The Suicide Certificate: A modest solution?

Physician–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.





  • To be honest, I would like to see more patients taking responsibility for a number of actions. Same for doctors but not in the sense of what you are thinking of. I like what you have here, just wish it wasn't that paperwork oriented.
  • Could do without the organizational reminders James I really don't understand why you are presenting this trivialised argument. The cry for change comes for those who are past healing and with full attention and with all their strength they have come to a terribly difficult decision which for them has nothing to do with doctors and their well meaning advise. The freedom should indeed be each of ours alone the compassion of a supportive legal system and medical workers who do not seek to control but rather to lovingly help and support is what we need. A simple death certificate, as my brother had with the cause of death given as the horrible disease that actually caused his death is all that is needed.
  • Sigmund Freud had an arrangement with his daughter and his doctor about the decision he made after he started to realize his end with cancer of the jaw, I believe. He was given an overdose of morphine and his body was cremated. His contributions, still constantly reviewed and thought about are,still brilliant. I think there may come a time when a choice makes sense for some people..good post!
  • Liz
    This sounds to me like paperwork to protect the doctor from a wrongful death lawsuit if the patient's family disagrees with the patient's action. This sounds more doctor oriented than patient oriented with a reminder to get your affairs in order before you do this. While superficially this resembles a DNR request, in fact the decision to commit suicide is far more complicated. If you look at the research about suicide depression can play a large role and counseling years or even days prior to choosing to do this is not the same as counseling in a moment of crisis. When my father died this way, the facility had a "cooling off" period, all of us (my mother and us kids) had to agree to let him do this, there was counseling… For thousands of years people have chosen to die "early" when terminally ill or very old and failing. Many societies have accepted ways for people to do this in ways that are not "wink wink" and above board. Be it walking out onto the ice or into the forest or stopping treatment thus shortening life but potentially increasing quality of life in some cases…or stopping medication that controls chronic conditions, or not even getting treated to begin with… My grandmother used to tell us that we needed to take her out and shoot her like a horse under certain circumstances but no one did, even when stopping her cardiac medication would have accomplished that. My aunt stopped all ovarian cancer treatment and then stopped eating. My father had his breathing assist tube pulled and was given morphine. My grandfather chose not to treat cancer at all… My other grandmother spent 7 years in a nursing home begging to die. My grandfather didn't even being treatment for a cancer, my other grandfather died of cancer while in treatment. An uncle stopped cancer treatment early on and pulled his breathing tube because he had a rare side effect that trashed his lungs... It sounds like you don't want any part of this, are afraid of lawsuits, and rather the dying involve more "passive" actions on your part such as no longer prescribing drugs, not pushing patients to continue chemo and not working to change their mind, etc. This is a slippery slope and you are already on it sliding down that hill. All your paperwork would do is protect you from lawsuits and get the patient's wishes out in the open. We already have ways we deal with these things - it is just that we don't talk about these topics quite in this blunt, out in the open way. It sounds like you prefer to be a part of death by "omission" rather than by "commission"… (never mind that we will all die anyway, eventually, some sooner than later)… In business speak, you'd rather outsource the actual death part to hospice, given a choice. All that being said, many people who have said they want to die, in the end choose not to (see the research on the states where people are allowed to take home with them drugs to do the job but then never use them). What some people want is the choice, have that choice decriminalized, and not be trapped by a doctor who doesn't even acknowledge that this could be a choice or actively works against their wishes in this respect. You would seem to deem acceptable stopping chemo - but where is your line to saying I'll go along with this rather than go along with a family member trying to prevent the patient from doing so? Is there a difference if the patient choosing to do so is 10 vs 80? Just how far into the "no curable" curve do they have to be for you to agree it is appropriate? Do all doctors agree with where your line in the sand is...? You are already making slippery slope decisions in treatment or lack there of, with being open to patients stopping chemo (or even suggesting it) and entering hospice… You just want a longer time period, a further distance, between your actions and the patient's death. And this is not uncommon. And I think very human. Heck I struggle with euthanizing my animals when their quality