Bioethicists: “Terminally Sedate” People Committing Suicide by Self-Starvation

In a newly released paper in the prestigious journal Bioethics, three prominent bioethicists argue that when someone decides to commit suicide via self-starvation and dehydration — known in euthanasia movement parlance as “voluntary stop eating and drinking” (VSED) — doctors should be allowed to “terminally sedate” the person trying to die when necessary to prevent intractable suffering.

Patients who commit VSED are often not terminally ill. In fact, euthanasia organizations promote self-starvation to the elderly who are not dying and as a means of becoming eligible for assisted suicide where it is legal by making oneself “terminal” via lack of sustenance.

VSED must be distinguished from the common circumstance when actively dying people stop eating. That’s a natural process and often peaceful because the body cannot assimilate food as organs shut down. VSED, in contrast, deprives the body of sustenance it needs to remain alive toward the end of causing death, i.e., it is a suicide method.

Without palliation, many people attempting VSED would abandon the attempt. The bioethicists know this and claim that once the decision to commit suicide is made, doctors are duty-bound to medically ameliorate the suffering that inevitably results:

If a patient is adamant in their refusal of food and water, the same physician must respect the competent refusal by not force-feeding the patient and should offer standard palliative care, as they would for any other dying patient. Medical support for patients undertaking VSED should be adequate and proportionate to their symptoms, as per any other form of palliative care. This is arguably not assisted suicide.

No, it is precisely that. First, but for the self-starvation, many people who undertake VSED would not be dying. Second, palliation permits the patient to complete the suicide that would otherwise be abandoned. Hence, the palliating doctor is facilitating the patient in becoming dead, i.e., it is a form of suicide assistance.

The authors acknowledge that if a doctor’s assurance of palliation factors into the decision to undertake VSED, that could be deemed assisted suicide:

We acknowledge that there may be some cases in which combining these two practices could amount to assistance in suicide. Jox et al. identify two key factors which, if present, arguably classify VSED cases as assisted suicide: (a) the promise of medical assistance is instrumental to the individual’s decision to pursue VSED, and (b) the physician shares, at least in part, in the individual’s decision to pursue VSED (amounting to some level of encouragement).

The authors next argue that VSED patients should be allowed to be rendered permanently unconscious if experiencing “refractory delirium”:

We propose the following criteria for VSED with TS in the setting of refractory delirium:

1. The patient is experiencing unbearable suffering.
2. The patient has lost decision-making capacity.
3. The patient has previously stopped all fluids.
4. The patient has previously indicated that they would not wish for fluid to recommence if delirious.
5. Other measures to address confusion/distress have been attempted (or refused in advance), such as antipsychotics.

Ah, the old “strict guidelines protect against abuse” scenario.

Let’s discuss this in the real world. Strict restrictions rarely stay strict. For example, needle “exchange” to prevent the spread of HIV eventually slouched into outright needle give away, no used syringes required.

The same kind of slippage would happen if sedating people committing VSED were allowed. Eventually, such drugging would become a standard technique, its availability amplified by assisted suicide advocates.

The authors’ answer to this objection? Let doctors predetermine whether to facilitate the suicide with sedation:

We believe that this harm can be reasonably mitigated through a thorough pre-assessment of individuals requesting VSED. Prior to initiating physician involvement in the VSED process, physicians should seek to confirm that the individual (a) has decision-making capacity, and (b) expresses a genuine intention to end their life. This pre-assessment should also seek to confirm that the individual is fully informed, their decision is voluntary, their decision is consistent with their known values, and that the individual is free from mental illness compromising their decision.

Wait: The authors wrote earlier that when “the promise of medical assistance is instrumental to the individual’s decision to pursue VSED,” and “the physician shares, at least in part, in the individual’s decision to pursue VSED (amounting to some level of encouragement),” that it would amount to assisted suicide. Pre-assessment would fit those very criteria, no?

So, we see the slippery slope slip-sliding away in the very article calling for allowing sedation under strict guidelines to prevent abuse. If this proposal is implemented, the next step will be to quit beating around the bush and get on with the lethal jabs.

Why write about this, Wesley? Articles in professional journals are a means of constructing future public policy and people need to be warned about what is being planned before it is imposed from on high. Or to put it another way, these issues are too important to be left to the bioethicists.