As a natural extension of informed consent
V FOR LIFE-ENDING DECISIONS
OPPORTUNITIES FOR THE PATIENT
TO RESCIND OR POSTPONE THE LIFE-ENDING DECISION
the well-informed patient must always
the power to change
her mind about the plan for a voluntary death.
The patient must not be swept along by the
so that it becomes impossible to
back out or to change
the date of death.
Doctors should remind their patients at each step in the process
that no boulder has been sent crashing down the mountain,
which cannot now be stopped because it has too much momentum.
When patients are
reminded of their authority to
revise earlier decisions,
they might take this opportunity
to re-think the whole process.
And they might have a new perspective
that would allow them to continue
living under limitations
they would have found intolerable
just a month or a year earlier.
explicitly say that the patient's mental
is not relevant to the decision to
rescind any earlier choice for death.
This is erring on the side of caution:
When a patient loses mental capacity
to make any other decisions,
he or she still retains the power
to say "no" to a plan for death.
Perhaps wiser laws
will make sure that the original
decision for death
was firmly based in the settled
of the patient.
And the original decision for a voluntary death
was also affirmed by others who are
taking part in planning this death.
Then if the patient loses
or becomes incapable of making
meaningful medical decisions,
the original choice will be
forward by the proxies
the patient for exactly such a possible situation.
The wisely-decided plan for death should not be overturned
just because the patient has now
become incapable of deciding
or says "no" in some questionable
The thinking behind
this safeguard emphasizes
The patient (and no one else) is
making the life-ending decision.
The patient should be allowed to
change his or her mind
up until the very last moment of life.
And if the patient decides to postpone
the moment of death,
this does not mean that the patient loses the authority
to choose a voluntary death at some later time.
As long as the patient has the capacity to make
the timing and mode of death
always belong to the patient.
Being reminded of the power to rescind or postpone the choice of death
makes sure that this death is being wisely decided.
The patient's free and wise choice
must always be the basis for any life-ending action.
HOW PROVIDING OPPORTUNITIES
FOR THE PATIENT TO CHANGE HIS OR HER
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE
If the patient was
tempted toward irrational suicide
by some temporary problem, which has
now been resolved,
then offering the opportunity to keep
could be a wonderful relief.
decision for death was poorly
conceived in the first place,
then constantly asking the patient to
reaffirm that decision
attempts to make the patient aware
that his or her autonomy is driving the decision
not some external forces over which
the patient has no control.
This safeguard does
have some potential
for saving patients from premature
Because of the delay involved in
multiple questions and answers,
some new facts or perspectives might
which will allow the patient to
the life-possibilities included in
And if the doctor
or other person asking for the
to reaffirm an earlier decision for
notices some ambivalence in the mind
of the patient,
then it might be wise to 'put a hold' on the plans for death
and to postpone the projected date of death
until any ambivalence can be resolved
one way or the other.
The patient himself or herself might
take such an opportunity
to delay the process temporarily
until his or her mind becomes
that death on the date
would be better than death at
some later time.
When some coercion
or manipulation distorted
the original decision,
this might come to light when the
patient is asked to re-affirm the plan.
He or she might admit that the
decision was mainly to benefit others.
And now he or she really
to continue living.
Any safeguard that uncovers coercion
will help to prevent choices that might have resulted in premature
March 2, 2007; revised 3-21-2007; 3-22-2008; 7-23-2008; 2-10-2010;
5-27-2011; 12-16-2011; 2-1-2012; 2-23-2012; 2-28-2012; 3-24-2012;
8-2-2012; 8-23-2012; 3-5-2013