of life is horrible because it is killing (and of course because I am emotionally attached to them) and feel awful when I hit an animal with my car. Using another imperfect example this is also kind of like abortion. While on one level I believe that people have the right to choose what they do with their body, it is not a choice I could ever make under most circumstances, perhaps under any circumstances - but I don't know for sure unless I was in a situation where this was personally relevant to me. But back to the point here - how will I choose do die presuming I even have a choice? I don't know, but what I do know is that there are many active and passive ways for doctors to have a hand in a patient's death - whether that death then is almost immediate or sometime in the future. I know I want a doctor who is open to all the choices on that slippery slope, not just the ones where they can emotionally and temporally distance themselves from this because their choices of those of omission where the act and the result of that act are separated by enough time that they can then pretend/believe that their actions aren't contributory… and I am equally as sure that I’d never survive in a profession where I couldn’t somehow emotionally insulate myself from the emotional fall out of having to make decisions like this; I’d need the veneer of an “act of omission” isn’t also “an act of commission” if one were to look at the decision from a different point of view…
  • meyati
    It took me 2 years to get a DNR in my system. If 911 is called, you become a ward of the state and they are legally required to resuscitate. A few months ago, it became legal for doctor assisted suicide,--but look at the previous sentences. I don't know if can find a doctor that will help me. Also-doctors and patients filed this tort-and judges ruled that people that have chronic and painful conditions can legally have a doctor assisted.death. Doctors had people in wheelchairs that were obviously suffering greatly, but death was probably years or decades away. Considering that when I asked for a DNR-I was asked if I was suicidal, I think this paperwork is pretty good---I told them that if I wasn't in my right mind, I would have gunned them down long ago for not signing my DNR. I also told them that the DNR did not give me permission to commit suicide, and a person that is suicidal does not need their permission to do so. So why can't I get a DNR? Anything that moves us into where a person can legally do what's best for themselves is progress. Anything that stops others from interfering in the doctor-patient relationship is good. Anything that gets these pompous better than thou counselors and doctors off of a patient's back-and recognize the patient has rights to die in dignity-the patient has the right to say, "Enough already, my family and I can't take any more." This article has a Catch 22 in it. If a patient tries to fill this out a bit early, the doctor and others probably wouldn't sign off on the paperwork because it would be so premature. If the patient is in pain and really needs this-can be considered not in their right mind because of either the pain or the medication. I live in an area with many Native Americans that make their own arrangements. I don't see why a funeral arrangements would be part of this. If you have to take jewelry, bearer bounds out of the safe deposit box, that person could have everything ripped off. There are a few more problems---It's basically well thought out but--
    • Oh my YES! I had all my affairs in order for like 10 years, and then legally done a couple of years earlier. I once mentioned I didn't care if something happened, everyone was provided for, and that got taken as evidence of mental illness. So making sure everything you have and everyone you have is taken care of is wrong? Not helping your family to grieve only in that time rather than tons of work to do with grief on top of that is wrong? Then again, the doctor in question had his own "issues" with "patient control" so I should not apply to this all. I do expect them to ask.
  • Having read this post again; When my brother went to Switzerland to end his suffering he was given a thorough interview and a lot of form filing and medical checks one would expect. He was interviewed by a doctor and had to provide proof of his illness. When he arrived at Dignitas they again, a number of times, questioned what he was doing there and why he had come. They filmed him stating his intention for the purpose of showing the police and coroner..No opportunity to question his intent was missed. He was clear and centred, brave and unshakeable. Why is it so difficult to understand this is not about the dying persons relationship with his or her doctor and the medical profession. It has nothing to do with the world of medics and what they can or cannot offer. It is far bigger than being controlled by those who know better. It is about an individual's clear intent to stop. To stop suffering To stop pain. To stop living in fear of being denied the end they choose for themselves. It is not about the doctor or nurse and how much he or she has to offer. it is about the man or woman who feels they have come to the the end of their life. How can anyone with a scrap of compassion and humanity deny them. At the end of the day it is about love and gentleness and giving. The paper work is the least of it.
