Over the last several years, Right-to-Die advocates have been increasingly advocating a practice known as “VSED” — which is harmful not only to vulnerable persons, but to health care professionals and to society. If you haven’t heard of VSED yet, you soon will. You may find that VSED will affect you, your loved ones, or Catholic clinicians in ways that you did not anticipate.
Origins. VSED is an acronym for “voluntarily stopping eating and drinking,” whereby a person refuses all food and fluid and dies within days as a result. The practice was first popularized in a 1994 article in the Journal of the American Medical Association by David Eddy, MD, who described how he helped his 85-year-old mother to die a peaceful death by VSED when she tired of life (i.e., she was not suffering from a terminal illness). The article was immediately praised by the editor of JAMA as “the most important article published in the last 50 years … legal, ethical, moral and loving.”
“Right to die” advocates quickly seized on VSED as an alternative to physician-assisted suicide, which at that time was legal only in Oregon. But support has continued to grow. In 2016, a conference on VSED in Seattle, Wash., drew over 200 advocates in law, medicine, and ethics. The New York Times and The Washington Post ran articles characterizing VSED as a justifiable exercise of autonomy.
Is VSED ethical? Advocates justify VSED on several grounds — that the decision is autonomous (freely chosen by a competent person), not illegal, consistent with our rights to refuse medical and non-medical interventions, and doesn’t involve another person (such as a physician) or a lethal act (by drugs or by lethal injection). These considerations, however, do not address the ethical principles which reason and our Catholic faith have identified as essential in such a matter.
First, VSED requires a determined will to begin and sustain a pattern of behavior that will cause one’s death. This is the very nature of suicide. Second, the Church teaches, based on a moral tradition that stretches back to the Fathers of the Church, that we have an obligation to use ordinary means to conserve our lives and those of the vulnerable. In the case of health care, this means medicines and procedures which are effective and do not involve grave burdens.
Pope Pius XII formalized this moral tradition in 1957. It was confirmed by the Congregation for the Doctrine of the Faith in 1980 (Declaration on Euthanasia) and again in 2007, when the CDF ruled that providing nutrition and hydration — even assisted nutrition and hydration — should be considered in principle ordinary treatment and care of a human person.
To deliberately refuse food and fluids outside the process of dying (when the body naturally begins to shut down, the desire and need for food and fluid recedes) constitutes a failure to respect the gift of human life in our role as stewards, not owners, of our earthly lives.
Implications for others, clinicians, and society. VSED is a tragic and unethical course of action for an individual. But what does it have to do with others and society? First, death by dehydration is very painful and unpleasant. For most, it can be borne only with professional and personal support. In short, to have a “controlled, dignified death” by VSED, people need medical professionals to provide morphine and symptom management — and to refrain from providing water and food if requested, since patients sometimes call out for them in the process. Health care professionals and institutions are increasingly being asked to go along with VSED and to provide the support needed.
Beyond this unethical cooperation, however, other legal and professional challenges are looming. Recently some families have demanded that nursing homes stop feeding incompetent senile patients by hand (even when patients willingly accept food), since the patient expressed wishes in the past that they would not want life-sustaining treatment or to live “that way.” Legal experts and bioethicists are beginning to argue for a legal expectation that handfeeding be withheld based on advance directives.
We should accompany the elderly through illness and dying by providing the most basic forms of treatment and care, and we should not abandon our ethical standards — or legal and cultural protections — in the name of autonomy or for the latest trends in bioethics.
JOHN F. BREHANY, PH.D., STL, is director of institutional relations at the National Catholic Bioethics Center.