advance directive

Many Western countries and jurisdictions are legalizing euthanasia and assisted suicide. That opens up a problem for the death pushers. Since states aren’t going to get into the wet work of the actual killing, medical professionals and caregivers are going to be conscripted to do the deadly deeds — even if that means violating their religious beliefs and moral consciences.

Instead of resisting this rank authoritarianism, the medical and bioethics establishments are increasingly going along. This proposed coercion includes requiring doctors’ participation in suicides when patients starve and dehydrate themselves to death — known as VSED for “voluntary stop eating and drinking.”

As I wrote a few weeks ago here, the British Medical Association just so opined. And now, following closely in that guidance’s wake, a major article in the Journal of Health & Biomedical Law argues similarly — using dementia patients as the prime example — that doctors have to both inform patients about their right to commit suicide by VSED and ease the process by providing palliative care against the agony that killing oneself in that manner causes.

Moves are afoot in bioethics to require caregivers to withhold food and water by mouth from a patient made incompetent by dementia if that patient, while compos mentis, has signed such a request — and even if the patient willingly eats, enjoys meals, or asks for food. It is sometimes called “voluntary stop eating and drinking [VSED] by advance directive,” in the parlance.

I have frequently criticized VSED by directive as inhumane to the patient, cruel to caregivers (as it forces them to starve people to death), and designed to open the door to lethally jabbing those with advanced dementia as the less onerous alternative to their being made to starve to death.

Now, as supposedly some form of compromise, there is a proposal on the table to barely feed — i.e., malnourish — dementia patients who have previously signed such a directive. From, “Mr. Smith Has No Mealtimes,” published in the Journal of Pain and Symptom Management (citations omitted):

Minimal Comfort Feeding (MCF)…is the provision of only enough oral nutrition and hydration to ensure comfort. With MCF, eating and drinking is not scheduled; rather, caretakers offer food and liquids only in response to signs of hunger and thirst. Patients are neither wakened for regular mealtimes nor encouraged to eat or drink. Instead, they are offered frequent, fastidious mouth care, continued social contact, therapeutic touch, sensory distraction, and medications to relieve distress associated with apparent thirst or hunger before being provided with minimal amounts of liquid or food.