Not all safeguards are created equal

If you thought that the safeguards prescribed by Oregon’s medical assistance in dying (MAID) law, and the similar laws in eight other jurisdictions, are too onerous, there are others to consider.  James Leonard Park has proposed numerous others–perhaps as many as the mind can imagine.  

Park, from Minneapolis, received a Bachelor of Arts degree (philosophy and humanities) from the University of Minnesota and a Master of Divinity degree from Union Theological Seminary in New York City.  He has written extensively about end-of-life  (EOL) issues, along with numerous other topics, publishing much of his work on the internet, where it is free for all to read.

I first became aware of his EOL writing about six years ago, and he has been an occasional commenter on FEN’s blog.  He believes in safeguards–lots of them–to carry out the decision to hasten one’s death.  His formulation of safeguards for reviewing life-ending decisions could involve from 26 to 54 or more people, according to his own calculations.  Park writes,

Medical decisions that will bring one human life to an end are among the most difficult choices ever faced by human beings.  Therefore, 26 safeguards are recommended below.  And each of these safeguard-procedures involves the personal and/or professional opinions of a number of people.

Many of his safeguards fit into the framework devised in Oregon’s MAID law and the framework followed by Final Exit Network (FEN).  Park wants to be cautious about how people make the decision to die, a position with which I agree, as a general proposition.  However, I favor more autonomy for individuals in deciding when and under what circumstances they might end their life.

Park seems to favor a medical model involving not only clinicians, but medical institutions.  For example, he suggests having a third clinician confirm the opinions of two previous clinicians in some cases: 

F. CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE CONDITION

Sometimes a separate statement of terminal illness should be created.  And it would be best if the hopeless nature of this case were affirmed by another independent physician.

I may be missing something in his reasoning, but if I decide that two clinical opinions are sufficient for my decision-making, I see no reason to add a third.

Another safeguard Park proposes is to involve a medical institution:

I. PALLIATIVE CARE TRIAL  The patient should actually receive comfort care in a medical setting by professionals in symptom-relief.  Only when the patient still wants to die even tho (sic) he or she is receiving the best possible palliative care would a life-ending decision be recommended.  At least three medically-trained individuals would be involved in this end-of-life comfort care.

Park seems to believe that receiving appropriate comfort care has the potential to change a person’s mind about wanting to hasten death.  While that could be true for some people, it has not been my experience with many people who want to hasten their death that they are just not receiving adequate palliative care, though that is a concern for some people.  Usually, though,  their decision process is much more involved.  The quality of a person’s life may be a greater concern than suffering.  Also, some people lack the financial resources, energy, and personal desire to seek out endless medical care once they have decided on a hastened death.  Most have tried to get adequate pain relief and would not want to be told they have to jump through yet another hoop to carry out their decision.

Two related safeguards that Park proposes confuse me:

C. THE PATIENT IS MENTALLY CAPABLE OF MAKING A LIFE-ENDING DECISION  If the mental powers of the patient or the ‘reasons’ for choosing death are questionable, then a psychological professional should evaluate the patient’s wish to die.

K. REQUESTS FOR DEATH FROM THE PROXIES  The duly-authorized proxies appointed by the patient might be called upon to make an official request for death if the patient himself or herself has already passed the point of being able to make wise medical decisions. 

If it already has been established that the person requesting a hastened death is mentally capable, no proxy would be involved.  Proxies act only when the person is no longer mentally capable.  If a person is not mentally capable, no MAID law, nor the procedures of Final Exit Network (FEN), permit a proxy to request a hastened death for another.  And it is not clear that by a “wise decision,” Park means a decision by someone who is mentally competent.  Perhaps Park is suggesting that a proxy be allowed to second-guess a decision by a mentally competent person.  I can’t tell from this formulation.

Park next suggests involving several other people in the decision by seeking their agreement or disagreement with the decision.  These include those who are providing care in a medical institution (“hospital and hospice staff members”) and an institutional ethics committee (should the person be a patient in a medical facility), family members, and a religious leader (“member of the clergy”). 

 A few optional people could provide further safeguards if desired by the person choosing a hastened death:  “those close to the dying person” can be asked “for a written statement of how religious or moral principles might apply” to the decision of a hastened death.  These optional contributors of opinion might also include  disability advocates, or a public prosecutor or other attorney for a legal perspective. 

This last item might receive my strongest disagreement, followed closely by involving a disability advocate.  I cannot imagine any time that I would want to involve a public prosecutor in a decision to hasten my own death.  Inviting a government official responsible for prosecuting criminal offenses to weigh in on what is a personal decision about my life is asking for government intervention.  Allowing people opposed to the right to die to do so is, likewise, a mistake that invites unwanted opposition and scrutiny into what should be a largely private matter between a person and the person’s family and friends.

Even involving medical personnel in a decision to hasten one’s death can be disastrous, as I have explained in earlier posts here and here.  It can result in involuntary hospitalization in a mental health facility as a suicide risk.

Park explains, “With so many people involved, there is much less chance of  this planned death being a mistake or an abuse of the right-to-die.  It will be a timely death—not too soon and not too late.” 

I agree that following Park’s 26 safeguards make it less likely there will be mistakes or abuse, but this is mostly a non-issue based on experience in MAID jurisdictions, if all MAID safeguards are followed.  However, it may well not be a timely death in the view of the person wanting to hasten death.  If too many people are involved, the period to achieve the hastened death may lengthen to the point that the person experiences grievous suffering, as well as enormous frustration.

But my primary objection to following Park’s safeguards is that what should be a private, personal decision will become virtually a public spectacle, especially if his optional safeguards are followed.  My view of personal liberty precludes asking ethics committees, clergy, caregivers, prosecutors, attorneys, and extra clinicians to weigh in with their opinions about a decision to hasten my own death.

I have twice during the past week invited James Park to reply with a post explaining his views.  To date, he has not responded to my offer to write a reply.