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License to die ?

Could there be a license to die ? Would it help relieve terminal suffering by putting everybody on notice that a person was coming to the end of their life?

Emails to the ERGO List started this unusual debate:-

To begin with, Derek Humphry wrote:
The report for 2005 on the state’s physician-assisted suicide law by the Oregon Department of Human Services contains a description of the part physicians actually play in the assisted suicide of dying patients.

What strikes me as interesting – and troublesome — is the third paragraph which says that in the beginning of the law’s implementation doctors were at the bedside about half the time but now presence at the bedside of the patient happens in about a quarter of the cases.

It is my belief is that if a doctor is willing to prescribe the lethal overdose [in accordance with the Oregon law] then he or she should also be present at the end to ensure that it works properly. This is serious stuff. And why the huge drop in the number of doctors who are willing to be at the bedside? Complacency? Nervousness?

This emailed opinion then set off this unusual ‘licence to die’ debate:

I think there might be at least one more reason: the patient and/or family don’t want the doctor around.

Physician-assisted suicide is misnamed. All the doctor does is write a prescription; he doesn’t really assist. Outside of that prescription writing, I’d like to get the professionals out of the picture entirely — no psychological evaluations, no second opinions.

I favor a system in which a person, some years in advance, gets a license to die from the state and, after one renewal two or three years later, can use the license to get an appropriate prescription from any doctor. Subsequent renewals of the license would be required every three years or more.

–George Delury. California

I consider this the most brilliant proposal I have read in these pages for a long time. An innovation that might very well be possible to sell to the public and to legislators, since it reflects the basic concept of Living Will and Advance Directive.

Why not explore this? It would be a great subject to propose at the forthcoming World Right-to-die Conference in Toronto.

–Dietrich von Haugwitz, Illinois

I see the process of enabling the patient to choose the means and timing of death in a socially approved context to be empowering. If the prescribing physician decides not to attend, I assume it is in accord with the patient’s wishes and does not represent a significant risk to the patient. I also assume that the patient is not alone, and that if need by the physician can be called for on short notice.

–E. James Lieberman, M.D.

Dietrich von Haugwitz was very impressed with George Delury’s idea for death licenses and suggested that it be on the program at the upcoming Toronto meeting of the World Federation of Right to Die Societies (in September).

There actually is a Canadian connection. Twelve years ago a Canadian doctor/ethicist named Eike-Henner Kluge made a very detailed law-reform proposal to the Special Senate Committee on Euthanasia and Assisted Suicide. Among other things, he proposed instruments which he called “permissions” but which were very similar to what George calls licenses.

–Ruth von Fuchs, Toronto, Canada

Though I commend some parts of the licensing suggestion, requiring a person who wants to die to get a license and then wait two or three years to die with assistance seems to me utterly crazy.

–Dick Wirtz

Granted, when you are ready to exit, the 3-year license makes no sense. But think of all us who – while still in good health – write a living will. The latter merely expresses the hope that, when the time comes, doctors will refrain from extraordinary means to extend our suffering. This license would constitute a guarantee that, when the time comes, we can choose to exit.

–Dietrich von Haugwitz

I am aghast at anyone proposing two or three years wait before a ‘death’ license be granted. I am appalled at any suggestions of three months, whether renewed once, twice, or three times every three months. I have been opposed to anyone having to wait 15 days plus repeating their wish in voice and in writing. (Writing can be totally illegible by this time.)

When one is really terminally ill, or has an incurable condition for years, surely that person has given serious consideration upon asking, and receiving, all the treatment possible and all the information from doctors, and does not ask for death release until having done so. Give me a week, or even less, depending upon the situation. Haven’t we learned to ” think before we speak,” especially relating to serious matters, from little up?

No license should be needed at all. We need our legal rights to choose our death with dignity as few governments now honor, and we need a short time once we have had at least two doctor’s forecast. I honor the individual who gives serious thought to life from the very beginning, and thus who knows when the time is right to leave, having had medical treatment and information steps covered. Maybe we should make suicide illegal again.

–Ruth Beard, Asheville, NC

Dick Wirtz misunderstands the two or three year wait I proposed between the time the license to die is first taken out and its use. That long lead time will require people to think about death long before they need to (something even the very healthy ought to do) and make clear that the subsequent suicide is not the result of a rash impulse but stemmed from a long-held conviction.

