Should Caregivers Be Forced to Starve Dementia Patients to Death?

There is a move afoot among bioethicists to allow written directives by dementia patients, signed before the patients have become incompetent, to force caregivers to withhold spoon-feeding and liquids from those patients. Now, one of the country's most notable and oft-quoted bioethicists, Arthur Caplan, has taken a position in favor of such a policy, in an article in the online publication Medscape.

First, Caplan discusses the potential withholding of feeding tubes (artificial hydration and nutrition, or AHN, in medical parlance), which is unquestionably legal because AHN is a medical treatment that involves surgery and medically prepared nutrients and — like other treatments, ranging from surgery to chemotherapy — can be ordered through advance directives to be withheld or withdrawn. Right or wrong, that's a done deal. (He brings up the Terri Schiavo case, about which he and I significantly disagree, but let's not relitigate that here.)

Then, however, Caplan takes the next step — which is currently on the cutting edge of bioethical discourse. From "Artificial Hydration and Nutrition in Dementia: Ethicist Weighs In":

Is feeding by spoon the same as medical intervention with artificial forms of hydration and nutrition? I believe it is. I believe that when you say "no more food and nutrition," it isn't just the equipment. I'll put it simply: It's who's on the end of the spoon. If nurses or doctors are feeding, it's medical. It's professional care, and you should be able to say no to that.