Study: Patients Who Want Death Hastened Refuse Food, Water

Bioethics   |   Steven Ertelt   |   Jul 23, 2003   |   9:00AM   |   WASHINGTON, DC

Study: Patients Who Want Death Hastened Refuse Food, Water

by Steven Ertelt Editor
July 23, 2003

Boston, MA ( — A study published in Thursday’s issue of the New England Journal of Medicine says some terminally ill hospice patients who wish to hasten their deaths forgo food and water.

Researchers from Portland Veterans Affairs Medical Center surveyed 429 nurses in Oregon, who said patients pick self-starvation twice as often as physician-assisted suicide.

Dr. Linda Ganzini, who directed the study, was initially surprised by the numbers because previous studies showed a relatively low number of cases of refusal.

Ganzini said she was altered to the problem when interviewing 35 physicians about assisted suicide. Seven of them knew someone who had refused food and water during their hospice care.

Hospice workers in other states said they saw similar choices being made by some of their patients, though they stressed the overall number of cases is low.

Ganzini said that although the number of people refusing food and water was surprisingly high, it accounted for only a tiny fraction of the more than 10,000 people who die under hospice care each year in Oregon.

While assisted suicide is legal only in Oregon, refusing food and water is legal in all states. Patients do not need to inform either their family or doctor. In some cases, patients simply decide to quit eating on their own.

Pro-life advocates say depression frequently leads to such choices and is often left untreated.

Burke Balch, Director of Medical Ethics at the National Right to Life Committee, told, "Whether death is deliberately brought about by starving and dehydrating a patient or through a lethal injection, we must ask about the effect of untreated depression on the patient’s decision."

"Tragically, too many in the medical profession now fail to recognize that someone expressing a desire to die deserves referral for appropriate counseling and medication from knowledgeable experts, not abandonment to death in the guise of respect for patient autonomy," Balch explained.

One-third of the nurses said they knew of at least one patient who deliberately hastened death by stopping food and fluids during the previous four years. At least 16 patients who stopped eating and drinking changed their mind and resumed receiving nutrition.

The nurses reported 85 percent died a "good" death within 15 days after stopping food and fluids.

"Nurses reported that patients chose to stop eating and drinking because they were ready to die, saw continued existence as pointless, and considered their quality of life poor," the study said.

On the basis of the hospice nurses’ reports, the patients who stopped eating and drinking were older than 55 patients who died by assisted suicide (74 vs. 64 years of age) and less likely to want to control the circumstances of their death.

Confirming Balch’s concerns, the study revealed patients were less likely to be evaluated by a mental health professional.

Nancy Valko, a leading pro-life nurse who monitors end-of-life issues, said she was surprised to see no mention of pain medication in the study.

Such medication "is often a routine part of self-starvation and can give the impression of a ‘peaceful’ death to others," Valko explained. "Such medication is also routine in cases of withdrawal of food and water from the so-called ‘vegetative’ and others without a terminal illness."

Valko also said it is important to distinguish between "the truly dying and those who are terminally ill but not close to death."

"When death is close and organs begin to shut down, there is indeed a loss of appetite and we give people what little they need or desire in terms of nutrition and hydration. We don’t force people to eat or drink because it can indeed cause suffering if people become overloaded," said Valko.

"However, it has become increasingly common in some hospices to tell or even encourage people to refuse food and water long before the person is actively dying," Valko explained. "Starvation and dehydration is very different (and uncomfortable) from the true dying process."