The assisted suicide movement teaches people how to commit suicide by self starvation. To be clear, I am not talking about when people stop eating as a natural part of the natural dying process. That isn’t suicide. But rather, refusing food and water, not because one can’t eat, but because one wants to be dead. (The story discussed below conflates those two concepts, but I don’t want to belabor that issue here.)
In New Mexico, an elderly couple obtained the information they needed to kill themselves together in this way. Their family approved (!!!) and the couple began to starve themselves. But when the assisted living facility management got wind of the plan, the couple was told, in effect, “Not here, you won’t,” and sought their eviction. Administrators also called 911 after the 4th day of self starvation. From the NYT story “Deciding to Die; Then Shown the Door:”
The Rudolphs faced increasing pain and debility. Mr. Rudolph, 92, suffered from spinal stenosis; Dorothy, 90, had become largely immobile. Both showed symptoms of early dementia. So in January, they set in motion their plan to stop eating and drinking. And the facility tried to evict the couple. The administrators, apparently on orders from the corporate legal department in Maryland, told the family the Rudolphs had to leave the next day. Current management would not comment beyond an e-mailed statement that when a resident “requires alternate placement, medical attention, or a level of care beyond the facility’s capabilities, we have an obligation to notify a medical provider.”
I support the facility in general. They had no obligation, it seems to me, to permit suicide by slow motion in their facility. After all, other people live there and the impact of such deaths could be enormous. I also don’t blame them for calling 911. People were dying who could be saved.
Here’s the problem: We have two mutually incompatible value systems co-existing in the culture. One embraces suicide as a freedom issue. The other respects the value of all lives, including those of suicidal people. Again and again, the former group insist that their suicides have to be respected and even facilitated–including by those who hold the latter value system.
But none of us should be required to be complicit in anyone’s self killing–whether a medical professional or a residential care facility. Or to put it another way, the facility’s management wouldn’t have been expected to stand by idly and allow the couple hang themselves. If that is so, why should they have to passively permit them to self starve to death in their facility?
We are getting to the place in which assisted living and similar facilities that do not wish such deaths taking place on their premises may have to publicly declare themselves “suicide free zones,” and let all residents know that all such attempts will be grounds for calling 911 and/or eviction. What a sorry world in which we live, and assisted suicide groups like Compassion and Choices–which was involved here–are very much to blame.
August 24th, 2011 | 6:19 pm
I’m not surprised that Compassion & Choices was involved here.
One interesting thing I noticed in the article: When the Rudolphs are first described, their physical conditions (including pain and lack of mobility) are noted – along with “early signs of dementia”.
When the police were called in response to their decision to V.S.E.D. (voluntarily stop eating and drinking), they gave “outraged and lucid” interviews to reporters.
The couple was suffering from dementia when it suited the reporter’s goal to create sympathy, and then suddenly they weren’t when they needed to enforce their choices.
Color me skeptical of any efforts to standardize the practice (or reporting) of assisted suicide in any context.
Kathleen Lundquist Reply:
August 24th, 2011 at 6:26 pm
@Kathleen Lundquist,
… that is, any consistent rendering of ‘why it’s good’. I agree with you, Wesley, that the couple’s rationale of ‘choice’ here seems ultimately to boil down to, “I wanted them (the AL facility and first responders) to have no choice but to give me my choice.”
August 24th, 2011 | 7:27 pm
While we may not all agree about VSED, physician aid-in-dying, and other interventions; we can probably agree in the spirit of John Stuart Mill, that pluralism is itself a good and a virtue of American society. Given both that pluralism and the need to be respectful of the autonomy of those who plan on VSED, declaring policy is not too burdensome.
Facilities, as well as individual providers, in almost every state have the right of conscientious refusal. This right is easy to invoke before the formation of the treatment relationship. It is more difficult, but totally possible to invoke, after formation of a treatment relationship. If a facility has a real problem with VSED/VRFF, they must put potential residents on notice. Otherwise, as I have argued, the facility may have an obligation to comply. http://tinyurl.com/3zm8ehh
Marlyn Reply:
August 25th, 2011 at 5:03 pm
@Thaddeus Pope,
That is backwards, as far as I am concerned. We, as health care professionals are there to SAVE lives, and to care for individuals. IF the person coming into any facility is open to starving themselves to death voluntarily, it is up to THEM to find out if this is acceptable. See the note above regarding hanging oneself in any health care facility. ALSO note that we must stand by the resident when giving meds and watch them take it, we cannot leave it at bedside for them to take later (or store for future use to take an overdose). Sorry, but the NORM (standard operating procedure) is to NOT facilitate suicide.
August 25th, 2011 | 12:21 am
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August 25th, 2011 | 11:11 am
One thing that I have found interesting in working in hospice in CA is that assisted living facilities are not normally allowed to have hospice patients–it is beyond the scope of their level of care (assisted living meaning that the patients do not need skilled level of care, a level of care most patients do need by the end of life). If an assisted living facility wants to have a hospice patient on the premises, they have to get a hospice waiver from the state. I didn’t read the article beyond the blog here, but maybe the facility was just objecting to not having the required availability of nursing care that a dying patient needs (according to the state). Either way, I am glad that they did not allow the suicides to occur on their premises.
August 25th, 2011 | 4:32 pm
This couple should have kept their choice to themselves and not made the facility complicit in their actions. Clearly I believe in a person’s right to choose VSED but I do not believe that others should be forced to help you do it.
August 28th, 2011 | 1:56 pm
Question: Don’t patients who try to do this usually require medication to get them through it? If so, was the facility going to be asked to provide medication (which would otherwise not have been needed) lest the couple lose their resolve and request food and water?
That was definitely the impression I got from another article I read recently about a woman who “helped” her mother do this. At a certain point, she was medicated.
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