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 all liquids
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 all fluids,
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 available
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 stop putting fluids into
our bodies.
Even people who
are completely paralyzed
—not
able to move even one finger—
can
still choose to end all 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.
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 to die 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 all fluids.
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
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 fluids
—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 claim 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 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 water and other fluids,
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 water.
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; 7-27-2018; 8-22-2018; 10-31-2019;
11-6-2019; 9-10-2020;
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 rejected safeguards as
irrelevant.
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 encourage the people closest to you at the end of your life
to use these
safeguards in helping
you
to review your own plans for death?
The
review above of safeguards for life-ending decisions
as
they apply to the choice of voluntary death by dehydration
is Chapter 38 of How
to Die: Safeguards for Life-Ending Decisions:
"Voluntary
Death by Dehydration:
Safeguards to Make Sure
it is a Wise
Choice".
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. comfort-care only; 2. induced terminal
coma;
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
Other
related chapters from the same book,
plus a few other on-line
essays:
Why
Giving Up Water is Better than other Means of Voluntary Death
Losing
the Marks of Personhood:
Discussing
Degrees of Mental Decline
The
One-Month-Less Club:
Live Well Now, Omit the Last Month
Taking
Death in Stride: Practical Planning
Pulling
the Plug:
A Paradigm for Life-Ending Decisions
A
New Way to Secure the Right to Die:
Laws Against Causing Premature
Death
Two
Approaches to Right-to-Die Laws:
Granting Permission and Banning
Harms
Advance
Directives for Medical Care:
24 Important Questions to Answer
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
Induced Terminal Coma:
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 Dehydration
Medical
Methods of Managing Dying
Books
Supporting 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,
you might join a Facebook Group
and Seminar called Right-to-Die Hospice.
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.
Which bibliography speaks to your present interests?
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.