DEHYDRATION, RIGHT TO DIE--MORAL AND ETHICAL ASPECTS---voluntary death by dehydration (VDD)

VOLUNTARY DEATH BY DEHYDRATION:
SAFEGUARDS TO MAKE SURE IT IS A WISE CHOICE

SYNOPSIS:

    When we are approaching the natural end of our lives,
we might choose to give up eating and drinking
in order to shorten the process of dying.

    Voluntary death by dehydration is a special pathway towards death.
If this way of ending our lives appeals to us,
we can begin a careful process of planning several months in advance.

    If our choice is wise and rational,
then we will receive help and cooperation from others.
Because voluntary death by dehydration is legal everywhere on Earth,
we can be open about our planning for the last year of our lives.

OUTLINE:

1. A NEW PATHWAY TOWARDS DEATH: VDD

2.   SAFEGUARDS FOR VOLUNTARY DEATH BY DEHYDRATION

A. ADVANCE DIRECTIVE FOR MEDICAL CARE

B. REQUESTS FOR DEATH FROM THE PATIENT

C. PSYCHOLOGICAL CONSULTANT EVALUATES
            THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

E. INDEPENDENT PHYSICIAN
            REVIEWS THE CONDITION AND PROGNOSIS

F. CERTIFICATION OF TERMINAL ILLNESS
            OR INCURABLE CONDITION

G. UNBEARABLE SUFFERING

H. UNBEARABLE PSYCHOLOGICAL SUFFERING

I. PALLIATIVE CARE TRIAL

J. INFORMED CONSENT FROM THE PATIENT

K. REQUESTS FOR DEATH FROM THE PROXIES

L. ENROLLMENT IN A HOSPITAL OR HOSPICE

M. STATEMENTS FROM HOSPITAL OR HOSPICE STAFF MEMBERS

N. STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

O. A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING DEATH

P. RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

Q. AN INSTITUTIONAL ETHICS COMMITTEE
            REVIEWS THE PLANS FOR DEATH

R. STATEMENTS FROM ADVOCATES FOR DISADVANTAGED GROUPS
          IF INVITED BY THE PATIENT AND/OR THE PROXIES

S. REVIEW BY THE PROSECUTOR (OR OTHER LAWYER)
            BEFORE THE DEATH TAKES PLACE

T. CIVIL AND CRIMINAL PENALTIES
            FOR CAUSING PREMATURE DEATH

U. WAITING PERIODS FOR REFLECTION

V. OPPORTUNITIES FOR THE PATIENT
            TO RESCIND OR POSTPONE ANY LIFE-ENDING DECISIONS

W. PHYSICIANS REVIEW
            THE COMPLETE DEATH-PLANNING RECORDS

X. COMPLETE RECORDING AND SHARING
            OF ALL MATERIAL FACTS AND OPINIONS

Y. THE PATIENT MUST BE CONSCIOUS
            AND ABLE TO ACHIEVE DEATH

Z. THE DEATH-PLANNING COORDINATOR
            ORGANIZES THE SAFEGUARDS

3. APPLYING THE BEST SAFEGUARDS TO OUR OWN SITUATIONS

VOLUNTARY DEATH BY DEHYDRATION:
SAFEGUARDS TO MAKE SURE IT IS A WISE CHOICE

by James Leonard Park

    When we decide to draw our lives to a close by voluntary dehydration,
this is a plan we can share with everyone who cares about us.
Family and friends might mention reasons for us to live a bit longer.
Will a new baby soon be born? Is someone getting married?
Do we want to complete some meaningful projects before we die?

    Taking a year to plan our own deaths
will enable us to make a number of wise practical decisions.
For example, we will not authorize elaborate medical treatments
if we know that we have begun the last year of our lives.
If death comes before we give up eating and drinking,
then we can accept that accident as a gift instead of resisting it,
as would be the normal medical response to any health-crisis.

