X FOR LIFE-ENDING DECISIONS
COMPLETE RECORDING AND SHARING
OF ALL MATERIAL FACTS AND OPINIONS
Complete openness about all the facts and
that went into the life-ending decision should help to
(1) premature withdrawal of life-support systems and medical care;
(2) irrational suicide; &
The documents created in fulfilling the other
will be distributed to all concerned persons who have a right to
And if anyone questions the reported facts or opinions,
he or she should raise objections to the process as soon as possible.
These objections should first be made to the doctors in charge.
If that is not appropriate or if the doctors do not seem receptive,
the suspicion that a crime
is on the verge of being committed
should be communicated to the county attorney
or other legal authority that is responsible for prosecuting crimes.
If we believe a crime
resulting in premature death is going to happen,
we have a responsibility to do our best to prevent it.
But if we conclude that the life-ending
decision is the right one,
then we will have no problem sharing with everyone
who has a legitimate
right to know
all the facts and opinions collected in planning for death.
The specific causes of every death must be recorded
by the doctor.
Suspicious deaths must be reported to the medical examiner or coroner.
Possible mistakes and abuses include:
excess pain-medication (a hidden cause of death),
unauthorized terminal sedation,
premature withdrawal of life-supports, irrational suicide, &
The medical examiner might request copies of all of the documents
created in the process of making this particular life-ending decision.
(If the medical examiner does not want all of these documents,
a summary can be provided, indicating which safeguards have been
And the complete documents could be offered if needed.)
If the medical examiner suspects some crime
has been committed,
the facts of the case will be forwarded to the prosecuting authority.
The fact that each life-ending decision
might be reviewed by the county attorney or other prosecuting authority
should discourage people planning to cause premature death
by pretending it was a withdrawal of life-supports
or some other form of chosen death.
As our society regularizes these life-ending
we might have to revise the laws pertaining to the recording of
As it becomes more common for the immediate means of death
to be the decision of the patient and/or the proxies,
the vital statistics should separate these three pairs:
(1) a legitimate in-hospital
from the act of causing premature death disguised as a medical
(2) a documented voluntary
death (whether assisted or not)
contrasted with an individual who was coerced into choosing death;
(3) a certified merciful
distinguished from a mercy-killing disguised as a merciful death.
In order not to distort the statistics
concerning causes of death,
the death-certificate should
list first the physical condition
or disease that led to the
decision to end this life.
It might also note the element of choice involved in the death
and perhaps even the means
that the patient and/or proxies
decided to use in order to bring this life to an end.
For example, if the patient was in a coma
dying from cancer,
and the duly-authorized proxies decided to turn off the life-supports,
the cause of death should be
recorded as cancer (of whatever type, etc.)
and additionally that life-support systems were turned off
at the request of the proxies, which resulted in a natural death.
Another example: If a patient dying of AIDS
and he or she decided (by fulfilling several safeguards)
that death by anesthesia was better than suffering a natural death,
then the death-certificate should indicate AIDS as the cause of death
and that the patient decided to shorten the process of dying
by being anesthetized until all bodily functions stopped.
This additional fact that it was a voluntary death
(here assisted by medical personnel who provided the anesthesia)
should be noted in the final medical record.
But the manner of this death
will not change the AIDS statistics.
This was another death caused
And an example of merciful death:
The patient can no longer express any current opinion
about life or death because of degenerative Alzheimer's disease.
But she had written an Advance Directive for Medical Care
covering this possibility, stating that she wanted a peaceful death
if ever she had permanently passed over to being a former person.
The duly-appointed proxies determine that this point had been
And after the 6 months process of creating the death-planning documents,
the tube that was providing food and water is withdrawn and the
The cause of death
was Alzheimer's disease.
The immediate means of death
was the withdrawal of life-supports.
If several safeguards were fulfilled,
this death should be registered as a certified merciful death.
Where the death-certificate asks for the cause of death,
the doctor will enter "terminal Alzheimer's disease".
In the space for additional notes, the doctor will explain
that the withdrawal of a feeding tube was the immediate means of death,
perhaps expressed as "dehydration due to withdrawal of a feeding
When most safeguards were not fulfilled,
then the coroner or medical examiner is required to list the deaths as
(1) the premature removal of
(with possible suit against the doctor for malpractice
and/or prosecution of others for conspiring to cause a premature death);
(2) an irrational suicide
(with possible prosecution for assisting
an irrational suicide); or
(3) a mercy-killing
(with possible prosecution for causing premature
The proper reporting of the true, underlying
causes of death
will prevent future statistical confusion
as more people make life-ending decisions
rather than waiting for a natural end.
Cancer, heart disease, Alzheimer's disease, & AIDS
will still be the basic causes of these deaths,
even if most of the people who die later in the 21st century
will make some life-ending decision at the end.
The official recording of these deaths
might include the names of those who assisted in the dying process
in order to discourage people from
assisting irrational suicides or causing premature deaths.
In the case of withdrawal of life-supports
and other medical treatments, the deciders should be identified:
(1) the patient if he or she participated in the decision;
(2) the proxy or members of the Medical Care
(3) the doctor who ordered the withdrawal of treatment; &
(4) any other persons materially responsible for the decision.
In the case of a voluntary death,
the primary decider is the
patient himself or herself.
But others who advised and supported this decision should also be
And if assistance was needed to achieve a
those who helped with the voluntary death should be named.
And in merciful death (even more than in the
the proxies who legally authorized the merciful death must be named.
And any doctors who aided in the merciful death should also be
HOW COMPLETE RECORDING AND SHARING
OF ALL MATERIAL FACTS AND OPINIONS
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Identifying everyone who
cooperated in the death-planning process
shows that these persons were
not ashamed of their participation.
And if there is later any question concerning their motives,
the participants in the life-ending process can be located easily.
If their actions were not
in the best interests of the patient,
they can be charged with
an irrational suicide or causing a
When people know their decisions and actions will be fully recorded,
they will be more cautious
about acting from mixed motives.
And the knowledge of this full disclosure should discourage people
from committing any of the following crimes:
(1) premature withdrawal of life-supports,
(2) assisting an irrational suicide, or (3) mercy-killing.
All three of these crimes should be defined in new laws,
which might use the over-all expression "causing premature death",
and which might replace all laws against assisting
When we know that all of our decisions and actions
are being recorded and possibly reported to the public prosecutor,
we act much more circumspectly.
We will make sure to fulfill the safeguards completely.
And since each safeguard is intended to uncover
instances where a bad decision for death might have taken place,
we know that the complete
record of safeguards carefully fulfilled
will show that everyone who participated in the life-ending decision
acted wisely, compassionately, & fully within the law.
The knowledge that our decisions and actions are
will help us to avoid and prevent harmful life-ending decisions
that would have caused premature deaths.
In the early days of the right-to-die movement,
almost all assistance with dying was secret or underground.
This meant that no records of decisions or actions were kept.
And almost no safeguards were fulfilled
probably led to at least a few premature deaths.
But if the future imagined here does come to
then complete openness and full recording of all facts and opinions
will lead to much better end-of-life decisions.
Instead of trying to hide incriminating evidence,
people who help patients to die will gladly collect the safeguards
because those facts will
keep them out of jail.
Fulfilling the safeguards
proves that no crime was committed.
Created January 17,
2007; revised 3-22-2008; 8-7-2008; 2-11-2010; 5-21-2010;
12-17-2011; 2-1-2012; 2-11-2012; 2-23-2012; 3-24-2012; 8-3-2012;