I envision several changes. First, I would propose that strict guidelines be implemented that parallel those I’ve specified in Chapter Seven. Briefly, these would establish criteria for determining which patients should qualify to receive assistance along with safeguards and guidelines for clinical practice to protect both patients and health care providers.
I envision several changes. First, I would propose that strict guidelines be implemented that parallel those I’ve specified in Chapter Seven. Briefly, these would establish criteria for determining which patients should qualify to receive assistance along with safeguards and guidelines for clinical practice to protect both patients and health care providers.
Second, I would recommend changes be made in existing homicide statutes to include provisions with criminal penalties for both assisted death and mercy killing. Laws covering assisted death would be enforceable if the statutory guidelines and safeguards were bypassed. Similarly, mercy killing statutes could cover cases of non-voluntary active euthanasia, where issues of patient competence were involved or where someone acts on his or her own without a final request in carrying out a patient’s earlier expressed desire to die. In cases where motivation is proven to be altruistic and disinterested, penalties might well be nominal or nonexistent, but these would need to be determined by a court of law and the burden of proof must reside in the defense.
Third, I would call for creation of bioethics committees through regional hospitals and local medical societies that would be charged with overseeing cases of assisted death by advising physicians on difficult cases (in terms of clinical procedures, guidelines, standards for care, and patient qualification), receiving in-depth reports from physicians on each case, assessing these reports, and passing on their findings to state medical licensing boards or other governing bodies for data collection purposes. This regional bioethics committee might do well to include a “law enforcement” representative from the local medical examiner’s office to ensure compliance with the law, and others, such as representatives from area hospices, to ensure a balanced perspective. Each case, however, would be handled confidentially to protect patients, significant others, and physicians from the kind of violence and emotional abuse that has dominated recent abortion battles. These regional committees could even oversee continuing medical education efforts locally on issues involving pain control and end-of-life care.
Fourth, I would argue that patients requesting help be interviewed about their decision by someone other than their primary care physician to discuss motives, ensure that coercion has not occurred, and ascertain that such a decision did not originate with any suggestions from their physicians — an act that should be considered a criminal offense. In the case of patients who are hospitalized, this investigative function could be carried out by the hospital social worker, a patients’ rights advocate, or hospital ombudsman. Patients in the community might be interviewed by a hospice social worker, patient rights advocate, or a psychiatric social worker or someone similarly charged with performing mental health assessments.
Finally, I would like to see a team approach be implemented in proposed cases of assisted death. As in the hospice model, physicians would not forced to act alone, but would have other professionals such as nurses, counselors, and social workers available for input. In this way, assisted death would be transformed from being the private act that it is currently to one that where the full circumstances of a patient’s situation is brought into the equation. In fact, I would argue that hospice itself, with its physical-psycho-social emphasis and the opportunities that it provides for emotional counseling and respite care, make it a natural entity to provide assisted death as an extraordinary option for those under its care.