Is there any difference between euthanasia and palliated starvation?


Xavier Symons

While euthanasia and assisted suicide are currently illegal in most countries, the practice of voluntarily stopping eating and drinking (VSED) is seen by some as an ethically and legally permissible alternative. VSED refers to seriously-ill patients refusing to eat and drink for a sustained period of time with the intention of bringing about their own death.

Yet a new paper published in BMC Medicine argues that VSED is ethically indistinguishable from assisted suicide, and should be subject to the same legal regulations as more salient cases of assistance in dying.

The paper, lead-authored by Ralf J. Jox of the Institute for Ethics, History and Theory of Medicine at the University of Munich, argues that “supporting patients who embark on VSED amounts to assistance in suicide, at least in some instances, depending on the kind of support and its relation to the patient’s intention”.

While VSED does not involve an invasive or aggressive act like many other means of suicide, the authors write that “VSED should [nevertheless] be considered as a form of suicide, as there is both an intention to bring about death and an omission that directly causes this effect”. Doctors who assist patients in VSED — by encouraging them, or promising pain-relief if VSED is undertaken — are potentially instrumental in the deaths of the patients, as the suicide would not occur without them, and they share the patient’s intention of inducing death.

The authors of the paper conclude that the same legal prescriptions or regulations that apply to physician assisted suicide should also apply to VSED.

“[We] maintain… that future ethical discussions on assisted suicide require consideration of medically supported VSED, and vice versa…Thus, the widely held position by palliative care societies, professional bodies of physicians, legal scholars, and ethicists to disapprove of assisted suicide but approve of and even promote medically supported VSED appears inconsistent”.

Is there any difference between euthanasia and palliated starvation?This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.


Accessed 2017-08-11


Judge rules family cannot order caregivers to starve mother to death

In a 44 page judgement, Mr. Justice Greyell of the Supreme Court of British Columbia has ruled that family members cannot order caregivers at a nursing home to starve an 83 year old resident to death.  Margot Bentley, age 83, is in the final stages of Alzheimer’s disease.  Based on written instructions she left before being diagnosed with the disease, family members went to court to stop caregivers from spoonfeeding her when she opened her mouth to accept food.  The judge noted that she is not dying, and that to comply with their wishes wold mean that Mrs. Bentley would die from starvation and dehydration and not an underlying disease.

Having considered the evidence, he rejected the claim that Mrs.  Bentley is in a “vegetative state” as “neither useful nor accurate,” concluding, instead, that it was possible that she had sufficient mental function to decide whether or not to eat and drink and to communicate that decision in non-verbal ways.  He held that spoon-feeding was not “health care” within the meaning of the law, but a form of personal care.  While he agreed that, under the common law, a competent adult can refuse food and fluids and thus commit suicide, he ruled that there was no legal precedent for the finding that such a decision could be made on behalf of an incompetent person by a proxy decision maker.  On the other hand he recognized statutory and public policy considerations that would tell against such a finding.

The case is of interest because it demonstrates how the kind of directives the family pursued in this case can generate conflicts of conscience among caregivers and health care workers.

American Nurses’ Association drafts policy against euthanasia and assisted sucide

The American Nurses’ Association has offered a draft policy document for public input until 8 November.  The position statement opposes nurse participation in euthanasia and assisted suicide.  Some of those opposed to the procedures remain concerned that the draft statement equates the provision of food and fluids with medical treatment that can be withdrawn from patients even if they are not dying.  [Lifesite News]

Withdrawal of nutrition and hydration should be normative

Catherine Constable of the New York University School of Medicine has published a journal article advocating that patients diagnosed as being in a permanent vegetative state (PVS) should be killed by starvation and dehydration unless their families insist that they receive assisted nutrition and hydration.

Constable, C. (2012), Withdrawal of Artificial Nutrition and Hydration for Patiens in a Permanent Vegetative State: Changing Tack. Bioethics, 26: 157–163


Warning that protection of conscience laws may enable euthanasia

Burke J. Balch, J.D., director of National Right to Life Committee’s Robert Powell Center for Medical Ethics in the USA, has warned that protection of conscience laws like the  Illinois Health Care Right of Conscience Act and Mississippi’s Health Care Rights of Conscience Act are dangerous because they may permit health care workers to commit euthanasia by withdrawing or refusing to provide medical treatment for reasons of conscience. [NRTL News]