That may be because, as a culture, we are growing progressively disdainful of people with serious incapacities caused by advanced age, particularly those that impact cognition. Indeed, many now accept the discriminatory premise that death is better than dementia.
Some now take that invidious concept to its logical conclusion. The Netherlands and Belgium have long permitted lethal injection euthanasia for the ill and disabled who are competent. But now, doctors also may lethally inject incompetent people with Alzheimer’s, stroke, or other cognitively disabling condition if the patient so instructed while still compos mentis.
“I saw in her eyes that she didn’t understand anymore,” Arends recalled in an interview, after one such refusal.
Self-Starvation
But what about jurisdictions in which euthanasia and assisted suicide are illegal? Assisted suicide advocates teach the elderly how to commit suicide by self-starvation—with the cooperation of a doctor palliating the agony—a practice known in euthanasia parlance as VSED for “voluntary stop eating and drinking.”As if that isn’t awful enough, bioethicists also are now arguing that people should be able to sign an advance medical directive ordering that they be denied food and water by mouth if they become cognitively impaired, just as people can order themselves euthanized in the Netherlands.
“Since it requires that the individual act before losing capacity, VSED requires that the individual act earlier than they prefer,” one prominent proponent, bioethicist Thaddeus Mason Pope, argues. “They must act while they still find life worthwhile. Because it is uncertain when the ‘window of opportunity’ will close, when the individual will lose capacity, individuals err on the side of acting early.
“To avoid the problem of premature death, many have proposed that individuals complete advance directives that instruct others to stop hand feeding. This is known as “advance VSED” or “SED by AD.”
Let’s be clear about what we are discussing here. It’s not force-feeding people who won’t eat. Nor are we discussing a feeding tube, which can be refused via a signed advance directive, because it is deemed by law to be a medical treatment. Rather, the point is to deny sustenance to people who willingly accept food and liquids by mouth.
Enforced Starvation
This important distinction between medical treatment and humane care is eroding fast.That is something no one should have the right to demand of others, but it’s exactly what the doctors and the patient’s wife acquiesced to, even though “the directives [to withhold food] were not legally binding.”
It took the man four days to die.
If the patient checks “no,” it would seem to require caregivers to make the patient die of malnourishment—perhaps, even if he or she asks for food. Remember what happened to the poor dementia patient in the Netherlands deemed incompetent to want to live.
But, you say, starving is a horrible way to die! Indeed, and that’s precisely the point. The ultimate purpose behind requiring caregivers to deny sustenance to people isn’t to pretend that such crass neglect is a civilized means of causing death. Rather, it is to create such revulsion that people will agree to dispatch such patients more humanely by lethal injection instead.
We can’t yield to that coercion. The answer to the difficulties caused by dementia isn’t to kill people less painfully, but to care for them properly with love and respect—which begins with not killing them at all.