If you wait to the last minute to think about a dignified choice of death, you are probably going to be out of luck under any legal system.

–George Delury, California

My proposal of a two to three year wait before a license to die can be used would, if legislated, be unfair to those with an immediate need. However, I think that if legislators are ready to approve such a licensing system, they would also be ready to approve a temporary measure to meet the needs of those with more urgent problems — something along the lines of the Oregon law, but with a some provision for those with incurable as well as terminal conditions.

I have looked at the proposal of Prof. Eike-Henner Kluge of the University of Victoria, B.C. [ www.righttodie.ca, then Researchers Buffet, Laws/Proposals, Within Canada, Proposals, Another Proposal)] It requires a petition to a court for approval of physician-assisted suicide under a variety of circumstances, some of which involve euthanasia of the incompetent. Euthanasia for the incompetent, except for a person with a license to die, is another issue that my licensing proposal would not address. Prof. Kluge’s proposal might be applicable in those situations, but perhaps the Dutch will come up with a better approach, one that does not turn the issue into a costly legal battle.

I am much heartened by the approval of the licensing idea as expressed by several mail list respondents.

–George Delury, California

Requiring a license to die with dignity is outrageous. Do women who seek a termination require a license? They most certainly do not, because the government has made it clear that a woman’s right to her body and privacy implies the right to abortion.

Why should a person seeking a dignified death be required to possess or obtain a license to do so? The right to control one’s own body and the right to privacy obviously implies the right to die with dignity and a time and place of one’s own choosing. For anyone to deny that this is blatantly obvious is at best sheer ignorance, and at worse, sheer arrogance.

If the government is going to make a concession for women to terminate what many consider to be *another* human being for *any* reason, then why won’t the government afford those suffering miserably from a terminal illness who have repeatedly and consistently expressed their wishes to die, the right to end their *own* lives with dignity in order to end their suffering???

Government, it seems, is unbelievably asinine. I agree with those who point out the obvious inconsistencies. Perhaps the medical and health care industries do not want people to have the right to die with dignity because they are afraid of losing some profits from all those dying patients who would have, if given the option, chosen to die with dignity rather than unnecessarily spending the rest of their days warehoused like animals in the company of strangers while having to spend exorbitant amounts of money to be kept alive *against* their wishes!!!

It’s time for a change. And right away!!!

–Benjamin Dowse, NSW, Australia

If all we’re really arguing about is time frame, this licensing suggestion must be very good.

Though I’d like to believe that everybody who will want to be assisted in dying will be clever enough to get a license years in advance of the need, I am afraid that for many reasons (incuding inability to face up to the prospect of becoming ill with a terrible disease) many people who will eventually wish they had will never get a license until it’s too late.

–Dick Wirtz

I am rather surprised at some of the reaction to my proposal of a long waiting period before a license to die could be used. Let me clarify.

Such a license would be applied for by people who are in good health, who facing no immediate life-or-death decision, but but who know that such a decision will have to be made some distant day. It would only work for those who look far ahead.

During an interim period of five to ten years, perhaps, something like the Oregon system could deal with those facing an immediate need. But once the licensing system is fully in place, those who do come face-to-face with that critical decision without a license to die will have no recourse. If they did not think about death while they were healthy and act to obtain a license, they will have to fall back on the current exit methods, most of them brutal and unreliable.

The licensing system will only work for those that shed that British and American habit of mind that shuns the thought of death, emotionally denies its inevitability, and/or procrastinates. It will also be useless for those who are uniformed about the useless cruelities of some modern medicine or that place unreasonable faith in doctors and medical “miracles.” The primary reason for my proposing this licensing system is to counteract that psychological and moral foolishness.

Other reasons include its affirmation of individual responsibility and the need for reasaonable forethought, its application to those suffering incurable but not terminal illnesses, and its avoidance of “better-knowing” interference from medical and legal professionals. The license, incidently, would also designate an assister (not necessarily a doctor) in the event the license holder becomes incompetent at some future time.

At bottom, the license idea is simply an extension of the Advanced Directive on Health Care Decisions with a time-lag to demonstrate a well-considered long-held intention.

–George Delury

I think this licensing idea is brilliant. It will give peace of mind to those of us who have some idea of what the future holds. For me, the two or three years later for renewal would be too long. In urgent cases such as mine where big invasive ops are out of the question at 87, I’d like three
months with three monthly renewals.