  • Susan
    Doctor, all due respect, but I'm frankly shocked that this is even in the conversation before you asco doctors get that house in order as regards bringing treatment protocols out of the dark ages. Do your job in policing your oncology practice ethics to insist that the FDA approve known treatment advances (such as palbociclib) which is light years ahead of chemotherapy in er + breast cancer in all regards including side effects and pfs. There are other such examples of known improvements in other cancers which are continuing to be slow tracked by FDA. Chemotherapy is not even a legitimate solution, as far as treating the underlying disease in most cases, yet it is the asco go to strategy, which is pathetic. The FDA is asleep at the switch in many regards and suicide is what is being focused on in the oncology profession? Really? What is going on now in oncology vs. protocols which should be in place reflects a cart with one broken wheel, the FDA. Use your powers for good, rather than sticking your head in the ground like an ostrich. Confront the FDA and insist that oncology be brought out of the dark ages with improved protocols that are better than the current barbarism. I'm pretty sure that you took an oath to police this profession however the public is being shortchanged with the current failings.
    • Excellent point. I just saw an article on surgical fires. One place studied its protocols and basically eliminated them. Other places haven't done it because they're not focused on the patients but on profits.
  • D Someya Reed
    Oh, Oh, Oh...Hold me back! Where do I begin? Suicide has been around for as long (I'm actually sure it's been longer) than its medical, ethical discussion which has ended in the rationalized justification of the Doctrine of Double Effect (more on that later). No paperwork of any kind gives anyone "permission" to kill themselves as we all have always had that ability with or without documented permission. No State in the U.S. currently prosecutes someone for attempting suicide. There are ramifications to those who are successful but those mostly have to do with the passage of property to heirs, insurance claims and, in essence, money. However, If you assist someone else in attempting or completing suicide...too bad for you. You are going to jail. Maybe not, though, if you are a doctor or a hospice. This is where the Doctrine of Double Effect comes into play. It states (as well as, is interpreted) that even if the physician knows (or suspects) that his/her actions (usually via medication given) may hasten or actually cause the death of a patient then as long as the "intent" of the physician was to relieve pain & suffering all is OK. NO ONE would ever abuse this power, right? So why is it that we, the patient population, are expected to accept without question that the intentions of all physicians and their support staff are beneficent and beyond reproach in these circumstances? Yet we, the patient population, are deemed too ignorant (not stupid…there is a difference) to determine if our intentions are correct or not. BTW Liz, your comments are absolutely correct! I would go so far as to add that, in my opinion, ALL medical paperwork is to protect either the practitioners or the payers (insurance companies) and not the patient. In a previous post, "Murder: an urban legion?" besides being shocked (myself) that you were so astounded at even the possibility that this could be happening (physician assisted suicide on the QT), you stated that "Professional caregivers, especially at the end-of-life, often take advantage of the centuries old concept of “double-effect.” Well, since it's so widely reported and seemingly accepted that traditional physicians in hospitals are unskilled in end-of-life circumstances and under-medicate out of fear of reprisal then what we're really talking about is hospice which is without a doubt the largest group using the Doctrine of Double Effect to their advantage (exemption from prosecution in questionable cases, if anyone ever could get that far). You also stated, in that same post, that you "suspect that most of the time what is seen as intentionally causing death is rather intentionally providing comfort with the possibility of death. The complex situation at the end-of-life caused by fear, anger, fatigue, deforming disease, treatment, other illness, complication and aggressive comfort measures, makes it very difficult for the lay person to sort out what is cause and what is result. A caregiver’s inadequate explanation such as, “the time has come to make her comfortable,” or, “we cannot let his suffering continue so I will hang the morphine drip,” may be very confusing." So, I'm going to lay out a few actual circumstances that happened to us and I'd appreciate it if you could tell me how I would or could have misinterpreted the actions of the hospice management and/or staff. 1. Our original hospice nurse wrote in her last end of day report that my wife's case "was complex" and she asked to have her case load reduced or share my wife's care with another nurse so as to give my wife the appropriate level of care. For this, she was immediately removed without notification to us and replaced by another nurse the very next morning. What was the intent and why weren’t we told when it is required by the Conditions of Participation? 