    Even more explicitly, if we have chosen our best date of death,
we will carefully create End-of-Life Medical Orders with our doctors,
so that just in case we have a heart-attack during our last year,
we will allow that event to run its course, resulting in our death,
rather than using the medical means at our disposal
to save us from death caused by a failing heart.

1. A NEW PATHWAY TOWARDS DEATH: VDD

    The choice to end our lives by dehydration
has been discussed under a number of other names:
Stopping Eating and Drinking—STED or SED
Voluntary Stopping Eating and Drinking—VSED
Voluntary Medical Dehydration—VMD
Terminal Dehydration—TD

    No matter what name we prefer, the process is the same:
We decide to give up eating and drinking.
We refuse all further offers of food, water, or other fluids.
Even people who are completely paralyzed
—not able to move even one finger—
can still choose to end all nutrition and hydration.

    Depending on the amount of water stored in our bodies
and any health problems we might have,
the process of dying by dehydration will take up to two weeks.

    We can choose this means of voluntary death at home.
Any location will work.
We can choose the best setting for ourselves
and for everyone else who will be present for our last days.

    Hospice care would be one helpful choice,
since hospice workers already know how to deal with the problems
that usually arise when a patient chooses VDD.
Hospice care can be given at home or in some health-care institution.
If we are already hospitalized or in a nursing home,
then staying in that setting might be the easiest choice.

    Because VDD is a legal and honorable end-of-life option,
we do not need to keep secret our chosen pathway towards death.
We should tell everyone who cares about us
that we are now proceeding with our plans for death by dehydration.
There will be a variety of responses from the people who know us.
And we will consider reasonable requests to postpone our deaths.
But if we are making wise end-of-life plans,
most reasonable people will support our choice of this method of dying.

    But just to make as certain as possible
that we are making wise end-of-life choices,
the following safeguards will ask for the opinions of several other people
who will be involved with our last days.

2. SAFEGUARDS FOR VOLUNTARY DEATH BY DEHYDRATION

    The following safeguards adapt the 26 recommended safeguards,
which could be used for any life-ending decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-Z.html
And the title of each safeguard is hyperlinked
to the complete explanation of that safeguard.

A. ADVANCE DIRECTIVE FOR MEDICAL CARE

    If we are planning to end our lives by voluntary dehydration,
this option should be affirmed in the section
of our Advance Directives devoted to life-ending decisions.
The fact that we created such plans several years in advance
would be strong proof that we are not being irrationally swayed
by any factors that have recently emerged in our lives.
When we first create our Advance Directives for Medical Care,
we usually do not know what medical problems will cause our deaths.
Rather, we are explaining our settled values
concerning how we want to conduct the last year of our lives.

    When we have decided to put our long-held plans into action,
we can ask those who will be most deeply affected by our deaths
to write their own statements of cooperation and understanding.
When we ask for such written statements endorsing our plans for VDD,
this will be an opportunity for the people closest to us
to review our reasons for choosing death now rather than later.
And their willingness to cooperate in our death-planning process
should be strong evidence that our choice of death is reasonable.

B. REQUESTS FOR DEATH FROM THE PATIENT

    When we choose our best date to die,
we will put these plans into writing in a number of ways.
But if we are under some form of medical care,
we will ask our care-givers to support our chosen means of dying.
When we put our plans into writing, having our requests witnessed,
this should preempt second-guessing from people
who have no reason to participate in planning our deaths.
We will have formal, written requests for death,
which will be shared with everyone legitimately involved.

C. PSYCHOLOGICAL CONSULTANT EVALUATES
            THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS

    Even if there is little doubt that we are making rational end-of-life plans,
it will be easy to have a conversation with a psychological professional,
who will issue a written statement confirming our voluntary choice
to end our lives by giving up eating and drinking.
The consultant will confirm that we have a good grasp of reality:
We know that we will certainly die as a result of giving up food and water.
Furthermore, the psychological consultant can confirm
that we are not being manipulated into making a foolish decision for death.
If this psychological consultant has any doubts about the process,
such questions should be resolved before the plans for death go forward.

