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Quality of life at the end of life

Choosing Not To Eat And Drink: Some Terminally Ill Hasten Death

Armond and Dorothy Rudolph, Courtesy Compassion & Choices

The choice to stop eating and drinking is a legal and ethical option to hasten death, says end of life counselor Judith Schwarz of Compassion & Choices, an organization that provides support to terminally ill patients. Schwarz discussed voluntary stopping of eating and drinking, or V.S.E.D., with Terry Gross on NPR’s weekday magazine, Fresh Air.

Compassion & Choices counselors can advise willing patients about informed decisions that may hasten death. “Many people have implanted cardiac devices and defibrillators,” as Schwarz explains. “Those need to be turned off if you want to get your death to happen naturally or in a more hastened fashion.” Some people also opt to stop taking medications.

Her organization facilitates talks with patients and families about the decision to stop eating and drinking. “It’s a process, it needs to be well understood. There needs to be support,” says Schwarz. “There are lots of things in place for it to be ‘successful.’ And by successful, I mean a peaceful death that happens within days or two weeks.”

Patients die of dehydration, not of starvation, she explains. This point is often misunderstood. Schwarz maintains that patients don’t even feel hunger, but they become drowsy from lack of hydration. As dehydration progresses, patients become sleepier. They then slip into a coma before death.

“It is often the case that people, as they get close to the end of life, just lose interest in their surroundings, in their loved ones and in food and fluid,” Schwarz says. “People have been dying this way for generations, for thousands of years.”

She acknowledges that forgoing water can be difficult, for both the patient and for his or her loved ones. “Some people have a really tough time with a dry mouth,” she says. “You need to have lots of supporting and skillful caregiving and oral care.”

V.S.E.D. is legal in every state for the terminally ill. “That a competent person can refuse any medical intervention, including tube feeding, has been recognized by the Supreme Court,” says Charles Sabatino in The New York Times. Sabatino directs the American Bar Association Commission on Law and Aging.

Voluntarily stopping eating and drinking remains controversial

However, Armond and Dorothy Rudolph, married for 69 years, were evicted last year from their assisted living facility in Albuquerque, N.M. for choosing to stop eating and drinking.

Mr. Rudolph, 92, suffered severe pain from spinal stenosis and had a permanent catheter. Mrs. Rudolph, 90, was immobile. Both suffered from the onset of dementia, and they consulted with Compassion & Choices about V.S.E.D.

Officials at their facility, the Village at Alameda, called 911 after learning of the couple’s plans to report attempted suicide.

Mrs. Rudolph later described her condition to The Albuquerque Journal. “Life is miserable,” Dorothy Rudolph said, when asked why she wants to die. “Our bodies are pretty rotten by now. You name it, I’ve had it.”

Squad vehicles and emergency personal arrived at the facility, with University of New Mexico’s emergency medicine department’s Dr. Drew Harrell.

“They were able to very appropriately and eloquently explain their wishes and what they wanted to have done,” Harrell said. “They didn’t feel the need to go to a hospital. They detailed that they wanted control over their own end of life issues.”

The couple’s son, Neil Rudolph, later spoke with ABC News. “Nearly 1 million Americans live in these facilities, yet most don’t know how their end of life rights could be infringed upon as my parents’ were,” he said. “Their eviction shocked me. I think it’s inhuman for mentally competent adults to be overruled at the end of their lives by an assisted living facility administrator, or by anyone else.”

The couple eventually moved to a private home, where Mr. Rudolph’s ten-day fast resulted in death. His wife died the next day, surrounded by family.

The facility released this statement: “Assisted living facilities are equipped to provide assistance with activities of daily living such as eating, dressing and bathing.

“If we can see that someone in our care requires alternate placement, medical attention or a level of care beyond the facility’s capabilities, we have an obligation to notify a medical provider.”

ABC News interviewed Marshall Kapp, director of the Florida State University Center for Innovative Collaboration in Medicine and Law, about the Rudolph ordeal.

“Legal apprehensions probably played a big part in their decision, along with the fear of bad publicity,” Kapp said about the Village at Alameda. “A facility retains the right to evict somebody if they can’t care for them properly most of the time, so you’d have to look at the contract they signed.”

Sabatino says that those who oppose the act for religious or ethical reasons (or for fear of lawsuits) can throw up roadblocks. “While the theory may be clean, the execution may get messy.”

According to a 2003 study on V.S.E.D. by the New England Journal of Medicine, most V.S.E.D. deaths are “good” deaths. Oregon hospice nurses explain, “Unbearable physical suffering did not appear to be an important reason for this choice. According to the nurses’ reports, most deaths from voluntary refusal of food and fluids were peaceful, with little suffering, although 8 percent of patients were thought to have had a relatively poor quality of death.”

Listen to the Fresh Air interview at NPR