
If the people planning a voluntary death or a merciful death
share their death-planning record with the prosecutor
before the death takes
place,
that public official who would be responsible for bringing any criminal charges
will make sure that any life-ending decisions were wisely chosen.
CIVIL AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
When clear penalties are known in advance by 'angels
of death',
they will think more carefully about doing harm.
They will create detailed written records
showing how they fulfilled specific safeguards.
These would be public safeguards fulfilled in private.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
If a
psychological consultant has confirmed
that the patient is able to make
medical decisions,
including any decisions that will
result in death,
and if the patient is freely and wisely choosing death now rather than death later,
then the persons who are
planning
to help the patient to die
will know that their plan is
valid.
AN
INSTITUTIONAL ETHICS
COMMITTEE REVIEWS THE PLANS FOR DEATH
'Angels of death' are no longer acting
alone
when they make sure that the institutional ethics committee
has also approved the chosen course of action
that will result in the patient's death.
WAITING PERIODS
BEFORE DEATH IS PERMITTED
Free-lance 'angels of death' often act
without giving enough time to review and revise any life-ending
decisions.
Waiting periods should be used by all involved
as an opportunity to re-think any and all decisions about death.
Taking time to reconsider can prevent premature death.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING THE CHOSEN DEATH
When the family is involved, the 'angel of death' is
not acting alone.
When family-members endorse the chosen death,
some of them might decide to be present for the last moments of life,
affirming by their cooperation that this was a timely death.
STATEMENTS
FROM
ADVOCATES FOR
DISADVANTAGED GROUPS
IF INVITED BY
THE PATIENT AND/OR THE PROXIES
'Angels of death' who are used to operating in secret
will seldom ask for a written opinion from anyone else.
So if they do have
such written approval
from someone who was specifically chosen to protect the interests of
the patient,
then everyone else should be assured
that this was a wise death, not an example of mercy-killing.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
Careful 'angels of death' will make sure that they are acting
on the basis of well-established medical facts about the patient.
It is not sufficient to get the patient and family to agree.
There must be objective
reasons for choosing death
now rather than death
later.
The written statement of the physician most deeply involved in the
terminal care,
explaining in detail the patient's condition and prognosis,
will be the background for all end-of-life decisions.
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
The written statement from the second doctor
will be further evidence for or against the choice of death.
The 'angel of death' is not acting alone
but with the cooperation of at least two licensed physicians.
HOSPITAL OR
HOSPICE ENROLLMENT
If the patient is receiving care in a hospital or
hospice program,
then the 'angel of death' will probably seek their approval and
cooperation.
And the hospital or hospice program will not cooperate
if they believe that the proposed death would be premature.
INFORMED
CONSENT FROM THE PATIENT
Patients usually do not want to be put to death prematurely.
If they approve of their own deaths in unambiguous terms,
then the 'angels of death' are doing them a service,
not committing any sort of
crime or harming them.
When the patient has requested the aid-in-dying,
this is strong evidence that this death was wisely chosen.
COMPLETE
RECORDING AND SHARING OF ALL MATERIAL FACTS AND OPINIONS
When the death-planning record is complete,
these several documents will go a long way
toward convincing any suspicious persons
that the planned death was chosen at the best time and by the best
means.
The specific documents will not
be shared with strangers,
but the fact that a
death-planning record has been created
in the process of making a wise end-of-life plan
might be made public.
THE
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
And
the fact that a death-planning coordinator
has compiled all of the documents into one place
should convince most detractors
that this death was not premature.
If these 13
safeguards do not seem sufficient to discourage 'angels of death',
there are two dozen more listed in the complete catalog of safeguards:
http://www.tc.umn.edu/~parkx032/SG-CAT.html.
Each of these descriptions contains a few paragraphs
explaining how that safeguard will discourage
all forms of premature death.
Created March 22, 2007; revised
7-16-2008; 7-31-2008; 11-2-2008; 1-29-2009; 3-1-2009