2. The 2nd hospice nurse didn't physically show up for a week and a half and only after me calling the hospice twice and asking as to why the no-show. The hospice nursing supervisor I spoke with told me that the first hospice nurse had a "medical condition" she couldn't discuss and, shockingly, had to have her case load reduced (a lie). The 2nd hospice nurse (for the week and a half no-show) wrote in his daily reports that I refused to let him in our house. Funny that the hospice nursing supervisor, when I called repeatedly asking when the 2nd hospice nurse would be coming, never asked me why I wouldn't let him in the house! She did ask me if we wouldn't be happier returning to home health care through the local hospital. What was their intent? What might I have misunderstood? 3. When my wife refused to be rolled on her side (as she was in the painful transition between paraplegia and quadriplegia while her spine ruptured a 2nd time...first the T12 then the C7 vertebrae...and a 2nd spinal cord compression occurred over a nine day period...not to mention the 30+ tumors in her lungs) the 2nd hospice nurse insisted that she be rolled on her side anyway to check for bedsores because there was always a possibility she might develop sepsis. Was this good medicine, good care? What was the intent as he said that if she did have any problem they weren't going to treat it anyway? 4. When my wife refused to be rolled on her side the 2nd time, the 2nd hospice nurse said that he could "medicate her to the point where she won't know what I am doing and I can get my job done." He never indicated in that day's or any other day's report that my wife was now fully quadriplegic. What was his intent in making this statement and obscuring such a major event? 5. The 2nd hospice nurse also offered to give my wife lorazepam to which I explained that she was fatally allergic even in small doses and offered him the name and contact info for the surgeon who discovered that she completely stopped breathing even under a very small dose and told us that she should never take it again. The 2nd hospice nurse still insisted that she take it as he explained it would calm her down (yet he was the only person in the room who wasn't calm). What would the layperson surmise was his intent? 6. The hospice wrote into the medical record that they conducted a special meeting just to discuss my wife's condition and their suspicion that I might be abusing her and trying to isolate her from others. Odd, since my wife's parents were staying with us, brother & sister in-law staying next door at the neighbor's, grandma came in from SF, aunt flew in from Honolulu and a near constant stream of neighbors came by to see how she was doing when hospice staff was there. The hospice neither reported their "suspicion" either by phone within 24 hours or in writing within 48 hours as required by law. Of course, that would have triggered an APS agent coming to our house to investigate. What might the hospice's intent have been? 7. I asked to have the 2nd hospice nurse removed from my wife's care team as the hospice nursing supervisor previously told me I could when we were finally informed about the 1st to 2nd nursing switch. My wife was overdue for a chemo-port flush and had her right arm painfully swollen 2-3 times its normal size probably due to a backup & buildup of fluid. The hospice said they would send another hospice nurse to do the flush but when they arrived they said we needed to sign a "new" contract first. The 3rd hospice nurse told us 3 things in this order: a. The contract was nothing more than a restatement of the original contract and that this was normal procedure when it was obvious that the patient/family did not understand what they originally signed (a lie). She added that they do this all the time. b. When I quickly scanned the 3 page document and found that it stated that we could not refuse anything the hospice wanted to do (either my wife or I) or we would be immediately discharged and I objected to this wording, we were told that we had to sign it otherwise if they continued to provide care the hospice would lose their license (another lie). c. When I stated that this was absurd, we were told that the hospice's medical, executive and nursing director's had jointly decided this course of action be taken without including our attending physician (a felony crime in CA) and that she (the 3rd hospice nurse) was told "not to lift a finger to help in any way" unless and until the contract was signed by both of us (and one of us being quadriplegic was irrelevant). If we didn't sign the contract, the hospice staff were to immediately walk out of our home and commence discharge. If we did sign but at any time refused anything the hospice wanted to do or interfered in any fashion their orders were to stop whatever they were doing, without respect to the safety of the patient and immediately exit our home and commence discharge. We were given an hour to decide and were told we must do so in their presence and all the while my wife's arm continued to swell. When asked if they could at least do the flush, they refused but the hospice nurse did lean over my wife and state, "Honey, all you have to do is sign the contract and I can make all that pain go away." I really want to know how I misinterpreted this intent of deliberate withholding of patient care to extort/coerce their desired result. Also, we were told not to bother trying to call our chosen attending physician because he was out of town. Intent, please? 