CERTAIN LIVES ARE WORTHLESS
Whenever the 'right-to-die' is discussed,
there are some people who think first of the Nazi Holocaust.
Six millions Jews and others were murdered by the Nazi regime
during the Second World War.
The Nazi ideology held that Jews were sub-human creatures.
Therefore the world would be better off
if as many Jews as possible were exterminated.
Gypsies, homosexuals, Communists, and the inmates of asylums
were also put to death because they were not wanted in the Nazi paradise.
For part of this history of atrocities,
the word "euthanasia" was used to describe killing people against their will.
Thereafter any program that allows chosen death
must work against the background of these Nazi atrocities.
Even if there is no similarity between the Nazi gas chambers
and the modern hospital,
some people will worry that new atrocities will be committed
in the intensive care unit by disconnecting life-supports.
It is not sufficient to say that we are good people,
who would never commit such crimes against humanity.
Actual safeguards must be kept in place to prevent
any human behavior even remotely resembling Nazi atrocities.
The life of every human person has inherent worth.
And we should resist devaluing the life of any person
just because someone else finds that life less worthy.
Some opponents of the right-to-die believe that is impossible
to separate good deaths from bad deaths.
Therefore, they claim, the only safe course for any society
is to prohibit all chosen deaths.
We who advocate the right-to-die do not agree.
Careful safeguards can separate those deaths that harm the victims
from those deaths that genuinely benefit the patients who are suffering.
Good safeguards, carefully fulfilled, will protect all vulnerable patients.
When patients cannot speak for themselves,
then advocates who can speak for them become even more important.
Good record-keeping will prove that vulnerable patients
were given extra protection—beyond what is needed by all patients.
PROTECTING PATIENTS WHOSE LIVES MIGHT BE DISMISSED AS WORTHLESS
The following 18 safeguards offer operational methods
for protecting patients who might seem to be
in danger of being put to death prematurely and/or unwisely.
These safeguards ask for the opinions of many other persons.
Thus, if one person dismisses a patient as having a worthless life,
other neutral observers might not agree.
And these other people asked to review any life-ending decisions
will have several good opportunities to prevent premature deaths
among patients who might otherwise have been allowed to die
because someone found their lives to have low value.
These safeguards to protect patients whose lives might be devalued
are arranged beginning with the most powerful and significant methods
for preventing premature deaths of vulnerable patients.
The blue title links to a complete explanation of that safeguard.
The red comments explain how that safeguard protects patients
whose lives might be regarded by some people as worthless.
A MEMBER OF THE CLERGY APPROVES OR QUESTIONS THE CHOICE FOR DEATH
Persons professionally employed to lead religious organizations
are well-placed to detect any devaluing of the lives of patients.
So, if they publicly approve the plans for death,
this might persuade others who have not closely examined the case
that the planned death would not harm the patient.
RELIGIOUS OR OTHER MORAL PRINCIPLES
APPLIED TO THIS LIFE-ENDING DECISION
When written ethical principles are applied to the death in question,
then everyone can be more assured
that no patient was put to death because his or her life was 'worthless'.
Everyone who reads any such document
will see that the moral principles applied
were intended to protect against devaluing any person's life.
REQUESTS FOR DEATH FROM THE PROXIES
The persons chosen by the patient to be proxies
already believe in the value of the life of the patient.
And if they too request death,
then we should be more assured that the patient
was not merely dismissed by people who know nothing of the patient's life.
Strangers applying abstract principles
might be more inclined to regard the patient's life as worthless.
But the proxies were chosen (usually selected by the patient)
precisely because they value the life of the patient.
STATEMENTS FROM FAMILY MEMBERS
AFFIRMING OR QUESTIONING THE CHOSEN DEATH
Family members usually affirm the value of the patient's life.
If relatives join in the death-planning process,
more distant doubters will know that this death was not premature.
If some family members might devalue the life of the patient,
then the statements of other family members become more meaningful.
STATEMENTS FROM ADVOCATES FOR DISADVANTAGED GROUPS
IF INVITED BY THE PATIENT AND/OR THE PROXIES
Advocates for less-favored groups will also be very sensitive
to the possibility that some patients might receive lower levels of care
because their lives are not as highly valued as other groups.
So, if these advocates also approve the life-ending decisions,
others who have not looked at the case as closely can be assured
that the value of the life of the patient as an individual person
was carefully taken into account.
PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS
When a doctor takes the time to write a medical statement,
this shows that the physician does not regard this patient as worthless.
Careful attention has been paid to all of the relevant facts
about this patient's medical problems
and a careful projection of the outcomes has been presented.