D. PHYSICIAN'S STATEMENT OF CONDITION AND PROGNOSIS

    Basic to any life-ending decision is the medical background
that is leading us to choose voluntary death by dehydration.
Putting these medical facts into a written and signed statement
will make explicit the medical reasons for choosing death this year.

E. INDEPENDENT PHYSICIAN
            REVIEWS THE CONDITION AND PROGNOSIS

    And because our life-ending decision is so final and irreversible,
a second doctor, perhaps a specialist in our disease or condition,
should issue a separate medical opinion about what is happening to us.
Any differences in these professional medical analyses
should be resolved before death-planning goes forward.

F. CERTIFICATION OF TERMINAL ILLNESS OR INCURABLE CONDITION

    If we are choosing death because of a disease that cannot be cured,
that terminal prognosis can be added to the doctors' written statements.
Or a separate document could be created stating our terminal condition.
Some forms of medical help—such as hospice care—
require an official declaration by a doctor of a terminal illness or condition.

G. UNBEARABLE SUFFERING

    If we are choosing a voluntary death by dehydration
because of some kind of suffering that makes life intolerable,
then we should explain our suffering in our requests for death.
But if our suffering has not yet been explicitly stated,
then a new statement from our own perspective as the suffering person
should be created so that everyone who has a right to know
will more fully understand how suffering is leading us to voluntary death.

H. UNBEARABLE PSYCHOLOGICAL SUFFERING

    And even if part of our suffering is inward or psychological,
we can explain why those problems are leading us to choose death
rather than merely allowing nature to take its course,
resulting in a more normal death at some random time in the future.

I. PALLIATIVE CARE TRIAL

    Often opponents of the right-to-die say that good palliative care
is a better alternative than choosing death.
And the most reasonable reply to this criticism
is that we have already tried all available means of treating our condition
and we now find life intolerable even under the best palliative care.
Using our most careful thinking, we now prefer death
over continued existence even with palliative care.

J. INFORMED CONSENT FROM THE PATIENT

    The other documents created in planning for death
will usually show that we have good information about our condition
and that we have considered the alternatives.
We are now giving our informed consent to a process
that will lead to our death within a few days after we give up all fluids.

K. REQUESTS FOR DEATH FROM THE PROXIES

    If our own capacity to give informed consent for VDD is questionable,
then our proxies can request the withdrawal of all food and water
—with the certain knowledge that such withdrawal will lead to death.
We might create a joint request, signed by both ourselves and our proxies.

L. ENROLLMENT IN A HOSPITAL OR HOSPICE

    Even tho hospitalization is not required for VDD,
if we are already being cared for in any medical facility,
this will be further evidence that our physical condition has deteriorated
to the point where we cannot easily be cared for in a more home-like setting.
The medical records of the hospital or hospice program
will be further evidence of the conditions leading us to choose death.

M. STATEMENTS FROM HOSPITAL OR HOSPICE STAFF MEMBERS

    And if we are receiving professional medical care at the end of our lives,
then our care-givers might be asked to add their own written statements
of understanding and support for our decision to choose VDD.
Such care-givers have no veto power over our decision for death,
but if they understand our decision and cooperate with our plans for death,
then distant critics will have less reason to doubt
that we chose a wise and meaningful way to end our lives.

N. STATEMENTS FROM FAMILY MEMBERS
            AFFIRMING OR QUESTIONING CHOOSING DEATH

    Family members (or others at the bedside)
should also be asked to write their own personal statements
affirming the choice of voluntary death by dehydration.
When they have put their words on paper,
it might allow them greater peace with the life-ending decision
and their own roles in helping voluntary death by dehydration.

