U FOR LIFE-ENDING DECISIONS
WAITING PERIODS FOR REFLECTION
In order to prevent mistakes that might occur
in any rushed process,
appropriate waiting periods should be observed for each form of
1. WITHDRAWING MEDICAL TREATMENTS AND LIFE-SUPPORTS.
For the withdrawal of all medical treatments
the waiting period might be one
beginning with the first written request for the withdrawal of
(Comfort care will continue, to make the
death as easy as possible.)
For patients already in a terminal coma without chance of recovery,
and whose coma has already continued for several weeks,
the case is so obvious no
additional waiting period would be helpful.
One week is short compared to the other
suggested waiting periods,
but people dependent on life-support systems to prevent them from dying
often have no chance
of surviving their disease or
So the only decision is the best
time for their lives to end.
Once a request for withdrawal of all
has been put into writing by the patient and/or the proxies,
then all persons concerned will be informed immediately,
in case anyone has new information or opinions
that might have a bearing on this life-ending decision.
In most cases, all concerned persons
will already be well aware of the grave condition of the patient.
This notification merely sets a definite date for the
after which immediate death is expected.
In cases where it might be wise to notify the
before the withdrawal of life-supports,
the law should require the prosecutor to act
within 5 business days or never thereafter to raise any objections.
But because the withdrawal of medical treatments is so
it seems most likely that the prosecuting authority
will not become involved unless someone close to the case
suspects that some harm
be done to the patient
by the withdrawal of all curative treatments and life-supports.
If the patient is going to be harmed
a crime is on the
verge of being committed.
And the prosecuting authority might be able to prevent any such
Usually everyone agrees that withdrawal
will not harm the patient.
Painful and useless
treatments might be more harmful
than ending all life-support measures
and allowing the patient to have a peaceful death.
Eventually the other forms of chosen death
will become so routine
that the review by the prosecuting authority will become a formality
looking for obvious signs of fraud.
The staff of the prosecutor's office might come to trust
the doctors and consultants often involved in withdrawing
2. VOLUNTARY DEATH.
The waiting period for a voluntary death
might be 12 months.
This waiting period begins with the creation of the first written,
signed, and witnessed request for death from the patient.
During each month of this death-planning process,
the patient might reaffirm in writing (properly dated and witnessed)
his or her choice of voluntary death.
This long waiting period will allow a complete
of all facts and opinions that have a bearing on this end-of-life plan.
But if the choice of voluntary death is truly rational, well based
in the facts,
thoughtfully and compassionately planned, & admired by others,
then the 12-months waiting period will only demonstrate more clearly
that voluntary death was the wisest choice under the
This 12-month waiting period gives the patient
plenty of time
to reconsider the decision to choose a voluntary death.
Something might change during this waiting period,
which will cause the patient to push back the proposed date
If we choose to end our lives rationally and voluntarily,
we are free to choose the timing
of our deaths
so that we end our lives at the best
possible time for all concerned.
If our health improves, we might want to live for a few more weeks.
If, on the other hand,
the patient becomes incompetent during this waiting period,
the months already passed since the first request for death
will count toward the waiting period for merciful death, discussed
Such a waiting period makes sure that the
is not being rushed
into death prematurely.
The patient's physical or mental conditions might improve.
If so, the doctors should issue
of condition and prognosis,
which supersede all previous
Old friends or relatives might turn up
as a result of the first written request for voluntary death
who will have new information, new offers of support,
perspectives to give,
causing the patient to reconsider the choice of a voluntary death.
During the waiting period, the patient might
have a change of heart.
Something new might emerge in his or her interpersonal, mental,
or spiritual life to modify the decision for voluntary death.
There might even be a new treatment for the
that caused the patient to choose voluntary death in the first
The patient can decide to try any new treatments
without interrupting the waiting period for an approved voluntary
If new treatments succeed, the
patient can always
And if the new treatments fail, the original date for death can be
Many people might think that 12 months is too
long to wait for death.
But it is better to err on the side of caution than to be
And simultaneous with the first application for voluntary death
the patient and proxies should agree
on which medical treatments will be tried or continued
and which treatments will be omitted or discontinued.
The patient and proxies might agree to Do-Not-Resuscitate orders,
so that there will be no efforts to revive the patient
if death should come from natural causes during the waiting
They should also exclude
that might merely prolong the process of dying.
Since at least a tentative date has been set for this death,
the patient will agree to forgo surgery or other treatments
that would only be appropriate for someone with an indefinite
The 12-month waiting period for voluntary
will give ample opportunity for those who care about the patient
to complete their business with that person,
to express all of their love and caring,
and perhaps even to begin to grieve for the loss
they will experience when the patient dies.
Those who are taking an active part in preparing for this death
—for instance, by writing statements
supporting the decision—
will be much more prepared for this death
even if it comes suddenly from natural causes during the waiting
The purpose of these waiting periods for
is not to impose additional
burdens on the patient and/or the family.
