culture of death

The subtitle of the revised and updated version of my book criticizing utilitarian bioethics, Culture of Death, is, “The Age of ‘Do Harm’ Medicine.” Helping patients kill themselves by self-starvation and dehydration — known in euthanasia parlance as VSED (for voluntary stopping eating and drinking) — certainly fits that designation.

Two major medical associations now have endorsed doctors assisting in such suicides by palliating the painful symptoms to help patients go all the way to death. The first was the American Academy of Hospice and Palliative Medicine (AAHPM) in 2023. This is especially notable because the organization shamefully went “neutral” on the legalization of assisted suicide, despite that action being the antithesis of the hospice philosophy enunciated by the great medical humanitarian Dame Cecily Saunders. The AAHPM’s journal also published a piece recently endorsing intentionally undernourishing dementia patients under certain conditions (MCF, or “minimal comfort feeding”) — VSED in slow motion, if you will.

Now, another “do harm” shoe has dropped. The British Medical Association has issued an ethical guidance that requires practitioners to participate in VSED when asked to do so by a patient. While the AAHPM guidance assumes that the act will only be done by terminally ill or seriously ill or disabled patients, the BMA guidance notably acknowledges that even those not in ill health can kill themselves in this slow manner — and that doctors must further the suicide palliatively. From the guidance (my emphasis):