Transdermal patches for a rational voluntary death?

James Park is one of our favourite contemporary philosophers, and like us he is a proponent of the right of people to decide on their own death. However, Park is seriously concerned about what he calls irrational suicide, that is people making an end to their life for futile reasons such losing a job or being rejected by their love, but if they had not chosen to die they would be able to recover from these setbacks and be able to live a happy life.

The problem, according to Park, is that most methods for voluntary death only require one decision: yes or no. And once the decision to commit suicide, a point of no return has been passed. It would be better in his opinion if people who want to die should use a method which would require multiple decisions. This would force people to consider whether their original desire for a voluntary death is actually what they want.

Park therefore proposes voluntary death by dehydration as a method for a rational voluntary death, i.e. the refusal of drinking water by a person with the intent of ending one’s life. Because death in this fashion is not instantaneous and require a period of at least several days, during which the person has to consistently to refuse water, this method precludes its use in an impulse suicide.

He then puts forward several arguments in favour of this method. First this method does not depend on doctors, and that it could be used by everyone. Also he states that no change of law is required, but this depends on the jurisdiction where one lives and in many countries doctors will put you on intensive care if you has lost your consciousness (but not yet your life) in this way.

But most important is his claim that this method is relatively painless. But this claim is highly questionable, and evidence suggests that voluntary dehydration does cause great suffering. But given that most people will agree with Park’s concern about irrational suicide, could we design a humane but slow method of voluntary death?

I think the answer might be found in transdermal patches. Unlike pills or potions, transdermal patches are designed to administer low doses of a drug to the body over a longer period of time. A well-known example of such devices are nicotine patches, but another example are contraceptive patches and there are several other applications.

What properties should the drug used in this type of transdermal patch have? First, the drug should be able to permeate through the skin into the blood stream. Second, the drug should have a long biological half-life, i.e. the rate in which the body removes this drug should be lower than the rate in which it is administered and hence enables a build-up of the drug in the body. Third, the drug should have a high lethal dose. This means that a large amount of drug should be present in the body before death will occur, this will prolong the time between the attachment of the patch and ultimate death.

A fourth but very important property would be that until the lethal threshold level is reached, the drug should have no or only minimal side effects. And as fifth and final property, is that if the patch is removed before the point of no return, total recovery is possible.

These properties together will ensure that the use of transdermal patches as a method for voluntary death, will not lead to irrational suicides.

In order to guarantee a responsible distribution of these patches, we propose that these devices will only be available through a thanatologist (a medical profession proposed by A. C. Grayling, specialized in euthanasia in order to free other medical personal from this practice). People should be certain that patches provided by licensed thanatologists are save and reliable. An additional benefit is that when a person requests a patch, the thanatologist can have a conversation with this person on why one wants put an end to his or her life, and whether this is the only solution.

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