Should We Starve Alzheimer’s Patients?

By Wesley J. Smith

Editor’s note. My family and I will be on vacation through August 25. I will occasionally add new items but for the most part we will repost “the best of the best” — the stories our readers have told us they especially liked over the last ten months.

Bill Harris walks with his wife, Nora, at the Fern Gardens memory care center in Medford, Ore. Nora Harris, 64, has late-stage Alzheimer’s disease. A former librarian and world traveler, she had signed an advance directive stipulating no care to prolong her life. Controversy has arisen over her husband’s claim that state law is forcing her to be spoon-fed against her stated wishes. (Photo: (Jim Craven for KHN))

Bill Harris walks with his wife, Nora, at the Fern Gardens memory care center in Medford, Ore. Nora Harris, 64, has late-stage Alzheimer’s disease. A former librarian and world traveler, she had signed an advance directive stipulating no care to prolong her life. 
(Photo: Jim Craven for KHN)

The idea of starving a helpless elderly person to death used to be thought of as the most egregious crime. An abhorrence.

Now, for some, it is merely another form of “death with dignity.”

The assisted suicide advocacy organization Compassion and Choices–formerly the more honestly named Hemlock Society–teaches people (with a prime focus on the elderly) how to starve themselves to death, a form of suicide they call “voluntary stop eating and drinking” (VSED).

But many in bioethics wish to take that avenue to dying further, requiring nursing homes to starve dementia patients to death if they so stated in an advance directive.

Now, as these things are wont to do, the idea has gone from the professional literature into the popular media. USA Today has a story about a man trying to force his wife to be starved because she has Alzheimer’s–this even though she willingly eats snacks and her meals. From the story:

Across the U.S., the more than 5 million people living with dementia are typically encouraged to put their end-of-life wishes into writing early and to pick a trusted person to carry them out, said Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association. That’s no guarantee, however, that those requests can — or will — be honored. In Nora Harris’ court case, her advance directive and testimony from her husband, her daughter and two close friends all indicated that she wouldn’t want anything to prolong her life. “That court decision basically condemned Nora to the full extent of the Alzheimer’s disease,” Bill Harris said. “They gave her no exit out of this situation.”

The “exit” is to refuse medical treatment, such as antibiotics or a feeding tube when it becomes needed–which under the law, is deemed a medical treatment.

But spoon feeding and handing out snacks, willingly eaten, is not medical treatment. It is humane care, the kind owed to every human being.

Advance directives govern medical treatments desired or to be refused when the signatory becomes unable to make her own decisions. It does not require caregivers to violate the fundamental rules of humanity.

Think of it this way: If a dementia patient had requested to be left in bed in front of an open window without a blanket on a winter’s night in order to die by hypothermia, should the nursing facility be forced to do that? Of course not! They owe the patient a duty to be kept warm.

Ditto if a patient asked not to be turned to avoid bed sores. Or directed that their linens never be changed. The same must go to spoon feeding and offering liquids, or we are no longer a moral country.

That isn’t to say forced feeding, but if a patient willingly takes nourishment, that must control.

The article goes on to describe VSED and says it can be a peaceful death without suffering. No–not unless a doctor participates in the suicide with heavy palliative interventions. But even then, VSED committers can always change their minds. That would not be true of a nursing home patient from whom food and water was withheld.

Of course I understand that no one wants to go through Alzheimer’s. Of course I understand the grief families feel and the many sleepless nights caused by having a beloved stricken with this dread affliction.

But life is what it is. We should mitigate suffering as much as we can, but there are just certain lines that must not be crossed, both because others could be victimized–ever hear of elder abuse?–and because some acts and omissions are inherently wrong.

On a more practical level: How many nursing homes would close their doors if the operators–many of which are religiously focused–knew they would be forced to starve some of their patients to death? How many loving and caring people would opt out of dedicating their lives to the people who live and are cared for in such facilities rather than risk killing their patients by a means that would now be branded criminal neglect, at best? And no more of people saying that I don’t know what it is like to have people I love suffer.

My mother died of Alzheimer’s in my home last year. My uncle died of it several years ago.

Believe me, I know what Alzheimer’s is like, up close and personal.

Editor’s note. This appeared at National Review Online and is reposted with permission.