No line in bioethics is ever fixed. Rather, the push to eradicate the boundaries that keep medical professionalism tied to Hippocratic values (sniffed at as “paternalism” by many in the field) continues unabated, with new boundary lines created, consolidated, and then moved again into ever-more extreme territory.
Some call this, the “slippery slope.” Case in point: Suicide by starvation, known as VSED (voluntary stop eating and drinking). Not only do bioethicists say doctors should participate in this method of suicide by palliating the pain starvation and dehydration causes, but also DO IT FOR THE PATIENT if they stated they wanted to die by VSED in an advance directive and they become mentally incapacitated.
More: They want nursing home or hospital personnel to starve such patients to death even if they willingly eat and drink! From a commentary in the Journal of Clinical Ethics by Thaddeus Mason Pope, about the Margot Bentley case:
Mrs. Bentley may have the capacity to “communicate a choice.” But this is just one component of capacity.
She does not understand the relevant information., does not appreciate the situation and its consequences, and cannot reason about treatment or care options…If the test for capacity is really this low, then current “consent” will often trump even the clearest prior instructions.”
When it comes to eating and drinking by mouth it damn well should! What if the patient said she didn’t want to be turned, whether in advance or currently? Should that be honored even if it leads to terrible bed sores? No! Turning is basic humane care.
But Pope, in a Twitter exchange with me, said yes. That “medical paternalism” is over, apparently regardless of the cost.
Please note that this isn’t refusing medical treatment–like a feeding tube–but denying basic humane care, e.g. oral sustenance.
And this should really chill your blood:
Medical, ethical, and legal commentators are reaching near consensus that capacitated patients may make a contemporaneous choice of VSED.
Far less clear is whether individuals can choose to VSED in advance, as an exercise in prospective autonomy. Fortunately, physicians and philosophers are developing the theories, tools, and maxims to help define how and when the practice of advance VSED can be legitimately and safely [!!!] implemented.
In other words, we want to make sure these people die, now we just have to figure out how to get there.
I call this “gotcha” killing. The statement of the person when fully compettent trumps the actions or, perhaps (why not?) statements of the same person if they become mentally incapacitated, even if they eat, and perhaps, even if they ask to eat.
It’s also another frontal assault on medical professionalism. But more on that later.