If the patient is suffering, then the waiting period could be
And those responsible for reporting the fulfillment of this safeguard
should explain any reasons for having a shorter waiting period.
Each death is a very individual matter.
And we should not impose rigid
rules on such personal decisions.
Let reason and compassion guide our application of all safeguards.
This long process of explaining one's reasons
for wanting to die
and getting agreement from doctors, clergy,
will show that the patient is truly getting ready for death.
The patient can arrange his or her practical affairs
and complete any projects that should be done before death.
Having set at least a tentative
date for death
will enable all of the people who care about the patient
to begin preparing themselves for this death to occur.
This death-planning process might stimulate
to consider how they
would like to meet their own
And the medical care-givers will abandon their automatic responses
—which are always to keep the patient alive,
no matter what burdens this puts on the patient, family, & friends.
The doctors and nurses will
be ready to let the patient die
because death is what this patient has carefully and rationally chosen.
3. MERCIFUL DEATH.
The waiting period for a merciful death should
be 6 months.
This period of waiting begins from the first application for either
voluntary death (written by the patient while still capable)
or merciful death (written by the proxies for an incapable patient).
During each month of this waiting period,
the proxies should reaffirm in writing their decision for merciful
And (as said above in reference to voluntary
simultaneous with the application for a certified merciful death,
the proxies should decide which medical treatments to continue
and which to discontinue.
They should make sure that a Do-Not-Resuscitate order is written
so that the patient will not be 'saved' by medical interventions
if he or she should die of natural causes during the waiting period.
In the case of a merciful death,
the patient can no longer participate in the decision-making process,
but if the patient wrote an Advance Directive before becoming
that document stands as the best expression of the patient's
And the duly-authorized proxies will be responsible
to carry forward the decision for merciful death.
When the patient can no longer participate in the decision for death,
all of the other safeguards become more important.
And if most safeguards are fulfilled,
everyone concerned should be assured
that the chosen pathway was the best way for this life to end.
The waiting period for a certified merciful
might also be shortened for good reasons, such as the fact
that the patient has already been in a coma for several months.
The person reporting on this safeguard should include any documents
showing that the
death-planning process was not rushed.
RIGID RULES ABOUT WAITING PERIODS
Some right-to-die laws have elaborate requirements
for paperwork related to waiting periods.
For example, they require some requests for death to be verbal
and some to be written, with specified waiting periods between
Some proposed laws even impose severe penalties
for any violation of such paperwork requirements.
However, this puts the emphasis in the wrong place.
The purpose of waiting
is to make sure that death
really a wise choice.
So every effort should be made to use the waiting periods
for the purpose of looking more deeply into options for the patient.
What additional medical treatments should be considered?
Is the patient being given the best kinds of physical and emotional care
so that the decision for death is not premature?
Do more distant friends and relatives wish to visit the patient before
What new medical facts and professional opinions might appear
that would change the plans for death?
The process of fulfilling other safeguards takes
And seeking the opinions of others who care about the patient
will be more meaningful than proving that a certain length of time
has passed between the various required requests for death.
No one should be punished because of incomplete
But if the patient was really rushed prematurely into death,
then that harm to the
patient might warrant some form of legal sanction.
Instead of just waiting for a certain number of days
spend each additional day working to fulfill meaningful
We do not merely want to delay
We want to make sure that this
death is being wisely decided.
HOW WAITING PERIODS
DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
Whenever significant waiting periods are observed
removing life-supports, choosing a voluntary death, or granting a
possible mistakes and abuses of such life-ending decisions are
In the situation of choosing a voluntary death,
the monthly reaffirmations of this choice will prevent irrational
self-harming, irrational, capricious, & regrettable taking of one's
Suicidal persons will not be
able to explain their reasons
in order to convince others to cooperate.
And their irrational urges to die will probably not last for 12 months.
When written plans for death (including 'reasons' for wanting to die)
are shared with members of the family and perhaps with friends,
others might see different solutions to the problems
that are leading the patient to choose death.
The 6-months waiting period for merciful death
serves a similar function:
If someone is plotting a mercy-killing—harmful
to the patient,
not based on real-world facts, sudden, & regrettable—
the long waiting period will allow ample time to discover the evil
and to prevent the
Creating the documents to fulfill the other safeguards
will be the specific way
in which any conspiracy to cause a premature death will be uncovered.
Requiring one week notice for withdrawing
will permit all concerned to review their thinking about this
If there are other realistic options,
the announced date of death will bring out the other possible solutions.
And occasionally, waiting for one week will prevent a premature death.
Created January 2007;
revised Feb. 2007; 3-2-2007; 1-20-2008; 3-22-2008; 7-16-2008;
2-10-2010; 5-9-2010; 9-9-2010; 5-27-2011; 12-16-2011; 2-1-2012 name
2-10-2012; 2-23-2012; 3-23-2012; 8-2-2012; 8-23-2012; 3-5-2013