Friday, September 13, 2013

Growing Legal & Ethical Clarity on Legitimacy of Hastening Death by VSED

In 2011, I argued that voluntarily stopping eating and drinking is a legal option to hasten death.  Specifically, I established that
both contemporaneous and (most) non-contemporaneous decisions for VSED are legally permissible. Individuals may refuse nutrition and hydration just as they may refuse other intrusions on their personal autonomy. This right is grounded in the common law of battery, statutes, state constitutions, and even the U.S. Constitution. Moreover, VSED does not, as many believe, constitute abuse, neglect, or assisted suicide. Even ex ante decisions for VSED (exercised through an advance directive or a surrogate decision maker) are legal in most United States jurisdictions.
The legality and ethics of VSED is now getting more attention.  There is a new lawsuit against a nursing home for disallowing VSED.  And in its September 2013 monthly publication NewsLine, the National Hospice & Palliative Care Organization has encouraged its 2000 member hospices to develop policies on VSED:
If a patient decides to forgo eating and drinking in order to hasten his or her own death, how should a hospice respond?
From a legal standpoint, “voluntarily stopping eating and drinking” (VSED) is an option for individuals in all 50 states and distinct from the natural reduction in nutritional intake that accompanies the dying process. It is a voluntary decision by patients with decision-making capacity, with the explicit intention of hastening death.
While legal, however, the peer-reviewed literature does not reflect strong ethical consensus about whether, how, and for what reasons hospices should or should not participate in patients’ care decisions about VSED. . . .  The Council also encourages each hospice to explore these questions in their organizational ethics committees, with the ultimate goal of establishing a policy or guidelines to address VSED so staff is prepared when such situations arise.


Carol Cross said...

Yes, I believe VSED is a better solution for terminal patients than legalizing assisted suicide.
It is a form of voluntary shortening of life that is legal and that requires reaffirmation of the patient of their desire to shorten life to shorten suffering well into the dehydration process,
With Hospice standing by to ease the final stages, patients sleep into death and primary care givers and family who have been supportive in standing by the patient's decision are absolved of any guilt for the shortening of the life of the patient. They also benefit because they are spared the pain of watching a long journey into death. Instead of months, it is just a matter of days!

Carol Cross said...

You know that Hospices have to be very careful that VSED is truly voluntary. I would assume that when VSED is requested that The Hospice wants witnessed signature of the competent patient or the surrogate/care giver with Power of Attorney to the request for VSED in the Hospice setting.

It is probably true that the majority of Hospice patients die from dehydration anyway --- rather than the actual terminal disease because the terminal disease leads to dehydration

VSED is certainly an easier and faster and cheaper way to die than choking to death ---!!