SAFEGUARD K FOR LIFE-ENDING DECISIONS
REQUESTS FOR DEATH FROM THE PROXIES
When the patient can no longer make reliable medical
the power to make medical choices—including
passes to the legally-authorized proxies
who were chosen to act on behalf of the patient in just such
The proxies might have to take over the medical
after the patient has already made one or more requests for death.
If so, the reasons for choosing death now rather than death later
should be clear from the patient's
requests for death.
The proxies will also be guided by the Advance Directive
for Medical Care
created by the patient while he or she was clearly able to make
The proxies will strive to carry forward the medical
ethics of the patient,
especially as they are articulated in the Advance Directive.
And the proxies might have further insights into the views of
because of their long association with the now-incapable person.
The proxies will probably be called upon to make
after the patient has declined towards death to such a degree
that the patient can no longer be expected to make
And the proxies might know
more about the likely causes of death
than the patient knew before he or she lost decision-making capacity.
The proxies will review all of the medical records
and the other statements already created for planning this death.
They will pay special attention to the doctors'
about the current condition and prognosis of the patient.
When the proxies consider making a request for death,
they should re-state in their own words
exactly how they understand the condition and prognosis of the patient.
Then if there is any misunderstanding (or incomplete grasp of the
the doctors can explain all of the medical facts and recommendations
until the proxies are satisfied that they fully understand
what is going to happen to the patient under each option worth
To make certain that these requests for death are
they should be in writing
as well as verbally stated for everyone.
periods will allow everyone to review their thinking.
And when considering a life-ending decision,
everyone involved wants to be sure that all options have been explored
and that death now is
better than any of the other possibilities.
All written requests for death from the proxies should be signed and
This will make clear just
who is authorizing the
In some cases, it will be appropriate for the
proxies to state explicitly
their reasons for choosing death at this time.
The proxies might know something about the patient
that is not contained in the medical records
and might not be known to others involved in the
For example, has the patient completed
Is the patient a member of the One-Month-Less
HOW FORMAL REQUESTS FOR DEATH FROM THE PROXIES
DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Once the power to decide has passed from the
patient to the proxies,
all talk of irrational suicide is no longer relevant
because the patient has lost the ability to decide
and carry forward any
plans for death—whether
rational or irrational.
But the proxies should be wary
of causing a premature death.
A death that comes too soon
harms the patient.
Do the proxies
completely understand the medical situation?
Are they deciding because of a sudden decline in the patient's
Are they making a rash decision before all options have been
Will their choices result in a premature death they will later regret?
Once the proxies have considered all of these ways
in which they might err on the side of death rather than life,
then they can be more confident that they have really weighed the
and they have chosen a merciful
death for the patient,
based on the patient's own settled values,
which were expressed when the patient was
fully in control of his or
her own destiny.
If the proxies must now decide for the patient,
they will ask themselves whether they are carrying forward the decision
that would have been
made by the patient
if the patient still had enough mental capacity to make the needed
To make the proxies' request for death
more formal and official,
it might be wise to have their written request witnessed by others
who have no vested interest in any particular course of action.
The goal of this safeguard is not merely to get
signatures on paper
but to facilitate a thoro
discussion of the pros and cons
of any particular pathway towards death.
And if the choice would lead to a premature death
as perceived by any of the neutral
observers and witnesses,
then they should not support that request for death.
If the request for death is not rational, not based in well-established
then this is an opportunity for any observer to prevent a premature
Created January 24,
2007; revised 4-13-2007; 3-15-2008; 4-23-2008; 2-6-2010; 5-21-2010;
5-27-2011; 12-15-2011; 1-29-2012; 2-11-2012; 3-23-2012; 8-2-2012;
8-22-2012; 11-15-2012; 5-22-2013
the power to make medical decisions has been officially taken over by
they also have the authority to request death for their patient.
is Safeguard K in How
to Die: Safeguards for Life-Ending Decisions:
for Death from the Proxies".