The Right to Die: The Suicide Checklist

flying cadeuciiPhysician–Assisted–Suicide; the collaboration of two through a professional relationship, to cause the death of one.

Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned.  Today, many argue that we have a right-to-die, sort of an infinite extension of free speech or thought.   Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow mend disease.  For a healer to take life is bizarre and threatens the physician-patient relationship.  If individuals really want and require assistance to die perhaps there is another solution.

A long trail of vital documents marks our lives. These include birth certificate, diplomas, driver’s and marriage license, advanced directives, wills and most recently the POLST. Perhaps we should create a new personal document.  Its purpose would be to give each person not only permission to kill themselves, but access to the means.  A permit controlled by the patient and only their responsibility.  A passport for dying.  A Suicide Certificate.

The Suicide Certificate would be a kind of application.  A legal checklist, which once complete would allow the individual to die by their own hand, but in a controlled and definite manner.

What would go on this form?  First, basic demographics; name, birth-date, address, social security number, etc.  It is important to confirm that the right person is filling out the form.  A photograph might be a good idea.

Next, statements regarding right-to-die laws.  This could include a review of the sanctioned methods available, as well as the legal indications and limits for committing suicide.  It might remind the applicant that a terminal disease is required, what is and is not a qualifying medical condition, and that suicide pacts are discouraged and therefore forbids sharing the lethal prescription. The whole form might start on-line and as part of the process an instructional video must be viewed and review answers given correctly, before it can be printed.  Alternatively, an app could be developed.

If the state requires terminal disease for suicide, the form should have a place for a doctor to confirm that the patient is dying.  Two signatures from the physician would be required, on two dates at least two weeks apart.  Either the specific disease must be entered, or, to protect privacy, a general statement of imminent natural death.  This means that while the doctor is involved in the application process, his/her role is not to prescribe the means to cause death, but rather confirm the presence of disease.

There might be a counseling section, which would require that the patient speak with a psychologist, social worker or clergy.  As an alternative a signature from a healthcare provider, other than the primary treating doctor, which affirms that the patient is not psychiatrically ill and understands their actions.

Finally, a list of organizational reminders to help with final plans.  “Is your will complete?” “Have you emptied your safe deposit box?” “Does your family know your plans and do they have copies of your important papers?” “Have you completed funeral arrangements?”   “Have you determined who will discover and/or handle your body?” “Have you said good-bye?”

Once the form was complete, itemized and notarized, the patient would take it to a suicide-assistance-registered-pharmacy or perhaps a specialty funeral home, which would exchange this ultimate document for death-inducing-drugs.  The sealed suicide kit would come with a final instructional booklet, including safety warnings.

While this idea is bureaucratic and strange, it does achieve two goals.  First, it removes doctors, healers, from the direct ordering of death.  The final signature at the bottom of the form, the “order” for the drugs, is the patient’s.  The second is that it empowers those who believe in suicide a legal outlet, as well as the tools to act.   If there is a freedom to die, then the responsibility must be each of ours, alone.

James Salwitz is an oncologist. He practices in New Jersey. 

8 replies »

  1. Certification for suicide should be available online. Your life is your own. Suicide certification could be away to make sure that foul play is not suspected, privacy is provided and your relatives can be contacted follow your death. Quality or compassionate mental health services are not available, so at least society should make end of life easy for people who are suffering.

  2. Well, if there is anything like a Suicide to occur, the best thing is to prevent it. I would recommend to avoid any suicidal thoughts, and tendencies, where so ever. And, moving further, it is important to keep a check on who is feeling how.
    This is why, a Suicide Certification, will be a great idea. At least, this can be a way, which we can help people with Suicidal Thoughts. It can be a great way of doing so. I am in support of it.

  3. I think getting a Suicide certificate before ending your life is a great idea . These days we find lot of patients struggling with lot of difficulties to survive . For such type of patients this certificate would be beneficial . Along with issuing this certificate one can also think of pre-arranged funeral with the help of Unity funerals ( http://www.unityfunerals.com.au/ ) professionals so as to minimize stress and cost on your family .

  4. Call me a prude……
    Who should pay for this suicide kit?
    Why should it be OK for a pharmacist to give the drugs, but not a doctor?

    The issue is really counter to health care as you are advocating death care. We die when we die, when our time comes. If someone wants to commit suicide, let them, but nobody else should be involved.

    That’s an accomplice to murder/suicide or whatever other word we want to use there.

  5. Rachel, you make a goo point. But in fact there is no “proper” way to discuss this mostly taboo subject. A checklist, no matter how perfunctory it seems, will at least obviate impulsive self-destructive behavior and rattle loose irrational thinking.

    I have followed Dr. Salwitz’ blog for some time (though not lately) and found him to be a totally compassionate and realistic man. His blog, Sunrise Rounds, is easily found. Go there and look around. You may come across reflections and observations that change your mind.

    In addition to the two links I left above, get hold of Atul Gawande’s latest book, Being Mortal, and explore some of the smartest end-of-life writing to date.

  6. I found this article strange and slightly disturbing. It almost seems as though “The Right to Die” issue is being made fun of, suggesting an “app could be developed” for a suicide checklist.

    Also, this so called “suicide checklist” would have questions such as, “have you said good-bye?” This “organizational reminder” seems cold and inappropriate to ask someone who is terminally ill.

    I realize the main point of this article is for someone to ultimately take responsibility for death, but the way this suicide checklist seems tasteless and impersonal.

  7. I recently wrote and published a novel — The Last Resort — about an African country that legalizes physician-assisted suicide as a way to attract tourists, much like India and other countries attract medical tourists. It focuses on the needs of people world-wide who want to control their own end, just like Brittany Maynard did. It showcases a family that struggles with the decision and the fallout from others.