PRESERVING
GOOD DOCTOR-PATIENT RELATIONS:
WILL MY DOCTOR DECIDE TO KILL ME?
Physicians often oppose the right-to-die
because of they fear that allowing doctors to recommend death
will harm the trust
between doctors and their patients.
Such fears are not well-grounded in reality,
since most doctors are committed to the well-being of their patients.
But some patients already have an irrational fear of doctors.
And permitting doctors to take any part in life-ending decisions
might seem to corrupt the
mission of the healing professions.
Many patients are already reluctant to consult
doctors.
Thus, adding the additional worry that doctors might recommend death
if a particular case becomes too difficult or troublesome
might not improve
doctor-patient relations.
When we consult doctors, we want to know in advance
that our doctors will do everything reasonable to save us from
death.
If we begin to see doctors as people who might provide death pills,
we might want to stay away from such 'executioners'.
This confusion is not helped by advocates of the
right-to-die
when they refer to life-ending chemical as "medication".
How are we supposed to react when offered pills?
Even if most such fears are completely groundless,
we would trust our doctors somewhat more
if we knew that they were not
considering death as a option.
We will probably know the doctor will consult
with everyone involved
before agreeing to participate in a voluntary death
or a merciful
death,
but even thinking that death might be recommended by the doctor
can turn us away from the healing services of the physician.
If the right-to-die is not associated with the
healing professions,
if, for example, someone
other than physicians could provide gentle
poison,
then the patients would not be confused about the role of their doctors.
They would know that their doctors are completely committed to curing.
See the
first safeguard linked below.
And if a doctor decides that cure is no longer
possible,
he or she might refer
the patient to another kind of professional,
who will help with the end-of-life decisions.
This would keep the doctor always
associated with healing
and allow others to
take over the care of the patient
when a chosen death might be the best option.
SAFEGUARDS TO PRESERVE GOOD DOCTOR-PATIENT RELATIONS
When we consider what safeguards to include in
new right-to-die laws,
we should try to keep the doctor-patient relationship
as meaningful and positive as possible.
The following 20 specific safeguards
should help ensure that wise decisions
are made.
The doctors will be in charge of all the medical information and
opinions.
But the patient and/or the proxies
will be responsible for making all end-of-life choices.
These safeguards are arranged beginning with the
most powerful.
The
blue title leads to a
complete explanation of that safeguard.
The red comments explain
how that safeguard
will enhance good doctor-patient relationships.
SPECIFICALLY-LICENSED
TERMINAL-CARE PHYSICIAN
AGREES TO
PROVIDE GENTLE POISON
Good doctor-patient relations will be preserved
between all regular doctors and their patients
because only
specifically-licensed physicians
will be authorized to provide life-ending chemicals.
Patients will know when they
have been referred
to these specially-licensed
terminal-care physicians.
These special doctors have specifically requested
to be allowed to provide lethal
chemicals
for patients who choose this pathway towards death.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
When the physician
who is primarily concerned with the patient's care
issues his or her written statement of condition and prognosis,
he or she will probably focus on the medical treatments still worth
trying.
Everyone who reads such a statement will note
that the best interests of the patient are uppermost.
INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
When another physician makes an independent
assessment,
once again all concerned will know
that good doctor-patient relations are being maintained.
The contents of all such statements
will shows that these doctors are not acting as executioners.
And this second professional opinion
is intended to catch any mistakes coming from the first physician.
If the first physician has prematurely recommended death,
then the second physician will raise appropriate doubts.
HOSPITAL OR
HOSPICE ENROLLMENT
When the patient is
being cared for in a hospital or hospice,
several professionals and laypersons are participating in the care,
even if everyone knows that the patient is dying.
In such settings of patient-care,
doctors will not capriciously or prematurely choose death.
INFORMATION ABOUT
PALLIATIVE CARE
AND OTHER
ALTERNATIVES TO DEATH
When the patient is
given everything he or she needs to know
about palliative care and other alternatives to death,
there will be less worry that the providers
are pushing for death prematurely.
PALLIATIVE CARE
TRIAL
When some actual
methods of palliative care are applied,
everyone concerned will see
that there is no premature move to 'pull the plug'.
PSYCHOLOGICAL
CONSULTANT EVALUATES
THE PATIENT'S
ABILITY TO MAKE MEDICAL DECISIONS
When a professional psychologist or psychiatrist
evaluates a patient and his or her plans for death,
it should be clear to everyone that maximum care is being observed
to do what is best for the patient.
