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Defending Advance VSED – Hasten Death by Dehydration

VSED has been getting a lot of attention lately.  NPR radio host Diane Rehm discussed her husband’s use of VSED to hasten his death.  Sir Chris Woodhead discussed VSED in the ongoing assisted dying debate that will reach the House of Lords on Friday.  And the Tampa Bay Times just published a 1000 word article.  

But I want to respond to a rather lengthy attack on me specifically.  Last Thursday, Lydia McGrew published this 5-page attack on advance VSED.   

First, let me clarify that I agree with McGrew: “The acceptance of good food and water should never be regarded as requiring explicit and mature consent.”  Consent to food and water, like consent to emergency treatment, can and should be presumed.   

Second, when the individual makes an informed advance refusal of food and water (e.g. to avoid living in the advanced stages of dementia), then the presumed consent is rebutted.  People have a negative right to refuse interventions with their body.  Similarly, while consent to emergency treatment (like a blood transfusion) is presumed, that presumption does not operate when the individual has previously objected.   

Third, the refusal stands until it is revoked.  

Fourth, the refusal cannot be revoked unless the individual has the decision making capacity to revoke it.  

Fifth, an individual in advanced dementia does not have the capacity to decide about eating and drinking, because she cannot appreciate the consequences of that decision.

Therefore, the refusal stands.    

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