INDEPENDENT PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
An independent physician can also protect against
any tendency to devalue the patient.
If either doctor merely presents a generic statement,
a pre-written set of words used for all patients in similar circumstances,
this is itself a sign of devaluing this patient.
Would either doctor issue a generic statement
for a close member of his or her family?
HOSPITAL OR HOSPICE ENROLLMENT
When the patient is receiving care from a hospital or hospice-program,
there are already safeguards in place which protect patients
who cannot fully protect themselves.
The fact that several professionals are involved in the terminal care
will help to compensate for any lower evaluations
by some care-givers or family members.
STATEMENTS WRITTEN BY HOSPITAL OR HOSPICE STAFF MEMBERS
Professional care-givers who have been deeply involved
in the last days of the patient's life
will also show by their daily behavior that they value the life of this patient.
When their statements also affirm any life-ending decisions,
we know this is not because they regard the patient's life as worthless.
PSYCHOLOGICAL CONSULTANT EVALUATES
THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS
A psychological professional who has evaluated the patient's thinking
can also see whether there is any possibility
that this patient is being dismissed as worthless by others.
Is this patient requesting death because he or she feels 'worthless'?
The psychological consultant should also look
for signs of the urge to commit irrational suicide.
REQUESTS FOR DEATH FROM THE PATIENT
When the patient himself or herself has clearly requested death,
this is a decision from the person who has the deepest interest
in preserving the value or worth of his or her own life.
The main exception to this would be patients with suicidal urges.
If the patient plans a harmful, irrational, capricious, & regrettable death,
then others must do their best to prevent any harmful self-killing.
INFORMED CONSENT FROM THE PATIENT
If the patient believes his or her life is worthless,
then he or she cannot give informed consent.
All the others involved in the end-of-life planning
must protect the patient from debasing himself or herself.
ETHICS COMMITTEE REVIEWS THE LIFE-ENDING DECISION
When an ethics committee carefully reviews a planned death,
they are necessarily indicating
that they do value this patient's life as having worth.
If their review is perfunctory, this might be a warning sign
that the ethics committee is giving less value to this life.
The ethics committee will demonstrate that they value the patient
by paying a personal visit to the bedside
to make sure that the plan for a chosen death
is really the best option for this particular patient.
WAITING PERIODS FOR REFLECTION
If anyone suffered a temporary phase
of thinking that the patient's life was worthless,
then giving ample time to review the facts and opinions
should allow everyone to recover from any such unwarranted beliefs.
THE PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
If the patient has valued and affirmed his or her life,
then the conscious choice for death
and using his or her own hands to achieve death
will be strong reasons to believe
that this death did not occur because this life was worthless.
COMPLETE RECORDING AND SHARING OF ALL MATERIAL FACTS AND OPINIONS
When the death-planning documents are shared with everyone
who has a legitimate right to participate in the end-of-life discussions,
someone who believes that the patient should continue to live
will have an opportunity to raise doubts
about the wisdom of choosing death for this patient at this time.
REPORT TO THE PROSECUTOR BEFORE THE DEATH TAKES PLACE
The prosecutor is aware of the danger of choosing death for others
because some people regard the patient's life as worthless.
Reviewing the life-ending decisions from a legal point-of-view
will assure everyone that no devaluation of the patient's life occurred.
CIVIL AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
And if death results from devaluing someone's life,
then the law provides appropriate consequences
for anyone who has harmed another person.
If these 18 safeguards do not seem sufficient
to protect against some patients being devalued as 'worthless',
there are several more listed in the complete catalog of safeguards:
Each of these descriptions contains a few paragraphs
explaining how that safeguard will discourage
all forms of choosing death too soon.
March 1, 2007; revised 3-22-2007; 8-30-2008; 11-14-2008; 1-15-2009;
2-4-2010; 2-26-2011; 12-21-2011;
2-18-2012; 3-25-2012; 5-29-2012; 9-11-2012; 3-17-2013; 6-20-2013; 7-16-2014; 10-10-2014;
above discussion of the danger of some patients being regarded as
has become Chapter 5 in How to Die: Safeguards for Life-Ending Decisions:
"Certain Lives Are Worthless".
If you read this chapter because you were concerned
that the right-to-die might devalue the lives of some patients,
you might want to consider joining a Facebook Seminar
discussing this issue along with several other problems
that might arise in advancing the right-to-die.
See the complete description for this seminar:
Join our Facebook Group called:
Safeguards for Life-Ending Decisions:
Go to other dangers, mistakes, & abuses of the right-to-die.
A closely-related worry is explored in:
Protecting Vulnerable Patients from Discrimination.