O. A MEMBER OF THE CLERGY
            APPROVES OR QUESTIONS CHOOSING DEATH

    If we have any important connections with organized religion,
we might ask for our choice of voluntary death by dehydration
to be reviewed by a professional religious leader we trust.
If we get religious support for our decision to die by dehydration,
this might reinforce our belief that we are making a wise choice.

P. RELIGIOUS OR OTHER MORAL PRINCIPLES
            APPLIED TO THIS LIFE-ENDING DECISION

    Even more explicitly, we might have reason to request a written statement
of how our religious principles apply to the situation at hand.
Especially if we are very religious, we might want to be assured
that our decision to die by dehydration does not conflict with our faith.

Q. AN INSTITUTIONAL ETHICS COMMITTEE
            REVIEWS THE PLANS FOR DEATH

    If we are receiving our terminal care in any medical institution
that has a formal ethics committee to review such cases,
we might also ask for their professional evaluation
of our decision to end our lives by dehydration.
Since these people have much experience with life-ending decisions,
they should be able to issue an unbiased opinion
concerning our reasons and plans for death.

R. STATEMENTS FROM ADVOCATES FOR DISADVANTAGED GROUPS
           IF INVITED BY THE PATIENT AND/OR THE PROXIES

    When we are choosing our own date of death for our own reasons,
we are probably not suffering discrimination of any kind.
But if someone might raise such a doubt,
then our death-planning process could be reviewed
by an advocate drawn from our own identity-group.

S. REVIEW BY THE PROSECUTOR (OR OTHER LAWYER)
            BEFORE THE DEATH TAKES PLACE

    And the most superfluous review might be done by the public prosecutor.
Perhaps there is some family member who is under the false impression
that cooperating in our voluntary death by dehydration
could result in some form of prosecution.
If so, the public prosecutor could review the complete death-planning record
and issue a written statement assuring all involved
that no crime will be committed by anyone if the plans are carried forward.

T. CIVIL AND CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH

    But because there is always a remote possibility of criminal behavior
disguised as a voluntary termination of food and water,
civil and criminal penalties should remain in place
to punish anyone who causes a premature death.

U. WAITING PERIODS FOR REFLECTION

    But it might be wise to require meaningful waiting periods
to allow everyone to review the plans and their participation in them.
Rushing into a voluntary death by dehydration would never be wise.
As said earlier, up to a year might be a reasonable period of time
for planning a good death by dehydration.

V. OPPORTUNITIES FOR THE PATIENT
            TO RESCIND OR POSTPONE ANY LIFE-ENDING DECISIONS

    In the process of planning our own deaths by dehydration,
there will be specific turning-points at which we can change our minds.
For example, we might easily find that we want to extend our lives
if our physical and mental conditions remain stable or improve.
As long as we have taken no irrevocable actions,
we can continue to live for as long as we find meaning in life.
Postponing our plans for a voluntary death by dehydration
is not the same as abandoning such plans.
But, of course, we could also change our minds so completely
that we will not choose to go ahead with death as planned.
Instead, we will allow some other death-dealing process to unfold.

W. PHYSICIANS REVIEW THE COMPLETE DEATH-PLANNING RECORDS

    If we are planning our own deaths with the cooperation of a physician,
then it might be wise to have this terminal-care physician
review the documents created in planning for death.
There probably were no mistakes.
But just in case there might be some doubts,
the physician in charge of our care might discover the error
in time to prevent a premature death.
Death at a later time might be best of all concerned.

X. COMPLETE RECORDING AND SHARING
            OF ALL MATERIAL FACTS AND OPINIONS

    When we are carefully planning our deaths by dehydration,
we can collect and share all the documents created in the process.
Who should receive copies of the planning statements?

Y. THE PATIENT MUST BE CONSCIOUS
            AND ABLE TO ACHIEVE DEATH

    In the situation of a voluntary death by dehydration,
we would not expect to remain fully conscious until the last moment.
This raises the explicit question
of what to do after we have lost consciousness.
Normally, death by dehydration unfolds in the following ways:
After a few days without water, our ability to think deteriorates.
We spend more time asleep.
And then we become completely unconscious.
We might have authorized sedation to make the process easier.

