PROTECTING VULNERABLE PATIENTS FROM DISCRIMINATION
When we are dying, we are more vulnerable than any
time since we were born.
We are often completely incapable of doing anything for ourselves.
Others must feed us, clean us, keep us warm, etc.
And sometimes merely omitting to do something
that is necessary for our survival will result in our deaths.
In addition to all such normal vulnerabilities,
some patients at the end of their lives are even more vulnerable
because they lack strong advocates
who are trying to protect their best interests.
We hope that most of us will have close family and friends
who will watch out for us when we are in the last year of our lives.
But we might come to the end of our lives
after many of our friends and relatives have already died
and when our remaining family members are distant and uninvolved.
Another kind of vulnerability arises when the
patient
comes from a different social group than the care-givers.
Sometimes the doctors and nurses cannot easily relate to the patient
because the patient speaks a different language,
belongs to a different racial or ethnic group,
or has a very limited education and/or low intelligence.
There are valid worries that patients with whom the
staff cannot identify
will not get the same level of care as given to patients
who are very similar to the professionals who are providing the care.
Do doctors give the very top level of care to other doctors like
themselves?
This is like the feeling anyone can have for close
family members.
We 'naturally' want to do the best for the persons we care most about.
And if this means that someone down the hall gets less attention,
that is not our problem.
We demand the very best for the people we care about.
And all the other patients do not matter as much to us.
All medical care-givers are subject to the same feelings,
even tho they are trained to give the same care to all patients in need.
When it comes to life-ending decision,
doctors and nurses might favor patients of their own ethnic group.
At least this is a valid question raised by members of minority groups.
Since minorities are not as well represented in the health-care
professions,
they might worry that they will not get as good care
from people they have sometimes seen as oppressors.
Even if such tribal thinking is absent from the minds of the
care-givers,
it might still be present in the minds of the minority-group patients
and their families.
And even baseless worries need to be taken into account.
PROTECTING VULNERABLE PATIENTS
Several safeguards would be helpful in protecting
those patients
who worry that they might be subject to discrimination for any reason.
Here is a listing of twelve safeguards,
beginning with the most effective for protecting vulnerable patients.
Clicking the
blue title will lead to a
complete explanation of that safeguard.
The red comments explain
how that safeguard protects vulnerable patients.
REQUESTS FOR
DEATH FROM THE PATIENT
If the patient himself or herself has clearly
requested death,
without any pressure from anyone else,
then this is strong reason to believe
that death at this time would not
be an example
of giving worse care to this patient for any non-relevant reasons.
INFORMED
CONSENT FROM THE PATIENT
If the patient is giving fully-informed consent,
who could claim that the patient is being treated differently?
If there are any valid doubts about the consent,
then the other safeguards should resolve such questions.
Vulnerable patients might need more education and explanation
before they are informed enough to make a wise decision about death.
UNBEARABLE
SUFFERING
The patient's suffering rather than any
discrimination
is the reason for considering a life-ending decision.
And the level of suffering must be carefully evaluated
for those patients who cannot easily communicate with the medical
professionals.
For example, has the suffering been confirmed
over a sufficiently long period of time?
Have meaningful efforts been made to relieve the suffering?
THE PATIENT
MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
If the patient himself or herself is making the
final decision
and actually causing his or her own death,
who could claim that someone was being put to death
because it was more convenient for other people?
If there is any doubt about the level of consciousness,
let additional experts evaluate the decision-making process
and let additional witnesses be present at the end
to make sure that the patient is really choosing to die.
PHYSICIAN'S
STATEMENT OF CONDITION AND PROGNOSIS
The physician's
medical statement
sets forth the objective facts
and the professional opinion of
the doctor.
The physician should be an
advocate for the best interests of the patient.
And if possible discrimination
might be present,
the physician should take that
into account.
Everyone who reads the physician's summary of the patient's condition
should look for any signs of giving a lower level of care
because this patient is especially vulnerable.
REQUESTS FOR
DEATH FROM THE PROXIES
The proxies for the patient are also in good position
to raise any doubts about possible discrimination.
If they also request death based on all the gathered facts and opinions,
then this life-ending decision is probably not an example of inferior
terminal care.
One of the primary functions of carefully-selected proxies
is to protect vulnerable patients who cannot protect themselves.
STATEMENTS
FROM FAMILY MEMBERS
AFFIRMING OR
QUESTIONING THE CHOSEN DEATH
Other family members will also be asked to review
the plans for death.
If they suspect that their dying relative is not being properly cared
for,
they should challenge
the plans for death.
But if the people who are closest to the dying patient
also approve the plans for a timely death,
this will also be strong evidence that this death was properly chosen,
even if the patient was in a very vulnerable condition
at the end of his or her life.
STATEMENTS
FROM
ADVOCATES FOR
DISADVANTAGED GROUPS
IF INVITED BY
THE PATIENT AND/OR THE PROXIES
Whenever the patient belongs to a group that has
suffered
discrimination,
then a special advocate drawn from that group
might be asked to review the plans for death.
And if this special advocate who is looking for all possible signs or
discrimination
also agrees that death at this time is the best course of action,
others who are more distant and perhaps more skeptical
might be reassured that a timely death was wisely chosen.
ETHICS
COMMITTEE REVIEWS THE LIFE-ENDING DECISION
Ethics committees are also able to protect
vulnerable patients.
They are well aware of how social factors might be affecting the
judgment
of other people involved in the death-planning process.
And especially when they know that this patient is especially
vulnerable,
they should exercise extra care
to make sure the plans for death are appropriate for this patient.
A
MEMBER OF THE CLERGY APPROVES OR QUESTIONS THE CHOICE FOR DEATH
Ministers, priests, or other religious leaders
might also be asked for their opinions about the proposed death.
If they too agree that no discrimination is involved in this
life-ending decision,
then more distant observers can be more assured
that the rights of a vulnerable patient have been protected.
REPORT TO THE
PROSECUTOR BEFORE THE DEATH TAKES PLACE
And all people working in the prosecutor's office
will also be aware of the possibility of discrimination
against patients who are vulnerable for any reason.
They will review the death-planning record
to make sure that the safeguards were applied with special care
because this patient was very vulnerable at the end of his or her life.
CIVIL AND
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
The power of the law rests of the side of protecting
the vulnerable.
Anyone who might be tempted to discriminate
will be careful to fulfill several safeguards
to prove that no discrimination is taking place.
In very difficult
cases, additional
safeguards might be needed
to resolve any doubts about the
wisdom of this proposed death.
created February 23, 2007; revised
3-9-2007; 8-30-2008; 11-14-2008; 1-5-2009