Should the desire to commit suicide justify admission into hospice to make their dying by starvation and dehydration easier to complete?
The other day, in response to the British Medical Association requiring doctors to participate in VSED (voluntary stop eating and drinking) suicides, I wrote that “suicide nihilism is exerting an ever-increasing gravitational force.” With this post, I double down on that depressing conclusion.
Hospice was designed to care for people who are diagnosed with terminal illnesses until their natural deaths. But a study just published in the Journal of Pain and Symptom Management — the publication of the American Academy of Hospice and Palliative Medicine — argues that people intending to commit suicide via VSED should qualify for hospice care even if they are not otherwise dying!
What? Why? Because someone dying within six months qualifies for hospice. VSED takes less than that amount of time to die. Hence, such suicidal people should be admitted to hospice. The mind just boggles.
The article describes VSED as a potential substitute for assisted suicide. From “Voluntarily Stopping Eating and Drinking (VSED) With Hospice Support in America: A Case Series” (citations omitted, my emphasis):
Voluntarily stopping eating and drinking (VSED) is an increasingly recognized practice for patients seeking to hasten death. As VSED is legal throughout the U.S. and does not require medical provider involvement, it may be the only option for U.S. residents who live in a state in which medical aid in dying (MAiD) is illegal; who lack access to medical providers willing to participate in MAiD; or who do not have a six-month prognosis despite having a terminal illness (such as amyotrophic lateral sclerosis [ALS] or Parkinson’s disease). For some, VSED can be the preferred practice for hastening death as it may be perceived as less abrupt or more “natural” than MAiD.
Well, since hastening death is now apparently a legitimate goal for hospice care, why not anyone with a serious commitment to ending it all by VSED? After all, that’s what the BMA’s guidance requiring physician participation stated.
The study followed some 20 people — many very elderly, some terminally ill, some not — who received hospice support for their VSED suicides based on quality-of-life concerns, loss of dignity, etc. To be sure, these are crucial issues for which people should receive concerted care, whether in hospice if terminal, or otherwise if not.
But should the desire to commit suicide justify admission into hospice to make their dying by starvation and dehydration easier to complete? The authors say yes, and moreover, they assert that the cost for such care should qualify for Medicare/Medicaid benefits. In other words, suicide on the federal government’s dime:
Based on this study, U.S. hospice medical directors should not fear prognostic uncertainty in those who are earnest in pursuing VSED. Given the likelihood that a person committed to VSED will die not only in less than 180 days, but in less than 15, it is more appropriate to question the justification for denying such a patient access to a federal benefit than it is to question whether such access should ever be granted. As is true of any EOL situation, hospice staff are uniquely positioned to provide anticipatory guidance, symptom management, and psychosocial, emotional, and spiritual support for patients and caregivers. Conversely, a lack of hospice support for those pursuing VSED can be anticipated to result in lower quality symptom management and additional risk of distress and complicated grief in caregivers.
Let me be clear about something. VSED is not about refusing nourishment as part of the natural process of dying when the body is shutting down. That is a common occurrence during natural death, and people who stop eating and drinking in that circumstance should be allowed to die in peace with caring support.
In contrast, VSED is a means of committing suicide by people who can take nourishment and would continue living if they did. That’s very different. Suicidal ideation is not a terminal illness. People can change their minds and continue on. Their desire to die should not be grounds to enter hospice when they are not terminally ill.
Hospice is supposed to be about helping patients live the best quality of life attainable during a terminal medical condition. It was not created by the great medical humanitarian Dame Cecily Saunders as a vehicle to make suicide easier. Indeed, she told me explicitly that suicide prevention is an essential hospice service when I interviewed her for one of my books.
Advocacy to the contrary — in a professional hospice journal, of all places — sullies Saunders’s memory.