Suicide by Starvation and Expanded Assisted Suicide Promoted in New England Journal of Medicine

The New England Journal of Medicine is a progressive menace when it comes to policy and cultural issues.

In our latest example, the Journal published a doctor who helped his non-terminally ill grandfather starve himself to death–and it is presented as a reason to expand assisted suicide eligibility.

The 103 year-old had the usual and difficult afflictions of very old age and had been widowed. But the prime reason for wanting to hasten his death was the isolation caused by COVID in his assisted-living facility.

“Grandpa” doesn’t qualify for assisted suicide in New Jersey as he was not diagnosed as terminally ill. So, Dr. Scott D. Halpern, suggests to Grandpa that he starve himself to death. From, “Learning About End-of-Life Care From Grandpa:”

I described another option to Grandpa: he could voluntarily stop eating and drinking. He’d never considered this possibility (which reminded me again how one’s family members and clinicians contribute to inequities in end-of-life care). The option intrigued Grandpa, and during subsequent visits he reinforced his plan to pursue it. I insisted that he first move into my home. I wanted to ensure the quality of his care, knowing that I could enroll him in my health system’s hospice program. But I also wished to test his resolve, reasoning that his mind might change once his isolation ended.

For a while, the old man thrives and enjoys life again. Good for Halpern!

Then, Grandpa decides to go through with making himself dead. He tried to do the deed, but the thirst was too much. So, physician grandson palliates his grandfather so he can complete his suicide by starvation–which in my mind is morally close to committing euthanasia:

When I asked whether he was having second thoughts about hastening his death or just wanted relief from thirst, he resoundingly replied, “I just want it over with. Scott, do whatever you need to do.”

I was now responsible for the success of his voluntary act — a responsibility that has been described by caregivers of other patients who have attempted to stop eating and drinking. When swabbing Grandpa’s mouth no longer provided relief, and after consultation with his hospice team, I began treating his thirst as I treat other forms of discomfort — with morphine and lorazepam. He became more tired, eventually bedbound and unable to interact, and after another 12 days that felt like a lifetime, he died peacefully.

First, nothing stopped Halpern from saying no. I don’t care who one is, they have no right to make someone else complicit in their suicide.

Second, by keeping Grandpa sedated, Halpern made it almost impossible for the old man to change his mind–as the article states, he had done before.

Halpern ends with a call for expanded assisted-suicide eligibility:

I’ve learned many things in living this story that no amount of studying, teaching, or providing palliative care could ever reveal: the power of isolation and the countervailing force of family, the devastation of existential suffering and the paucity of options for relieving it, and the inequities at play, such that stopping eating and drinking is largely impossible without knowledgeable family members and dedicated hospice care.

And I’ve learned that despite many problems with physician-assisted dying, it may provide the most holistic relief possible for people who are not immediately dying, but rather are done living.

This is known in euthanasia parlance as the “completed life.” The aim is to expand assisted suicide to elderly people who want to die even if they are not ill. In other words, rather than helping such people with existential despair overcome the darkness, the goal is to validate their termination. It’s an insidious abandonment in which death, rather than life, becomes the impetus.

I am sure Halpern thought he was doing the loving thing for his grandfather. But beneath the veneer of compassion, his article illustrates the yawning moral chasm into which a society will fall once it broadly accepts the assisted-suicide value system now promoted in the NEJM.