    If we are not conscious up until the last moment,
this should not overturn our plans.
We put our trust in the people caring for us at the end of our lives:
They will carry forward our plans for death by dehydration
even when we can no longer actively participate.

Z. THE DEATH-PLANNING COORDINATOR
            ORGANIZES THE SAFEGUARDS

    If we want the record of our death to be complete,
we will arrange for someone to collect all the documents in one place.
The last chapter of our lives will be written by others.

3. APPLYING THE BEST SAFEGUARDS
            TO OUR OWN SITUATIONS

    When we are approaching the natural end of our lives,
we might decide to shorten the process of dying
by giving up eating and drinking.
We can do this in cooperation with several other people
who are close to us at the end of our lives.
The more safeguards we fulfill,
the more professional and personal opinions we will gather.

    If we would like to count up the number of different people
who will be involved in our end-of-life plans,
here is another chapter that makes those numbers explicit:
The Number of People Reviewing a Life-Ending Decision
Using the 26 Recommended Safeguards.

    Safeguards are less important for choosing VDD
than for other kinds of life-ending decisions
because the very process of dying by giving up fluids
contains its own safeguard of stretching out the time
in which we die to several days,
during which we can re-think our plans for death
if our plans were somewhat misguided or poorly conceived.

    But the more other people we involve with our end-of-life choices,
the more certain we and others will be
that this was a truly voluntary death
rather than some form of irrational suicide
or a process that will result in a premature death.
And when the laws regarding the recording of deaths are changed
to recognize the differences between irrational suicide and voluntary death,
then choosing death by dehydration will be recorded as voluntary death.

    If we take several months to plan our own deaths by dehydration,
we will call upon several other people
mentioned in the safeguards discussed above.
The more completely we fulfill the safeguards,
the better our claim will be that we chose a voluntary death.

Created August 26, 2011; Revised 9-13-2011; 10-27-2011;
1-11-2012; 1-31-2012; 2-3-2012; 2-27-2012; 3-18-2012; 7-6-2012; 7-26-2012; 8-26-2012;
3-29-2013; 6-13-2013; 3-24-2014; 8-1-2014;
1-21-2015; 4-3-2015; 7-2-2015;10-8-2015; 12-24-2015;
3-15-2016; 10-26-2017;

AUTHOR:

James Park is an advocate of safeguards for all life-ending decisions.
He is the founder of a website called
Safeguards for Life-Ending Decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG.html
Much more about him will be found on his personal website:
James Leonard Park—Free Library

This full exploration of 26 safeguards for life-ending decisions
as they apply to voluntary death by dehydration
has become one chapter of a small book:
Right-to-Die Hospice.

How has this review of safeguards changed your mind?

Perhaps you originally thought that no safeguards would be relevant.
Do you now see that fulfilling several safeguards
would help to make certain that death at this time
and by this method is a good idea?
Can you see yourself applying these safeguards
to the life-ending decision of someone you love?
Would you want the people you love
to use these safeguards in helping you
to review your own plans for death?

RIGHT-TO-DIE SEMINAR ON FACEBOOK

The review above of safeguards for life-ending decisions
as they apply to the choice of voluntary death by dehydration
is also Chapter 38 of How to Die: Safeguards for Life-Ending Decisions:
"Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice".

Would you like to join a world-wide Facebook Seminar
discussing this book-being-revised?

See the complete description for this book-club:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-HTD.html

Join our Facebook Group called:
Safeguards for Life-Ending Decisions:
http://www.facebook.com/home.php#!/groups/107513822718270/

Links to further information about voluntary death by dehydration:

Go to a bibliography of books on Voluntary Death by Dehydration.

Go to an Internet portal called
Voluntary Death by Dehydration—Questions and Answers.
This portal explores more details of the process of dying by dehydration.

