If the model is instituted correctly, providers will not recommend suicide as the option their patient should choose. Instead, the presentation of options outlining the advantages and disadvantages of each option merely provides patients with more information and contributes to a more informed decision. In addition, those patients who wish to commit suicide may not know about the other options that could alleviate their suffering in “better” ways. Perhaps the model can actually prevent deaths by suicide, though it was not developed to persuade others to take action in one way over another.
Important research has shown that “people do not start thinking about suicide just because someone asks them about it” (American Foundation for Suicide Prevention). In fact, because “research has found that many older adults and women who die by suicide saw their primary care providers in the year before death, training doctors to recognize signs that a person may be considering suicide may help prevent even more suicides” (National Institute of Mental Health). People who are already considering suicide might benefit greatly from knowing more about the disadvantages of suicide.
Again, doctors should not suggest their patients take one particular course of action over another. That kind of persuasion does not represent the key tenets of the model. Instead, because all of this information is readily available on the Internet, we have simply curated the empirical data, anecdotal evidence, and other information to present patients with a clear understanding of the advantages, disadvantages, and alternatives to each of their options. Just as a patient cannot hold a doctor liable for complications that arise in surgery, The Choice Model is designed around a patient’s right to make decisions for themselves.
Though the model lists some options that are illegal in various states, the model is respectful of those laws and attempts to further the conversation to consider the ever-changing needs of patients around the world. Just as Brittany Maynard moved from her home in California to establish residency in Oregon where physician aid in dying is legal, patients are encouraged to pursue their preferred option legally, perhaps with a referral from their doctor. Those patients who wish to circumvent laws they find unsuitable may jeopardize the chance the model has to lawfully benefit others.
Certainly, palliative care is a valuable resource for managing a patient’s pain and suffering, and its benefits are well researched. But one of the limits of palliative care is that the person who uses its services may not want to endure an inevitably deteriorating life and body, even if their pain is well controlled. A more suitable death might be a very quick one, and palliative care does not afford patients this kind of control over the very moment of a person’s planned death. There are associated risks to every choice, but consideration for all choices equally is important to the model.
We agree that competence and full understanding of the options is vital, but we also believe the model allows for a more nuanced, case-by- case determination of who is capable of making these decisions. Since the mutual decision of care can only occur after hearing about the patient’s story and wishes, we expect that particularly capable facilitators of the model can implement it with young people who face a terminal illness, just as they would with older adults.
Absolutely. The Choice Model holds dear that every human being has immanent value and worth, and our intention is to respect and honor that innate importance. By providing patients the opportunity to exercise their autonomy, we believe we are respecting the very thing that makes us human: free will.
We invite further discussion and debate about the information contained in the forms, and we are interested in hearing how the forms can be made better, more accurate and comprehensive while still remaining neutral and simple. Because some of this information is constantly changing, please share your story, thoughts, perspective, and knowledge by sending us a note on the Contact page.