The topic of Voluntary Stopping Eating and Drinking (VSED) has been discussed in the medical world for a number of years. It is generally touted as a “natural” and/or “legal” way by which one can purposefully end one’s live without resorting to Physician Assisted Suicide (PAS)* or Euthanasia.
This came up recently at Strong Hospital while I was on the inpatient palliative care service. Ultimately, the questions that arose include: 1. What is the medical team’s responsibility to patients who are undertaking (or planning to undertake) VSED? 2. Should we treat hunger/thirst with opioids/benzos, or with offering food/water? 3. Can a patient use an advance directive document (e.g., living will) to direct that, when he becomes confused and asks for food/water that this be withheld and he be treated with opioids/benzos (or even sedation)? 4. Can a health care proxy enforce a patient’s explicitly-stated wish for VSED if the patient is asking for food/water.
These questions, and others, will be the topic of a panel discussion, which I will be part of, at Strong Hospital on April 17. See Upcoming Events for more info.
The issue of continuous deep (to-unconsciousness) sedation (CDS) to relieve suffering has been discussed in the literature and, indeed, used in clinical practice for a number of years. Two recent articles prompted this brief post…
First…
For our purposes, we should note that while a minority of all patients receiving continuous deep sedation (CDS) do so for psycho-existential suffering (8.5%), and only one for solely this type of suffering… the VAST majority of these patients (78.6%) also desired “hastened death.”
So, it seems that we have a patient who is suffering and wishes to end his/her life. Then, the doctor administers a medication (with the express purpose of inducing CDS) that renders that patient incapable of eating/drinking… until the patient dies. It is far from clear how one could claim that this is anything other than euthanasia.
Second…
We very much appreciate the balanced approach of Drs. Dalle Ave and Sulmasy. Finding a balance between the maintenance of consciousness and the relief of otherwise intractable (perhaps “non-beneficial”) suffering is often difficult…and always important.
Catholic Medical Association Condemns Oregon’s Removal of Residency Requirements for Physician Assisted Suicide
Philadelphia, PA -April 4, 2022- Catholic Medical Association, which strongly opposes Physician Assisted Suicide, today condemned the State of Oregon’s decision to no longer enforce residency requirements for patients seeking euthanasia.
“Removing the residency requirement from Oregon’s so called ‘Death with Dignity Act’ further undermines the dignity and sanctity of life. Inviting people from across state lines to come to Oregon to end their lives is not aligned with good medical care,” said Craig Treptow, M.D., President of CMA.
CMA advocates for the respect of life in all of its stages and this includes ensuring dignified end-of-life care.
“The State of Oregon has now extended its promotion of assisted suicide beyond its borders, inviting residents of other states to die with Oregon’s help. Every state has physicians and other health care professionals, including the members of CMA, that believe every patient deserves better than what Oregon offers,” said Tim Millea, M.D., Chair of CMA’s Health Care Policy Committee.
### The Catholic Medical Association is a national, physician-led community of 2,400 healthcare professionals consisting of 115 local guilds. CMA’s mission is to inform, organize, and inspire its members, in steadfast fidelity to the teachings of the Catholic Church, to uphold the principles of the Catholic faith in the science and practice of medicine. Jill Blumenfeld blumenfeld@cathmed.org cathmed.org
Co-Chair of CMA’s Ethics Committe, Greg Burke, M.D., previously explained that a physician’s role is not to abandon a patient at the end of their life, but to “caringly walk with the patient through that uncertainty, alleviating suffering, while providing every opportunity for meaningful living as one prepares for death.”
CMA urges Oregon to reconsider its position on Physician Assisted Suicide and restore dignity for its patients and their families.
Catholic Medical Association | 550 Pinetown Rd, Suite 205 , Fort Washington, PA 19034
I agree that doctors certainly should “engage” with this issue…and…of course I strongly disagree with the BMJ’s position in favor of physician assisted suicide (PAS).
There is much more to say, though for today I am going to focus on three points: 1) languaging, 2) the idea of organization “neutrality” on this issue, and 3) physician engagement on this issue.
First, languaging around the issue of PAS is important and should not be overlooked. Names matter and, specifically, the specificity of naming matters. Diseases, treatments, etc. in medicine tend to become more exact and accurate over time. This is to help distinguish between one and the next in meaningful ways. The push to move from terms like “assisted suicide” to “assisted death/dying” suggests, charitability, that those in favor of the latter see no difference between someone dying of their disease vs someone dying because of a purposeful lethal ingestion prescribed by a doctor.
Please read that again…people on the pro-PAS side of the argument, at best, see no difference between you dying of cancer and a doctor prescribing you a lethal overdose.
If you believe there is an important moral difference between these then please, please speak up next time you see this in writing or hear it in conversation. Kind, charitable questions can generally help clarify whether the other person understands this essential difference. At the very least we should be clear about what we’re discussing. If you’d like to let the BMJ know what you think, you can contact them here.
Second, Dr. Godlee states both, “The BMJ’s position is that terminally ill people should be able to choose an assisted death…” AND “…the journal has called on professional organisations to adopt a neutral stance on the grounds that a decision to legalise assisted dying is for society and parliament to make.” Just so we’re clear, it’s ok for the BMJ to be in favor of PAS AND it is improper for other organizations to take the opposite position. Gotcha. (Hopefully) No further comment needed on this point.
Third, “Engagement of doctors in recent polls has been limited, with only 20% of physicians, 19% of BMA members, and 13% of GPs responding.” I hope this makes it clear that any polls that might be out there woefully under-, and likely mis-represent, the true opinion of physicians.
This debate is far from over and we are continuing to work with our colleagues and friends across New York State to keep our patients, friends, family, ourselves, and indeed our very profession safe from the scourge of physician assisted suicide!
-Tom Carroll, President – FLG
The BMJ also published a short response by Dr. Carroll to their article here.