Medical and psychological professionals are cooperating
in helping the patient to choose the best pathway towards death,
even if they recommend postponing death as long as reasonable.
ADVANCE
DIRECTIVE FOR MEDICAL CARE
The patient creates
an Advance Directive for Medical Care.
By doing so, the patient provides the most important input
for making all future medical decisions.
The terminal-care physician follows the patient's settled values,
rather than applying abstract, generic medical ethics to all cases.
REQUESTS FOR
DEATH FROM THE PATIENT
When the patient
himself or herself
has decided that death now
is better than death later,
this puts the patient's wishes ahead of the doctor's opinions.
Everyone who reads a written request for death from the patient
will be able to ask whether this is a wise decision
actually coming from the patient.
INFORMED
CONSENT FROM THE PATIENT
Open discussion between
the doctor and the patient
results in a written document spelling out what the patient wants.
When fully-informed consent is obtained,
the doctor is not just following his own rules of thumb.
Especially with regard to all decisions that will result in death,
care must be exercised to make sure
that the patient's consent is fully informed.
OPPORTUNITIES
FOR THE PATIENT TO RESCIND THE LIFE-ENDING DECISION
If the patient has
already made a life-ending decision,
that person should be given several opportunities
to change his or her mind about the choice and timing of death.
Each such opportunity shows that the doctor is not making the
decision:
The patient is always in
charge.
THE PATIENT
MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
And if we require
the patient to take the life-ending actions,
then it is certain that the
doctor is not putting the
patient
to death.
Requiring the patient to take the lethal chemicals, for example,
makes clear that the doctor is not killing the patient.
The patient is freely and
wisely choosing a timely death.
The other safeguards help to insure that this is not an irrational
suicide.
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
When an ethics
committee has reviewed the plans for death,
this is further protection for the patient,
preserving good doctor-patient relations
and making sure that there
is no inappropriate pressure
from the doctor that might lead to a premature death.
Even the fact that there
will be a review by an ethics committee
will give the doctor pause about recommending death
until death is obviously the best remaining alternative.
Several minds will reach a better decision than just one mind.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING THE CHOSEN DEATH
When family members
provide their written opinions,
they show their cooperation in whatever end-of-life process
is unfolding for their loved one.
Family members will usually not cooperate in any premature death.
A
MEMBER OF THE CLERGY APPROVES OR QUESTIONS THE CHOICE FOR DEATH
When a member of the
clergy approves the planned death,
only a few people would continue to feel
that something harmful is being visited upon the patient.
Clergy-persons can bring non-medical perspectives to end-of-life
decisions.
RELIGIOUS OR
OTHER MORAL PRINCIPLES
APPLIED TO THIS
LIFE-ENDING DECISION
And this religious
adviser might prepare a document
explicitly stating how the appropriate moral or religious principles
apply to the life-ending decision now being considered.
REPORT TO THE
PROSECUTOR BEFORE THE DEATH TAKES PLACE
When everyone knows
that the prosecutor has reviewed the case
and found nothing that warrants further investigation,
this should be good evidence for everyone
that proper safeguards have been fulfilled
and that the planned death will not be premature.
CIVIL AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
And if someone has
broken the law,
then the appropriate penalties should be applied.
Patients who know such safeguards are in place
will have less reason to fear that they might be harmed in any way.
The civil and criminal laws are the patients' safeguards
against the very rare 'angels of death'
among licensed physicians.
COMPLETE
RECORDING AND SHARING OF ALL MATERIAL FACTS AND OPINIONS
Also, during the
process of creating the death-planning record,
several people
will have numerous opportunities to raise doubts
whenever any reasons to question the decisions are warranted.
Everyone involved knows that their actions and opinions
are being placed in a permanent record of the patient's last year of
life.
THE
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
And the final
summary of the death-planning process
will be conclusive proof that all the appropriate safeguards were
fulfilled.
Good doctor-patient relations have been preserved.
This record will show that there is no reason to suspect
that the doctor has pushed the patient towards death
before the best time for that patient to die.
If these 20
safeguards do not seem sufficient
to preserve good doctor-patient
relations
and to reassure everyone that the physician is not causing premature
death,
there are a 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 choosing a premature death.
Created March 22, 2007; revised
4-12-2007; 9-26-2007; 7-16-2008; 11-2-2008; 1-29-2009; 3-26-2009;
3-30-2009;
1-30-2010; 5-21-2010; 2-25-2011; 12-29-2011; 1-27-2012