8. When I brought up a contract technicality, as they had stated 3 regulations that they claimed authorized them to do this and we were entitled (even with a legally "unconscionable" contract such as this) to copies of the relevant passages, I was told I must go to their office "right now" to be given them. I went but I suspect they didn't think I would. They didn't give me any copies as, of course, no such regulations exist that would authorize patient terrorism but the nursing director did tell me to my face that "your wife will do what we ask and I don't care how much pain she's in." I also received a call back as I was leaving their office from the medical director whom I had called on the way down. He told me, "I know exactly who you are. I know exactly what my people are doing and I authorized all of it." This individual had a bit more information available on my wife's condition as he was, it turned out, the first oncologist we had seen who offered her a chemo regimen that there was no way she could survive but that he said she should do anyway because of what he stood "to learn from her death." So thinking of the Doctrine of Double Effect and the Hippocratic oath to "First, do no harm" what possibly could have been their beneficial intent that we were unable to comprehend? 9. So after letting my wife suffer with a painfully swollen, life-threatening, rock-hard arm for two full days and a backed up chemo port they refused to flush, artificially stressed out (manufactured might be a better word) by the hospice’s actions and stressed for real with the imminence of her death, she finally said she couldn’t take it anymore and would let the hospice roll her. The hospice nursing supervisor was the one who came to the house (social worker in tow) and without requiring either of us to sign the contract (a demand they claimed two days before MUST BE MET) they rolled her like a log. She almost immediately started having breathing problems and began crying out to be let back down. Keep in mind they knew the tumor load her lungs carried, the condition of her spine, the extent of her metastases, her swollen arm, the backed up port but they held her there fully on her side while she screamed and they drew pictures and took measurements. When they let her down, the nursing supervisor said everything looked good and that I was providing good care. My wife was coughing up clear fluid at this time which they simply blew off as normal dyspnea of the dying. Her normal, unhampered breathing never returned and she was taken to the hospital where she ultimately died with some of the doctor’s reports stating that she died of respiratory failure. Now I find it hard to believe that this scenario would be the standard way that any hospice would handle a patient as cancer compromised as was my wife. I find it easy to believe that with all the misrepresented statements and omissions from the medical file, the improper requests for us to rescind hospice, the stress and terror, pain and agony, extortion and threats the hospice placed upon her in her final days, they wanted her gone in whatever way would work. These are my true feelings. Please, tell me how I could possibly, realistically interpret these in any other way. What would you say was their intent? Finally and the most egregious action, at least to other hospices anyway, is when my wife was asked for a hospice donation during her initial 72 hour assessment and during the discussion of whether or not she had made out a will. The hospice staffer ended the discussion with "and when you do (make out your will) you might want to leave a little something to the hospice." We didn't jump all over that or make any kind of commitment. Now there is, has been and probably will continue to be bickering between for-profit and non-profit hospices with respect to the quality of the provision of care. The for-profit hospices cannot accept donations and are accused by the non-profits of undercutting care in the name of increased profit. OIG investigations have determined that both versions of hospice are equally capable of sub-standard care and both have indeed under-cut patient care nearly equally in some of their findings. But I'd hate to think that any hospice would have a "you get what you pay for" attitude; yet, I can't help but believe that if we had had the resources to have left a sizable donation, none of this would have happened. So what do suppose was their intent in asking a dying patient for a donation when it is so frowned upon (other hospices claim) in the industry? And, what do you suppose was the hospice’s intent in sending me a letter from their attorney stating that if I continued to speak about this with anyone, anywhere, they would take legal action against me. Staff members of the State Assembly laughed when I showed them the letter. I took it to the City Police of my town, the City Police of the hospice’s town and the County Police for us both and they said there was nothing in there that they could realistically enforce. I took it to the D.A.’s office and they said it was just a scare tactic. I think their intent here is obvious to anyone but would they want to go public with this story? If that is also their intent I think it would benefit me more than they. Do you have a different intent in mind? I should add that all of the references to the hospice reports were not available to us during my wife's final days with hospice. If they had, things likely would have turned out much differently. I can’t say that my wife would have lived longer but the 1st hospice nurses notes on our third day about reducing her case