–Pauline Reilly, Aireys Inlet, Australia

Subscriber Benjamin Dowse had written:-
”Why won’t the government afford” those suffering miserably from a terminal illness who have repeatedly and consistently expressed their wishes to die, the right to end their *own* lives with dignity in order to end their suffering???”

I couldn’t agree more with those sentiments. Benjamin may have missed some of the correspondence on the license idea though. The way I understood it, the ‘license’ proposed by someone on this list is a way of repeatedly and consistently expressing a wish to die.

As an alternative to the advance directive, the license should leave more control in the hands of the person who wishes to die. ie:- provided the ‘license’ conditions are met, you don’t have to wait until you’re incapable and at the mercy of others who might or might not honour your advance directive.

–Lynda Cracknell, Queensland, Australia

I agree wholeheartedly with Mr. Dowse who said, “Requiring a license to die with dignity is outrageous.” It ought to be easy and honorable to leave with dignity at a time of one’s choice.

Unfortunately, it is not easy. Quite beyond the asininity of frightened governments and greedy medical systems, many persons are not able to end their lives by themselves. A license would show that dying was their choice, not the act of a diabolical assistant.

Further, acquiring the means to end one’s life in a dignified fashion is not easy in many places. A license would entitle the desperate or their assistants to obtain the means easily and legally.

And most important, the idea of a license is something frightened politicians can understand and are more likely to agree to than they would to a carte blanche for assisted suicide for just anyone by anyone.

If there had been a license to die in New York in 1995, my wife’s death would have been much more dignified, her family and friends could have been at the bedside, and I would not have spent time in Riker’s Island prison for assisting her suicide.

–George Delury

What would be the qualifications for a license? Think of the great interest of various business enterprises in obtaining the list of license holders….It boggles the mind.

–Steve Schanes, San Diego, California

I understand the debate about the particulars of a “license to die.” I respect those who point out that the idea is foolish-but…

Such license is merely a negotiating ploy — a tactic to alleviate the fears of some who are concerned about the possibility that the right to die might become the right of others to dictate that you must die. The tactic may also serve to undermine the ridiculous arguments of the opposition to the right to die. It gives “them” some measure of control over the final decision of whether to grant the license or not.

As such, a license might merely be a step along a continuum of progress toward eventually gaining true freedom. Many civil and human rights movements make progress with similar fits and starts–first seeking a small piece rather than the whole pie. Such compromises do not undermine the rightness of securing the “whole” right. They merely acknowledge human nature and respect the fact that, in most cases, change is a process.

Whether or not a license to die ultimately has merit as a tactic in this long (too long) battle depends on the context in which such a proposal is made. A license that serves as an advance declaration of a person’s intent and preliminary evaluation of competence that person to make such a declaration is little different from the process that already exists in Oregon. To the extent that such license would strengthen and coordinate with other elements in an advance directive — a living will and a medical durable power of attorney — and to the extent that such license would further empower individuals to exercise their last human right C, and to the extent that such license would provide legal shelter to those who assisted with hastening the death of a licensed person, a license to die might have value.

In a perfect world we wouldn’t waste time discussing such foolishness, but in our world, unfortunately, such foolishness is often how things get done.

–Jim Moore, Aurora, CO

I have been opposed to the licensing idea, but I think Jim Moore’s argument for it is very persuasive. The point that I and possibly other writers have missed is that we have to start somewhere.

–Dick Wirtz

It is amusing and fascinating to read this lively debate about George’s modest proposal. Before we expend more energy arguing among ourselves, why not put the idea of licensing to our own sympathetic legislators and see if it would fly any more easily than any of the other RTD proposals considered over the years?

My detachment may stem from the two “teachings” I’ve had these last two days from the Dalai Lama. Though he hasn’t touched on the issue specifically, in the past he has spoken tolerantly of euthanasia in the face of unbearable suffering as have some of the other Buddhist writers I have read here. Of course his primary interest is the suffering of the Tibetan people. In China even possession of his picture is a crime!

–Faye Girsh

My deepest thanks to Dick Wirtz for making a cogent argument for my idea of a license to die. I believe it is an idea that will spread to many who might, at first glance today, be opposed to assisted suicide.

And as medical science grows even more powerful and all-consuming, it may be an antidote that many will welcome.

–George Delury

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