In the United Kingdom, a 34-year-old unnamed patient (MSP) with a severe but treatable bowel problem is going to be kept in an artificial coma and denied sustenance until he dehydrates to death. This gets a bit complicated, so bear with me. MSP has a history of serious depression, mental illness and chronic bowel issues. He had a temporary stoma implanted as doctors tried to overcome the bowel problem. But after an attempt at corrective surgery, the doctors have now concluded that the stoma will have to be permanent.
MSP repeatedly expressed great horror at that prospect, worrying he would not be able to get a job or find a woman who would love him. Accordingly, he has been kept deeply unconscious post surgery. MSP’s parents are terrified that he will kill himself if he is released from the hospital with a stoma. They are convinced, given his advance directive and many conversations, that he would now rather be dead than alive.
So the hospital went to court to see whether — and how — doctors can make that happen legally. The court has ruled that the death can proceed. Here is the plan that the court approved as being in the patient’s “best interests.” From the ruling:
Dr W considers that if MSP’s wishes are to be given effect, there should be withdrawal of artificial nutrition and hydration with continued sedation which, ultimately, will compromise respiration and lead to MSP’s death.
Let’s unpack this:
- Euthanasia and assisted suicide are not legal in the U.K. This is a way around that prohibition.
- MSP is not terminally ill.
- The court is deciding what is supposedly in his “best interests” because he is incapacitated and unable to speak for himself.
- He is incapacitated only because the doctors are using drugs to keep him in an artificial coma — which is not medically necessary for his proper care.
- If MSP were awakened and recovered, he would be able to breathe on his own and receive sustenance.
- Having a stoma can be a hard and emotional adjustment — I know, because my father went through it. But millions of people live normal and happy lives with stomas.
- MSP will be made to die by being kept in a coma without sustenance or respiratory support.
- Maintaining the coma is an active means of enabling the refusal of artificial nutrition and hydration and ventilation; hence, it is being implemented as part of the process to allow the killing of this patient by dehydration or by suppression of respiration as the patient weakens.
- In other words, this isn’t really about refusing medical treatment. That’s a facade. Indeed, keeping the patient unconscious is not a medical treatment but rather a means of facilitating slow-motion euthanasia known as “terminal sedation.” Indeed, Dutch doctors who are queasy about lethally injecting patients often resort to terminal sedation as a means of causing death.
- Terminal sedation should not be confused with “palliative sedation,” a legitimate end-of-life medical treatment that keeps patients with intractable pain who are close to death comfortable. Those patients die naturally of their disease, not by intentional dehydration.
What are we to make of this case? Some will say that MSP should be allowed to die because he wouldn’t want to live with a stoma. It’s his life, after all, and he shouldn’t be forced to live in a way that he would find unacceptable. Indeed, that was the essence of the court’s opinion. People may also say that he should die because his parents — at the end of their ropes and desperate to do what is right by their son — think that is best for him. Others might say this is merely a case of refusing medical treatment — that is, of a ventilator, which the court ruling notes he no longer needs, and tube-supplied food and water.
But this is all wrong. First, how is this any different from administrating a lethal injection, other than the speed of death? The drugs given to keep him in a coma are infused for the explicit purpose of keeping him unconscious so that he requires these artificial medical means to continue living.
Second, there are many people who face very difficult medical situations and become suicidal. For example, people who become quadriplegic suddenly. But studies show that over time, perhaps with mental-health interventions, the rate of depression among such people is roughly the same as that among the general population. Should we also terminally sedate such people because they “wouldn’t want to live like this,” even if they may later be happy to still be alive? No!
Besides, everyone who is suicidal wants to die. What difference does the medical aspect make? Should we allow doctors to facilitate the deaths of otherwise healthy people who are suicidal? That’s where we are heading.
In conclusion, here’s how I see it: This is a profound abandonment, albeit by a judge and parents trying to do the right thing. MSP is being given no chance of recovery. No chance of adjusting to new circumstances. No chance of receiving intensive mental-health interventions that might help him overcome his despair. No chance of finding happiness. No chance of finding a job. No chance of finding a woman to love. No chance at life.
Moreover, dehydrating this patient to death is a half step toward allowing and normalizing lethal-injection euthanasia. After all, it’s only logical. If he is going to be made dead anyway, why not simply administer a lethal jab instead of putting MSP, his parents, and the medical team through the grueling one or two weeks that his terminal sedation will take?
As the cliché goes, the road to hell is paved with good intentions.