load to provide for better care and the nursing supervisor lying to us about it on day 5 then no one showing up for a week and a half would have easily told us we were using the wrong hospice. I acquired the medical file later when I found that I was entitled to it then just as she was in life. I'm sure you can imagine my shock at what I was reading. But no one ever sees these files and when they do no one seems to question them. So, please, talk to me about intent. Talk to me about how we laypeople misinterpret what we see and what we are told even without all the "false facts" or “facility friendly fashion” as may be reported in a patient's medical file. Oh, and here's a tip for we laypeople, when filing a complaint, terminology seems to be gravitating towards the legal. When I told the CDPH L&C that the hospice “falsified” the medical records, meaning they lied, I was informed that to prove that I must have both a copy that says one thing and then another copy of the same document that has been altered to say something else. Of course, I didn’t have that. What I had, they later explained, was either (or both) a "material misrepresentation of fact" or a "material omission of fact." But, since I used the word “falsified” in my complaint, they stated that they would have to conclude a finding of no fault by the hospice even though I had also stated that the hospice had lied in the medical record. What?! How many of you talk like this? Think like this? My complaint has been going on for nearly 5 years now. The State was supposed to start the investigation within 45 days of original submission. When I found that the most incriminating documents had been removed from my wife's file in year two (hospice is legally required to protect the patient's file for the 7 years they must keep it) and reported such to the State CDPH L&C they refused to let me compare my copies with theirs to confirm whether or not the documents had been pulled just before the State had come to the hospice to make their copies, as I suspected. This would be a likely indication of collusion and someone tipping off the hospice, which is a crime. L&C refused to let me view the file on the grounds that it was an open investigation and they don't allow inspections of an open investigation's documents. So, when I took it up with the CDPH Director's office they said "wimpily" that that was the L&C's policy and they couldn't do anything about it. What part of "Director" don't they understand? Not surprisingly, I received then an overnight mailer of a letter from the L&C stating that they had closed my complaint (even though from the beginning they stated that their policy is such that the only way a complaint can be closed is either by them completing an investigation or the complainant withdrawing the complaint). Neither applied to me. So, this could be a good thing, right? The CDPH Director's Office staff stated that now I should be able to go to the L&C office and see the now closed file as it's no longer an active investigation. Well, guess what? I won't make you wait for it...L&C now says that I cannot see the file because it's not part of the "public domain." Really? If this is true, wouldn't it equally have not been part of the public domain when they told me the reason I couldn't see it before was that it was an open investigation? Who's protecting who and who's looking out for patients? With my complaint closed and they've steadfastly refused to re-open it, they claim that all the transgressions that occurred are no longer valid for them to pursue/investigate. Especially, I’m sure, about any collusion within the L&C. I guess I should ask...what do suppose the CDPH L&C and Director's intents are? Again, please, talk to me about intent. Talk to me about who looks out for the patient. Talk to me about making sure this kind of abuse never happens again. And, please, tell me who is on the side of the patient? Please don’t tell me that this is rare and not the norm because we have no way of knowing how much of it is actually going on. Please don’t tell me that no doctor (or hospice for that matter) has ever or would ever assist in the ending or hastening of a suffering patient’s life because it's illegal. Sticking our head in the sand or pretending something isn’t happening doesn’t make it go away. No amount of forms will prevent abuse of their intended purpose. The end-of-life wishes people document today are just as often ignored as they are followed. Although I applaud your attempt, this hypothetical “suicide certificate” will be no different. Note: I am absolutely serious in my request of you for comments on intent.
  • D Someya Reed
    And then please tell me why I should ignore my wife's dying request that I do everything in my power to make sure that what happened to her in hospice doesn't happen to someone else as I was told to do by the executive director of the CA Hospice and Palliative Care Association. She stated that she felt what I was doing was "unhealthy." She added that I should just "move on and find new joy in my life." What do you suppose was her intent? Would she have been looking out for my betterment or the betterment of the hospice industry her association represents? You stated that your "suicide certificate" will be "A permit controlled by the patient and only their responsibility." Should your idea come to pass, how long do you suppose (if ever) that control will actually reside with the patient?

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