7 FAM 200 APPENDIX E
DEATH WITH DIGNITY
(CT:CON-804; 04-30-2018)
(Office Of Origin: CA/OCS)
7 FAM 210 APPENDIX E INTRODUCTION
(CT:CON-724; 08-11-2017)
a. 7 FAM 351 b(2)(e)
explains that a consular officer cannot make decisions about treatment of
patients. Likewise, a consular officer cannot make decisions regarding removal
of life support system or withholding treatment. 7 FAM 358
provides general guidance about living wills and other advance directives.
Laws pertaining to the removal of life support vary greatly from country to
country. Consular officers can express the familys wishes regarding removal
of life support or the patients wishes as expressed in an advanced directive
or living will, but consular officers need to be prepared to explain local laws
governing this practice with next of kin (NOK). Removing life support is quite
difficult in some countries, and medical
personnel will often refuse to comply with the NOKs wishes because of local
laws or practices.
b. On occasion, CA/OCS receives inquiries from posts
and the public regarding sensitive issues related to gravely ill U.S. citizens
abroad and their families confronted with difficult decisions about the end of
life. Questions we have received include:
(1) Question: Can a consular
officer authorize removal of life support in the absence of instructions, a will or advance directive, consultation, or
direction from any family member?
Answer: No. The consular officer cannot
act in this capacity. The local law would govern. CA/OCS would work with post
to try to find a family member, legal representative or other person who might
be designated as guardian. In 2006, CA/OCS and a post faced such a case.
Local authorities would not remove life support without a request from a family
member, but also would not continue to allow the U.S. citizen to remain in a
local hospital. Physicians determined that the individual could survive a
flight to the United States with a full life support medical evacuation.
CA/OCS and L/CA determined that the Department could not deny the medical
evacuation since it would amount to making the decision to allow the person to
die. The patient was medically evacuated to the United States where the
patient died shortly after arrival.
(2) Question: Can a consular
officer assist a family seeking to prevent removal of life support from a
pregnant U.S. citizen to allow the viable unborn fetus one more month gestation
to increase the chance that the child, to be delivered alive by cesarean
section, might survive.
Answer: OCS advised post to assist the
family in putting them in touch with appropriate local authorities, provide the
family with a list of lawyers, and convey to local authorities the familys
concern.
(3) Question: Can a consular
officer stop a U.S. citizen from availing him/herself of assisted suicide under
local law?
Answer: No, but the consular officer
should report the matter to CA/OCS. CA/OCS/ACS will confer with CA/OCS/L and
L/CA to formulate an advisory opinion based on the facts of the case. This
guidance may include a recommendation that the consular officer encourage the
U.S. citizen to designate a legal representative or next of kin (NOK) to handle
disposition of remains and personal effects. (See 7 FAM 230 Appendix E).
c. Much debate has arisen in the United States over
the question of euthanasia, and what constitutes actively causing death
(positive euthanasia) and what constitutes merely allowing death to occur
naturally. See 7
FAM 220.
d. Questions regarding this subject should be addressed
to ASK-OCS-L@state.gov.
7 FAM 220 APPENDIX
E Foreign Law, Death With Dignity, Euthanasia
(CT:CON-724; 08-11-2017)
The Department is aware that some foreign countries have
enacted laws permitting assisted suicide or euthanasia. Posts should try to
keep apprised of developments in host country law regarding this subject. Specific questions may be directed to CA/OCS/L (ASK-OCS-L@state.gov).
7 FAM 230 APPENDIX
E ROLE OF THE CONSULAR OFFICER - U.S. citizen seeking assisted suicide in the
consular district
(CT:CON-724; 08-11-2017)
Should you become aware of a
U.S. citizen who is seeking assistance to commit assisted suicide under local
law, reach out to CA/OCS/ACS and CA/OCS/L for guidance.