Category: End of Life

End-of-Life End-Arounds seem to keep popping up. One of the “big ones” is the renaming of intrinsically evil actions like suicide to sound better, e.g., the, sadly, successful effort to rename Physician Assisted Suicide to the now so-called Medical Aid in Dying (MAiD).

As you might have guessed, however, it does not stop there…

An article was recently published authored by, among others, Dr. Timothy Quill and Dr. Thaddeus Pope, both long-time advocates for Physician Assisted Suicide, introduces “a framework that resolves competing ethical and clinical considerations in caring for those with advanced dementia,” which they are calling Minimal Comfort Feeding (MCF).

Basically, the idea is that for patients with advanced dementia, rather than offering them food at, say, mealtimes, we might rather offer them food/drink “only in response to signs of hunger and thirst.”

While we can, partially, applaud their attempt to find an option for oral nutrition and hydration that does not involve actively withholding food and water from those who have lost the ability to ask for it (which is very likely being done even as we write this), we feel confident in concluding that, regardless of the author’s hopes:

1. the risk of MCF morphing into actively withholding oral nutrition and hydration is too high for it to be a licit practice, and
2. even if MCF was carried out as the authors suggest, it is very likely illicit given that we have a positive duty to feed the hungry. Most assuredly, this positive duty does not extend to “force feeding” (as is made clear in the Catechism), but from that it does not follow that we can forgo offering*

If you would like the full text of the this article, you can request a reprint (PDF) from the corresponding author:

Hope A. Wechkin, MD
12822 124th Lane NE
Kirkland, WA 98034
hawechkin@evergreenhealthcare.org

*While this seems to be true, this should be qualified in that there may come a time in a person’s life where it is clear that he can take no oral nutrition or hydration, that this situation is irreversible, and continuing to offer such has become an undue burden. However, that would seem to be a relatively high bar, and, licit justification for deciding to no longer offer oral nutrition/hydration would not include that the person does “not want to continue living with this illness.”

The topic of Voluntary Stopping Eating and Drinking (VSED) has been discussed in the medical world for a number of years. It is generally touted as a “natural” and/or “legal” way by which one can purposefully end one’s live without resorting to Physician Assisted Suicide (PAS)* or Euthanasia.

This came up recently at Strong Hospital while I was on the inpatient palliative care service. Ultimately, the questions that arose include:
1. What is the medical team’s responsibility to patients who are undertaking (or planning to undertake) VSED?
2. Should we treat hunger/thirst with opioids/benzos, or with offering food/water?
3. Can a patient use an advance directive document (e.g., living will) to direct that, when he becomes confused and asks for food/water that this be withheld and he be treated with opioids/benzos (or even sedation)?
4. Can a health care proxy enforce a patient’s explicitly-stated wish for VSED if the patient is asking for food/water.

These questions, and others, will be the topic of a panel discussion, which I will be part of, at Strong Hospital on April 17. See Upcoming Events for more info.

See also a related recent post and an article in the Linacre Quarterly by Dr. Cavanagh

– Tom Carroll

—

* Often now referred to as Medical Aid in Dying (MAID)