First, bioethicists said people should be able to refuse being “hooked up to machines” even if that meant almost certain death. Good.
Then, they pushed that meme farther, arguing that the right of refusal (including by surrogates) should also include nourishment by tube so the patient dehydrates to death. Give them an inch . . .
After that, they said patients who are terminally ill (for now) should have access to prescribed poison to make themselves dead. Not good.
Now, they want to force caregivers to starve patients with dementia who eat and drink by mouth if so instructed in an advance directive.
This abusive proposal, which is being pushed aggressively in the professional literature, has now reached the august pages of the New York Times in a column by Jane Brody, the Gray Lady’s health columnist. From, “An Advance Directive for Patients with Dementia”:
Missing in standard documents [advance directives] are specific instructions about providing food and drink by hand as opposed to through a tube.
There is a logical reason for that. Advance directives cover medical treatments. But eating and drinking by mouth is not a medical treatment. It is humane care — like keeping clean, warm, turning to prevent sores, etc. — which are not part of advance directives.
Brody throws up some smoke, stating that the starve-me instructions would apply at the very end of life.
While trying to provide nourishment for a terminally ill person nearing death is commonly done in the name of comfort and caring, if that person cannot benefit from food or drink, it can become quite the opposite. When patients can no longer swallow what they are fed, they may choke and aspirate food or drink into the lungs, resulting in pneumonia that adds to their misery and hastens their death.
That can be true, and at such times, great care must be shown.
But the document Brody supports, written by an assisted-suicide advocacy group, does not require forced starvation to be limited to such times (my emphasis):
In the final, ‘terminal’ stage of all dementias, a person may become unable to swallow what is placed in his or her mouth, and lose the ability to ambulate, speak, recognize loved ones, and control bowel or bladder functioning.
Individuals with Alzheimer’s disease who contact End of Life Choices New York want to know how they can avoid the final stages of this disease. It is for those individuals, and others who fear being diagnosed with dementia in the future, that the Directive about assisted oral feeding has been created.
In other words, it could well before the end stages, when the patient can still swallow and enjoy food and drink, when an incompetent patient could no longer feed themselves, not when they could no longer safely swallow.
The purpose of the document would be to force caregivers to starve a patient who willingly eats and drinks:
If I am suffering from advanced dementia and appear willing to accept food or fluid offered by assisted or hand feeding, my instructions are that I do NOT want to be fed by hand even if I appear to cooperate in being fed by opening my mouth.
What if the qualified-to-be-starved patient asks for food? Tough. If incompetent, she would not be deemed qualified to make that decision. (Such a horror happened in the Marjorie Nighbert case, involving the removal of a feeding tube from a stroke patient who begged for food and was refused nourishment anyway by a court.)
This is very wrong. No one should have the right — no matter how scared of dementia they may be — to compel others to starve them to death.
It is a sign of our times that acts and omissions that only a few years ago would have epitomized elder abuse, now receives the full-court bioethical press in the Establishment “paper of record.”
This is precisely how radical proposals enter the policy mainstream. Ugh.