The VE Bulletin Excerpts
'No price is too high to pay for
the privilege of owning yourself' Rudyard Kipling
Vol 19: No 1 March 2002
Dying in Australia by refusing food
and fluids
Refusing food and fluids is sometimes
attempted as a way of achieving a hastened and peaceful death, in the face
of hopeless illness when there is no reasonable prospect of return to an
acceptable quality of life. The process has been thoroughly examined by
Chris Docker in a dissertation published in Beyond Final Exit (1).
This publication is currently out of print, but a slightly updated version
of Docker's paper recently appeared in EXIT, the newsletter of the Voluntary
Euthanasia Society of Scotland (2).
It quotes extensively from no less than 80 references and is a valuable
source of a variety of opinions and claims regarding the efficacy of this
approach to self-deliverance. In the end though, the author comments, "…
it is still difficult to say that refraining from food and drink will guarantee
a peaceful death."
The Dutch voluntary euthanasia society
(NVVE) published a brochure on the method in 1998 and updated it in 2001
(3). Extracts have been published
in their Newsletter (Relevant) and the inherent difficulties in
approach are very well described. SAVES has prepared a four page English
translation of the extracts
(4) and
obtained permission from NVVE to distribute it.
The method came into prominence in
Australia in January 2001. Cancer sufferer Norma Hall tried to use it with
full access to palliative care, found it unbearable, and committed suicide
after seven days (5). The case
received a great deal of publicity. Norma Hall, a clear thinking, courageous
and determined person, had attended one of Dr Phillip Nitschke's advisory
clinics to explore her options as her premature death from cancer approached.
She was attracted by the legality of the method - it could apparently be
achieved openly without compromising others - and decided to involve the
media in the monitoring process. She signed a declaration of her intentions
and gave a short interview for national television explaining in detail
why she was using the method, which was widely reported in the press, and
on radio. There is no doubt that she demonstrated the inadequacy of the
method under prevailing medical and legal conditions in Australia, and
the need for legislation to define the circumstances and safeguards under
which proper medical assistance in hastening death at the request of the
patient may be provided.
In summary, it seems that:
· this
method of self-deliverance avoids some of the legal/ethical dilemmas by
relying on our common law right to refuse medical treatment;
· refusing
food alone is a very lengthy process, so that fluids must also be refused.
Even when both are refused, times in excess of a week may be involved;
· the
method is most unlikely to achieve a peaceful death without medical treatment,
particularly palliative care;
· medical
treatment will include the provision of sedation, possibly terminal sedation,
at some stage. The level of sedation will usually be decided by the treating
doctor with the patient, and patient's advocate if one has been appointed,
having limited capacity to insist on increased sedation. If adequate sedation
is not provided, the method may be experienced as agonisingly slow, and
certainly not peaceful.
· the
medical treatment invokes the dubious principle of "double effect" (6)
in which medical treatment to relieve suffering when the foreseen outcome
is the death of the patient is permissible in certain circumstances provided
the doctor does not "intend" the death of the patient. Ethical/medical/legal
dilemmas may arise over whether providing food and fluids can properly
be regarded as medical treatment, particularly when taken orally. Consequently
there may be excessive scrutiny by medical/hospital/police/coronial authorities;
Only a small percentage of those attending
Dr Nitschke's clinics show interest in the method. Its increasing use in
institutions may be because it is offered as the only option. Many patients,
though, might find themselves in sympathy with Esther Wild's question,
"Why would I want to spend five days dying when I could die in five minutes?"
(Esther Wild lived in the Northern Territory and had satisfied all the
legal requirements for medical assistance to a hastened death under the
Rights of the Terminally Ill Act. The Act was overturned by federal
parliament before she was ready to use its provisions. The Senate refused
to allow her and the one other person in her situation to use its provisions
as a compassionate exception.)
The method may well have its place
for patients whose particular belief system finds it preferable to methods
specifically designed to bring about a requested, quick, peaceful death.
The current legal/medical prohibition of the latter options contaminates
the process, however, and seriously reduces the chances that refusing food
and fluids will achieve the desired peaceful, hastened death.
Anyone in Australia interested in using
the method would be well advised to read the NVVE notes (4)
in preparation for an essential consultation with their medical adviser.
Bill Mettyear
References
(1) Docker C, in Beyond Final Exit,
Chapter 8, "The Art and Science of Fasting". The Right to Die Society
of Canada, 1995.
(2) Docker C, in EXIT, Newsletter
of the Voluntary Euthanasia Society of Scotland, Vol. 21, No. 2, Summer
2001.
(3) Stopen met eten en drinken,
NVVE, 1998, second edition 2001
(4) To stop eating and drinking,
NVVE approved SAVES' translation of extracts from (3) (as published in
the NVVE Newsletter, Relevant.)
(5) Nitschke P, in Deliverance,
Newsletter of the Voluntary Euthanasia Research Foundation, Volume 3 &
4, 2000-2001.
(6) SAVES Fact Sheet 23, The Principle
of Double Effect, 1998
The author gratefully acknowledges
helpful comments from Dr Phillip Nitschke.
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