7 FAM 200 APPENDIX E
DEATH WITH DIGNITY
(Office Of Origin: CA/OCS)
7 FAM 210 APPENDIX E INTRODUCTION
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 family’s wishes regarding removal of life support or the patient’s 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 NOK’s 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 family’s 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
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
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.