The Corner

Health Care

‘Starve Me’ Advance Directives Would Be Immoral

Julio, 88, a patient with Alzheimer’s disease and vascular dementia, poses for a photograph inside the Alzheimer Foundation in Mexico city, Mexico, April 19, 2012. (Edgard Garrido/Reuters)

Not content with assisted suicide, the euthanasia movement wants people with dementia to be able to force caregivers to starve them to death when they become severely impacted — even when they willingly eat.

An assisted-suicide advocacy group in New York previously created an advance directive containing such instructions. And now the Hemlock Society — which today calls itself Compassion and Choices — boosts the starve me to death” approach to dementia with instructions that would force caregivers to withhold spoon feeding:

I request that food and fluids in any form, including spoon-feeding, be stopped if, because of dementia, any of the following conditions occur: » I appear indifferent to food and being fed. » I no longer appear to desire to eat or drink. » I do not voluntarily open my mouth to accept food without prompting…» I turn my head away or try to avoid being fed or given fluids and am clearly repelled by food or fluids. » I spit out food or fluids. » I cough, gag, choke on, or aspirate (inhale) food or fluids. » The negative consequences or symptoms of continued feeding and drinking, as determined by a qualified medical provider, outweigh the benefits.

Many of these provisions are, to say the least, subject to interpretation. And people with dementia may refuse food one meal, and accept the next.

Starvation for someone who still eats would cause agony, so C & C suggests asking for sedation. But here’s the thing: If someone isn’t imminently dying, sedation is actually a request to be kept unconscious so the patient can’t change their mind.

The instructions would seek to handcuff surrogate decision makers and force starvation even if the patient opens their mouth to eat — characterized as a mere reflex” in the document (my emphasis):

I want the instructions in this provision followed even if the person who has the right to make decisions for me and/or my caregivers judge that my quality of life, in their opinion, is satisfactory and I appear to them to be comfortable. No matter what my condition appears to be, I do not want to be cajoled, harassed, or forced to eat or drink. I do not want the reflexive opening of my mouth to be interpreted as giving my consent to being fed or given fluids or misinterpreted as a desire for food or fluids. I have given considerable thought to this decision and want my wishes followed.

Before I am admitted to a long-term care facility, I want that facility to affirm its willingness to honor these instructions. If the long-term care facility where I already reside will not honor these instructions, I want to be transferred to one that will.

No care facility should ever honor such instructions.

This isn’t about the circumstance when a patient stops eating as a normal part of the dying process. It isn’t about force-feeding with a tube down the throat or surgically inserting a feeding tube. It is about withholding food and water by mouth even when the patient accepts nourishment.

I don’t believe these instructions are enforceable. Advance directives control the provision or withholding of medical treatments. Spoon feeding is not treatment, it is humane care akin to being kept warm and clean.

But even if the law should, one dark day, permit such a horror — the suffering of the dementia patient would not be the only important matter at stake. So too would be the emotional health, consciences, and moral wellbeing of husbands and wives, children, nurses, doctors, aides, and the like who would be compelled by the instructions to starve the patient to death. Talk about causing nightmares! I’m sorry, that is too much to ask of anyone.

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