Dying of Thirst is Excruciating Agony

Observing irony can be funny - but it always carries with it a poignancy of some kind. For example: North Korea calls itself the Democratic People's Republic of Korea. Mmmm! Democratic? 

Similarly the US group Compassion and Choices seems to be about anything but its title description. Take its endorsement of Voluntary Stop Eating and Drinking as described on its website:

Voluntarily Stopping Eating and Drinking (VSED) is a legal means to accelerate the dying process. The U.S. Supreme Court has affirmed the right of a patient to refuse any medical treatment, including food and fluids. When planned for and supported in the right circumstances, VSED can be a peaceful and gentle way of dying. Many terminally ill patients naturally lose interest in eating and drinking as their illness progresses, and may find that choosing to stop eating and drinking relieves their discomfort and other symptoms.

Compassion & Choices Oregon provides support to patients and family members who request to learn more about VSED. Please call us at 503-525-1956 for our recommendations for a quick, peaceful process and to discuss whether VSED is a good option for you.

Okay, so the U.S. Supreme Court acknowledges such a right; so what? Sure, appetites can wane when we are ill and, certainly, feeding and hydrating can in fact be pointless and even cruel right at the very end. But that's not what they're really talking about here.

It seems to me that this promotion is all about people who don't qualify for assisted suicide in the US states where it is legal and for everyone and anyone in all other circumstances. In short, if the law isn't going to change where you live or if you're really not that sick but want to die anyway - go for it.

But quick and peaceful it certainly isn't - as Wesley Smith describes below.

But that's what's on the menu this week in Brisbane at the International Conference on End of Life: Law, Ethics, Policy and Practice annual shindig. The conference has much to offer even though most of its international and local speaking roster is populated by known pro-euthanasia academics, including Peter Singer. But if the interesting presentations on what look like genuinely interesting issues for end-of-life don't grab you there's a stream of concurent sessions on euthanasia and assisted suicide, appropriately coloured green (wasn't the koolaid green?) might be your cup of tea.

Two sessions apposite to Wesley's article below:

Voluntary stopping of eating and drinking (VSED) as a means to end intractable suffering and Assisted suicide through 'nil by mouth' in a residential aged care facility: Policy and practice.

Over to you Wesley:

By Wesley Smith, August 8, 2014 - Link to this article on his blog.

Health writer Larry Bernstein of the Washington Post has written an excruciating column about how awful and painful it is to die by thirst. The article laments–as any civilized person would–the potential mass deaths by dehydration of the Yazidi at the hand of the butchers of ISIS in Iraq.

Dying of dehydration is an awful death. From the piece:

I'm not about to start ranking the horrors visited on the human body this summer, from Ebola in West Africa to bombs and bullets in Gaza and Israel. But thousands of particularly excruciating deaths may soon be added to the list by the Sunni extremists of the Islamic State of Iraq and Syria, the terrorist group that is sweeping through parts of Iraq and establishing its own state.As this barbarism continues.

Bernstein did some research:

I asked Jeffrey Berns, president-elect of the National Kidney Foundation and a nephrologist at the University of Pennsylvania, what these children may be going through. "Thirst, as you probably know, is one of the most potent drives for behavior we have. It may be the most potent we have, more than even hunger," he said. "People are going to be miserable."

The body is about 60 percent water, and under normal conditions, he said…If it's not replaced over time and dehydration becomes severe, cells throughout the body will begin to shrink as water moves out of them and into the blood stream, part of the body's efforts to keep the organs in fluid. "All the cells will shrink," he said, "but the ones that count are the brain cells. They don't operate normally when they're' shrinking."

Changes in mental status will follow, including confusion and ultimately coma, he said. As the brain becomes smaller, it takes up less room in the skull and blood vessels connecting it to the inside of the cranium can pull away and rupture. Without water, blood volume will decline and all the organs will start to fail, he said. Kidney failure will soon lead to disastrous consequences and ultimately death as blood volume continues to fall and waste products that should be eliminated from the body remain.

Yes, an awful, horrific death.

Except when inflicted on people like Terri Schiavo? That can't be right.

This is a biological process–yet conscious and unconscious disabled and elderly alike are made to die of thirst throughout the country and much of the Western world by thirst through removal of tube-supplied sustenance.

Yet how many times have we seen advocates for removing feeding tubes from the cognitively disabled sooooothingly assure us it is a peaceful, painless way to die?

From a 2005 Chicago Tribune story about the pending death of Schiavo:

One of the main rationales of religious advocates and lawmakers seeking to keep Terri Schiavo alive through a feeding tube has been that removing her only source of nutrition and liquid would be cruel, leading to a "horrible and painful death," in the words of one activist.

But many of the doctors and nurses who witness the consequences of removing such treatment from patients say withholding nourishment is a common—and largely painless—way of letting nature take its course for ill patients. They say many people near death actually choose to have their feeding tubes removed, which typically leads to a calm, peaceful death.

Yes, IF PEOPLE ARE ON THE VERGE OF DEATH BY CANCER or some other disease. In those cases, the death is not from thirst!

But the people we are discussing here are not dying other than having their water and food taken away. That's a huge difference The same process described in Bernstein's piece happens to them.

Oh, and notice what Berns said about the size of the brain after dehydration: Terri's shrunken brain was touted as proof she could feel nothing. Remember?

People in cognitively disabled conditions may not be able to cry out and beg for food–although I know of at least one case where that happened–because they don't have the ability. But that doesn't mean on the inside, unless given powerful drugs–Terri Schiavo wasn't given that courtesy–they aren't feeling the same pain as those poor people on the Iraq mountain.

And now Compassion and Choices and other assisted suicide organizations push suicide by thirst and starvation (VSED). From the C & C book, "Voluntary Stop Eating and Drinking:

Some call us because they feel overwhelmed by the symptoms of chronic and progressive illnesses that fill their days with misery and suffering. There are also those who may not be seriously ill but are simply "done." After eight or nine decades of life, they want information about ways to gently slip away in a peaceful and dignified manner.


Add to that advocacy now for VSED-by-proxy that would force nursing homes to withhold oral sustenance to Alzheimer's patients who asked to be starved and dehydrated to death in an advance directive–even if they willingly drink water and juices and eat food.

The elderly, the profoundly disabled, babies born with Down syndrome that have intestinal blockage, etc. are not a different species. They are people. Making them die of thirst is agonizing too. Those who push these kinds of deaths as merely "medical ethics:" Own it!