F FOR LIFE-ENDING DECISIONS
CERTIFICATION OF TERMINAL ILLNESS
OR INCURABLE CONDITION
The full account of the patient's condition will be
the primary physician's written
statement of condition and prognosis.
But a separate certificate
of terminal illness might be needed.
If the patient has an incurable condition that will cause death,
a second professional opinion might be wise.
The second doctor will also examine the patient
and order any medical tests needed to confirm that the patient is
Generally, terminal illness is defined as having less than 6 month to
The over-all purpose of this safeguard is
sure that the patient is already
before considering any life-ending decisions.
For patients who are being sustained by any
the certificate of terminal illness should make clear
whether the patient will die within the next 6 months
while still connected
to the life-support systems
or will die within 6 months without
the life-support systems.
In some cases, the patient will die immediately
after the life-supports are unplugged.
If this is the meaning of "terminal illness",
then any patient kept alive by life-supports is terminal.
Some laws expand this safeguard to
include incurable disease.
If the patient has a condition, illness, or disease
that within reasonable medical judgment cannot be cured,
then this 'terminal illness' safeguard has been met.
If the patient will never
and return to his or her normal life as it was before the illness,
then a life-ending decision might be appropriate.
When the patient is suffering
as the result of an incurable disease,
then full evaluation of the medical situation would be wise.
What is the nature
and degree of the patient's suffering?
If the condition is getting worse, what would be the tipping point
at which a life-ending decision would be appropriate?
However, "incurable disease"
is even more difficult to define than "terminal illness".
Thus we need the physicians’ complete
statements of condition and prognosis.
This medical analysis should go beyond a simple yes/no determination:
Yes or no, is this patient terminally ill?
Yes or no, is this disease incurable?
However, some laws do require an official
declaration of terminal illness.
One example is admission
to a hospice program:
The physician must sign a statement saying
that the patient is likely to die within the next six months.
Likewise, some right-to-die laws require
an official certification of terminal illness
before a patient might be eligible for aid-in-dying.
However, it is probably much wiser to allow
terminal illness or incurable condition
to be one of the optional
that would justify a chosen death.
Keeping this safeguard optional protects the
for those patients who are not
going to die within the next 6 months.
Patients with slow, degenerative diseases
such as Alzheimer's would be
The best time-to-die for such patients
who can no longer decide for
should be wisely decided by the duly authorized proxies,
all the most appropriate safeguards to prevent premature
And even when the patient is still capable of making
the full medical diagnosis and prognosis
should inform any possible life-ending decisions
—not just the official yes/no certification of terminal illness.
Patients who are not yet in the last 6 months of
should explain in their own
requests for death
proxies should explain for them)
why death at the planned time
is better than waiting for
And these requests for death should be based on the full medical
as explained in the statements of the first and second
—not just on the certification
of terminal illness.
HOW CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE DISEASE
DISCOURAGES IRRATIONAL SUICIDE AND OTHER MISTAKES AND
Most people who are thinking of killing themselves
for foolish 'reasons'
do not believe that they are terminally ill.
And they will not seek any physician's statement
that certifies that
they are dying or
that they have an incurable
(And if any suicidal person seeks such a statement,
this will be an opportunity for the medical professional
to intervene to
prevent an irrational suicide.)
Thus a certificate of terminal illness will be one easy way
to separate voluntary deaths from irrational suicides.
However, a special problem should be
taken into account:
Some patients become
suicidal when they receive a terminal diagnosis.
When they are told they have AIDS or cancer,
they immediately believe that they are dying.
And they might foolishly decide to shorten the dying process
before their meaningful lives are really absolutely finished.
Then, a declaration of terminal illness does not prevent irrational suicide.
Rather, the physician's declaration might precipitate an irrational
If and when there is some danger of a foolish self-killing,
the physicians should fully explain the patient's
condition and prognosis.
Whether a certification or non-certification of
will prevent other forms of premature death is debatable.
But it will be a defense against the charge of causing a premature death
if the person(s) charged can show
declaration of terminal illness or incurable disease.
Some mistakes and abuses of the right-to-die have
when the medical status of the patient was not clear.
Thus an official declaration of terminal illness or incurable disease
might help all the other elements of the death-planning process.
But such a declaration should never be a substitute
for a full
presentation of the patient's condition and prognosis.
17, 2007; revised 3-8-2007; 3-14-2008; 3-20-2008; 2-5-2010; 5-9-2010;
5-27-2011; 12-15-2011; 1-29-2012; 2-22-2012; 3-22-2012; 8-1-2012;
some cases, an official declaration of terminal illness or incurable
be relevant for making end-of-life choices.
is Safeguard F in How
to Die: Safeguards for Life-Ending Decisions:
of Terminal Illness or Incurable Condition".
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