Most dementia directives call for voluntarily stopping eating and drinking (VSED) at a prescribed point late in the progression of dementia. In most cases, this requires eliminating hand feeding based on the proposition that hand feeding is a medical treatment or medical care.
A 30-year old Florida Supreme Court decision may provide support for the use of a dementia directive that provides for voluntarily stopping eating and drinking (VSED).
This post, Part 3 of a series on dementias directives, discusses the supplemental advance directive for dementia offered by Final Exit Network (FEN) for those people who do NOT want to live into the later stages of dementia. The FEN dementia directive was drafted by FEN’s legal counsel, Robert Rivas.
Not only is Canada further advanced than all states in the US with respect to Medical Aid In Dying (MAID or MAiD), it also has surpassed the US for those who want to Voluntarily Stop Eating and Drinking.
Since the 1970s there have been debates about whether “patients” have the right to refuse various forms of life-saving or life-sustaining medical treatment, ranging from blood transfusions to ventilators and feeding tubes. More recently the debate has moved into the area of dementia and which, if any, kinds of treatment may be refused under the terms of a directive written in advance of loss of decision-making capacity. The issue of forced feeding is addressed by several articles in the July/August issue (48:4) of the Hastings Center Report, one of the nation’s preeminent bioethics publications.
I learned that VSED doesn’t have to be a horrible way to hasten one’s death. With proper care, it can be done without pain or distress. The first two or three days are sometimes the most difficult because of hunger pangs and thirst. The hunger is easy to control if one has access to pain medication. The thirst can be ameliorated with proper oral care, such as judicious use of ice chips, rinses, and lubricating gels.
Following is my Supplemental Directive. I do not consider it to be superior to any other, nor do I suggest that anyone copy it, though everyone is welcome to use any of it that suits their needs. I offer it merely as an example of what can be done. Referring to posts 1 through 3 on this topic should clarify the reasons for my choices. You will judge how well I have resolved the issues. I welcome ideas, critiques, and comments to improve my efforts.
“Over himself, over his own body and mind, the individual is sovereign.”
— John Stuart Mill
The United States Constitution and the common law (along with some state constitutions) give us the right to make directives that control the health services we receive if we become mentally incapacitated. The instructions provided by most states in the statutory forms that have been approved since the late 1980s do not limit us. We can write non-statutory directives I call “supplemental directives” when they are attached to and referenced in the statutory directives. We can also write our own health care directives without using statutory forms (an issue to be discussed in a subsequent post).
