By Kelduyn R Garland, PhD, DD, of the Silver City End of Life Options Coalition
Although seven states and the District of Columbia currently allow Medical Aid in Dying as an end of life option (where a terminally ill, mentally competent individual can obtain a self-administered prescription to bring about a peaceful death), New Mexicans do not yet have this choice. However, in addition to the proposed Medical Aid in Dying that will be considered in New Mexico’s 2019 legislative session, there are other end of life options that currently exist for terminally ill patients.
One such option is Voluntary Stopping of Eating and Drinking (VSED), wherein a mentally competent individual with unrelieved suffering from a chronic or incurable and progressive disorder may choose to control their own dying process by making a conscious decision to refuse foods and fluids of any kind. This option is legal in every state – the U.S. Supreme Court has affirmed the right of a mentally competent individual to refuse medical therapies, including food and fluids.
But isn’t death from starvation or dehydration painful?
When people think about someone stopping eating and drinking, they immediately think of starvation and the person being in great discomfort and pain. However, there is a clear and distinct difference between someone voluntarily stopping eating and drinking at the end of their life and some otherwise viable person experiencing dehydration / starvation.
We see people starving to death due to famine / lack of food being provided them, or going on ‘hunger strikes’ as IRA members in Irish prisons have done in protest to British rule, as political activists in US prisons have done, or as Gandhi did in protest to fighting between the Hindus and Muslims during the 1920’s and 1940’s. These cases of starvation occurred for people who were very much alive and in the midst of living, who did not consume food, either by choice or through deprivation. In such cases, the body physiology is geared for life functioning and needs food for fuel, so the individuals go through ‘hunger pangs’ and discomfort when their bodies are deprived of sustenance and they are starving.
This is quite different -- and poles apart -- from someone with no remaining quality of life or at the end of their life. They have come to a point where they actually are not interested in food and do not feel hungry, and, therefore, do not want to eat. This ‘choice’ can also be a natural / default response of having entered the dying process, and because the body’s physiological functions have begun shutting down, the person has no interest in eating or drinking. That person should not be forced to eat or drink, or be put on a feeding tube, unless they have specified in their Advanced Directive / Living Will.
As the end of life approaches, organs (including the brain) go through changes, ‘shutting down’ in their functioning because life is coming to an end. It’s similar to someone shutting down or closing up a house at night when going to bed: lights are turned off; thermostat is turned down; doors, and perhaps windows, are closed… household functions have slowed down for the night.
Our bodies do the same thing as we near death: organs begin shutting down because they are not needed any more for maintaining life. For this reason there is not the pain and discomfort in VSED as there is in starvation. Many times, actually, drinking or eating can bring more discomfort than not doing so. In addition, in VSED, death most commonly occurs from dehydration, not lack of eating, per se.
Although VSED is available to anyone with no prescriptions or ‘permissions’ required, an individual who decides to use VSED does need to plan and does need help. Individuals typically need 24-hour care during this process, and ongoing help such as hospice care from an agency or friends. Legal medications are available to ease possible symptoms of discomfort. When a person reaches this point in his/er life and has stopped eating and drinking, several things can be done to help keep them comfortable. For example, keeping their lips moist so that they do not get dry and crack is important, and can be done with a damp sponge or cloth gently pressed against the lips. There are even specific moisture sponges that can be bought for this purpose.
The prime service and goal that family and friends can provide their loved one during the end of life process is support and comfort care, which in turn is supportive and comforting to them in witnessing their loved one departing in peace.
When a person chooses VSED, the process usually takes about 10 days to 2 weeks (though the length of time depends on many variables like age, physical condition, and illness). A number of internet resources are available to learn more about VSED (and other end of life options). For example, Compassion and Choices has a publication on VSED available for download that includes important considerations for individuals thinking about this option.
With appropriate planning, the VSED process can be a very peaceful time with loved ones as the individual fulfills their end of life wishes.
For more information on end of life options see the following resources:
To contact the Silver City End of Life Options Coalition or leave comments: email@example.com