The Bioethics Push to Starve Dementia Patients

The Bioethics Push to Starve Dementia Patients
A resident of a senior living community dances on her balcony as she listens to a DC area motown band play a social distance concert in the community’s parking lot in Arlington, Va., on April 14, 2020. (Andrew Caballero-Reynolds/AFP via Getty Images)
Wesley J. Smith
Did you know that the United Nations declared June 15 as World Elder Abuse Awareness Day? Probably not. It didn’t get much publicity.

That may be because, as a culture, we are growing progressively disdainful of people with serious incapacities caused by advanced age, particularly those that impact cognition. Indeed, many now accept the discriminatory premise that death is better than dementia.

Some now take that invidious concept to its logical conclusion. The Netherlands and Belgium have long permitted lethal injection euthanasia for the ill and disabled who are competent. But now, doctors also may lethally inject incompetent people with Alzheimer’s, stroke, or other cognitively disabling condition if the patient so instructed while still compos mentis.

And, it turns out, patients may not be allowed to change their minds once they lose capacity.
A recent case out of the Netherlands illustrates the horror. A woman diagnosed with Alzheimer’s left instructions that she be euthanized once incapacitated—but she reserved the right to decide when that time had come. After becoming incompetent, her doctor, Marinou Arends, asked her three times whether she wanted to die—and the patient told the doctor on each occasion that she did not.

“I saw in her eyes that she didn’t understand anymore,” Arends recalled in an interview, after one such refusal.

So, the doctor drugged her patient’s coffee, and began the lethal injection procedure while the woman slept. But her patient awakened and struggled against being killed. The doctor ordered the family to hold her down as she finished the process.
Arends was tried for murder but was quickly exonerated and even praised by the judge for furthering her late patient’s best interests. In other words, the patient was deemed incompetent to want to live.


But what about jurisdictions in which euthanasia and assisted suicide are illegal? Assisted suicide advocates teach the elderly how to commit suicide by self-starvation—with the cooperation of a doctor palliating the agony—a practice known in euthanasia parlance as VSED for “voluntary stop eating and drinking.”

As if that isn’t awful enough, bioethicists also are now arguing that people should be able to sign an advance medical directive ordering that they be denied food and water by mouth if they become cognitively impaired, just as people can order themselves euthanized in the Netherlands.

“Since it requires that the individual act before losing capacity, VSED requires that the individual act earlier than they prefer,” one prominent proponent, bioethicist Thaddeus Mason Pope, argues. “They must act while they still find life worthwhile. Because it is uncertain when the ‘window of opportunity’ will close, when the individual will lose capacity, individuals err on the side of acting early.

“To avoid the problem of premature death, many have proposed that individuals complete advance directives that instruct others to stop hand feeding. This is known as “advance VSED” or “SED by AD.”

Let’s be clear about what we are discussing here. It’s not force-feeding people who won’t eat. Nor are we discussing a feeding tube, which can be refused via a signed advance directive, because it is deemed by law to be a medical treatment. Rather, the point is to deny sustenance to people who willingly accept food and liquids by mouth.

Being provided breakfast, lunch, and dinner, even when spoon-fed, aren’t medical treatments, but humane care—akin to being kept warm, clean, and free from bed sores—basic assistance to which everyone is entitled simply because they are human beings.
Consider: If a patient stated they wanted to die by hypothermia by being left in front of an open window during a blizzard, would we ever permit it? No! Doing so would be castigated as gross neglect regardless of what the patient wrote they wanted.

Enforced Starvation

This important distinction between medical treatment and humane care is eroding fast.
If Pope and his fellow travelers get their way, nursing homes and other caregivers could be forced to starve incompetent patients under threat of lawsuit or loss of professional license—just like doctors today cannot refuse to cease life-sustaining medical treatment when so ordered in an advance directive.
Oh, Wesley. Things would never go that far!
Alas, they already have. The Medical Journal of Australia just reported on an incapacitated stroke patient who had signed an advance directive stating, “If I am suffering from advanced dementia and appear willing to accept food and fluid by hand offered by assisted or hand feeding, my instructions are that I do NOT want to be fed by hand even if I appear to cooperate in being fed by opening my mouth.”

That is something no one should have the right to demand of others, but it’s exactly what the doctors and the patient’s wife acquiesced to, even though “the directives [to withhold food] were not legally binding.”

It took the man four days to die.

It can happen here now, too. A recently passed law (SB 121) allows Nevadans to sign an “End of Life Decisions Addendum: Statement of Desires,” to an advance medical directive by marking “yes” or “no” to the following question: “4. I want to get food and water even if I do not want to take medicine or receive treatment.”

If the patient checks “no,” it would seem to require caregivers to make the patient die of malnourishment—perhaps, even if he or she asks for food. Remember what happened to the poor dementia patient in the Netherlands deemed incompetent to want to live.

But, you say, starving is a horrible way to die! Indeed, and that’s precisely the point. The ultimate purpose behind requiring caregivers to deny sustenance to people isn’t to pretend that such crass neglect is a civilized means of causing death. Rather, it is to create such revulsion that people will agree to dispatch such patients more humanely by lethal injection instead.

We can’t yield to that coercion. The answer to the difficulties caused by dementia isn’t to kill people less painfully, but to care for them properly with love and respect—which begins with not killing them at all.

Award-winning author Wesley J. Smith is chairman of the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.
Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times.
Award-winning author Wesley J. Smith is host of the Humanize Podcast (, chairman of the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council. His latest book is “Culture of Death: The Age of ‘Do Harm’ Medicine.”
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