FOR LIFE-ENDING DECISIONS
UNBEARABLE PSYCHOLOGICAL SUFFERING
Most people would accept unrelievable
as a legitimate reason for choosing death,
but how many would agree that purely
is a good reason to choose death?
Psychological suffering would include
happening within the mind of the patient,
which does not have any physical component that can be treated.
Grief would be one
form of psychological suffering.
However, normally grief is self-limiting: after a few years at the most,
the grief at the loss of a loved one has diminished enough
to allow the person who was grief-stricken to return to a more
Other forms of mental suffering do not automatically
fade with time.
And sometimes all treatments prove ineffective
in overcoming the demons that torment some patients.
If every day is another day of fearing dangers that do not exist,
if every day is another day of harming oneself for unintelligible
and if no amount of treatment has been able to alleviate this
then a chosen death might be the best solution.
Such a conclusion should be reached only after
the most exhaustive attempts to relieve the suffering
by every reasonable means available.
And such attempts must be well-documented before others will be
that death would be
better than continued
Also persons whose suffering is mainly mental or
sometimes have a questionable grasp of reality.
Part of the psychological problem might render them
incapable of making wise medical decisions.
Such incapacity should be determined by the psychological
safeguard to use in close coordination
with this one.
Especially when psychological suffering is a reason
more than one professional medical opinion might be needed.
Each additional evaluation by a psychiatrist should be documented.
The medical record will show the various methods of treatment tried.
Keeping the patient medicated to reduce the psychological suffering
might be a useful interim method while new means of healing are tried.
But if full consciousness always means the return of suffering,
then open-minded psychological professionals might agree
that a chosen death could be better for this
Are the psychiatrists willing to put such recommendations into writing?
When a patient is not able to make medical decisions
(for whatever reasons, including having a tentative grasp of reality),
then proxies should
be officially appointed and empowered
to make medical decisions for that patient.
To whatever degree possible, the
proxies should cooperate with the
attempting to determine the most rational wishes of the patient
while at the same time attempting to filter-out the irrational urges
that might be pushing the patient toward a harmful 'decision' for death.
Any decision for death should be taken
only by persons
whose thinking processes are beyond doubt.
For some mental patients, this will mean that the proxies
bear the legal responsibility for making all medical decisions
any life-ending decisions.
HOW UNBEARABLE PSYCHOLOGICAL SUFFERING
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Irrational suicide is a real danger
for persons whose psychological suffering cannot be relieved.
This is why psychological experts must be consulted
before the proxies decide that death would be better
than forcing the patient to continue suffering every
Proxies would have this power to decide
if the patient's suffering is so great
that it renders the patient unable to make wise medical decisions.
After the proxies have made all reasonable efforts
to find solutions to the patient's suffering,
and after they have documented their failures one-by-one,
then this medical record will stand as proof of their good-faith efforts
to help the patient recover from the psychological suffering.
If the proxies then choose death,
it will not be an irrational
It will be in the best
interest of the patient—a
benefit, not a harm.
It will be well-planned
in the sense that they have spent
months or years trying to find good alternatives.
And it will be a commendable
because others who examine the same facts and professional opinions
would see the validity of the choice the proxies made.
The medical record itself would be sufficient proof
that this was not a
Given all of the facts and opinions collected
about this unbearable
when does the point come when death
better than forcing the patient to continue suffering?
created January 31, 2007; revised
2-9-2007; 3-15-2008; 4-3-2008; 2-6-2010; 5-9-2010; 9-9-2010; 5-27-2011;
1-29-2012; 3-22-2012; 8-1-2012; 8-19-2012