{more links wanted}

Because this essay applying the 26 recommended safeguards to VDD
was originally the last chapter of PART FOUR of
How to Die: Safeguards for Life-Ending Decisions,
the summary is published here.
If you would like to read any of the summarized chapters,
simply click that chapter number on the right.

Summary of Part Four

Step-by-Step Planning for Our Own Deaths

    Once we acknowledge that death is our destiny,
we can take specific steps to prepare for the end of our lives.

    First, we can create our own Advance Directives for Medical Care,
which will explain in our own words how we want to meet our deaths,
especially concerning the medical treatments we want or do not want.   Chapter 28

    If we will die while under some form of medical care,
we (or someone else) will probably make life-ending choices.                  Chapter 29

    Even more explicitly, we can decide now (while we are in good health)
that we prefer to skip the last month under standard medical care.
If that month will have little meaning and high cost,
what will be lost if we omit the last month in the hospital?                        Chapter 30

    As we approach the likely end of our lives, we can even select the best date.
We do not want to die too soon; we do not want to die too late.
So what would be the best day to die?                                                 Chapter 31

    Also, in addition of choosing the ideal day,
we can select a method of dying that appeals to us and our families.
Would we prefer: 1. increasing pain-medication; 2. terminal sedation;
3. withdrawal of medical treatments and life-supports; or
4. voluntary dehydration? Chapter 32

    We can also decide exactly what events we want to precede our deaths?
All pathways lead to death, but we can still choose the best one.       Chapter 33

    And we will be able to take death in stride
if we have already made our plans concerning such things as:
our medical care, distributing our assets, disposing of our remains,
& planning our funerals or memorial services. Chapter 34

    As we make plans for the last year of our lives, we can ask:
How will we know when we have completed our lives?    Chapter 35

    Because of the danger that we might lose the capacity to choose death,
we should make clear arrangements to preserve our right-to-die.         Chapter 36

    We might consider voluntary death by dehydration                      Chapter 37
because it contains several advantages over other methods of choosing death.

    In fact, all 26 recommended safeguards can be applied
to the choice of voluntary death by dehydration.                                 Chapter 38

Fifteen Safeguards for Life-Ending Decisions

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Will this Death be a "Mercy-Killing" or a "Merciful Death"?

Four Medical Methods of Managing Dying

Terminal Sedation:
Dying in Your Sleep—Guaranteed

Depressed?
Don't Kill Yourself!

Further Reading:

Best Books on Voluntary Death

Best Books on Preparing for Death

Books on Terminal Care

Books on Helping Patients to Die

First Books on Voluntary Death by Dehydr ation

Medical Methods of Managing Dying

Best Books on the Right-to-Die

Books Opposing the Right-to-Die

Go to the Right-to-Die Portal.

This chapter on using safeguards to help decide
when might be the best time to die by dehydration
is included in:
Medical Ethics at the End of Life.

WOULD YOU LIKE TO MEET OTHER SUPPORTERS
OF RIGHT-TO-DIE HOSPICE?

If you agree that careful safeguards should be used
in considering voluntary death by dehydration,
consider joining a Facebook Group and Seminar called Right-to-Die Hospice.
This discussion group is completely free of charge.
And members are welcome to join from any place on Earth.

The essay above explaining safeguard for voluntary dehydration
has become Chapter 9 of Right-to-Die Hospice.

Here is a complete description of this on-line gathering of advocates of the right-to-die:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-RTDH.html

And here is the direct link to our Facebook Group:
Right-to-Die Hospice:
https://www.facebook.com/groups/145796889119091/

Go to the Book Review Index
to discover 350 book reviews
organized into more than 60 bibliographies.

Return to the DEATH page.

Go to the Medical Ethics index page.

Go to on-line essays by James Park,
organized into 10 subject-areas.

Go to the beginning of this website
James Leonard Park—Free Library