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Arizona ‘Living Will’ Bill Could Force Caregivers to Starve Cognitively Incapacitated Patients

by | Jan 16, 2024

By Wesley J. Smith

The euthanasia movement is continually looking for new ways to allow people to be made dead. One of the cruelest is known as VSED (voluntary stop eating and drinking). The idea is for doctors to help people commit suicide by self-starvation and dehydration by palliating the agony such a slow death would otherwise entail.

Activists are also trying to pass laws that would allow people to prepare a written directive (VSED by Advance Directive) ordering themselves starved and dehydrated should they become incapacitated by dementia or other cognitive disability. This is even if they willingly eat or ask for food after losing decision-making capacity. (Here is a piece [] I wrote that describes the agenda in more detail.)

A bill has been filed in Arizona that VSED activist, the bioethicist Thaddeus Mason Pope, thinks would legalize VSED by Advance Directive. The bill is vague, but depending on how the law would be interpreted if it passes, he may be right. From, HB 2254:

A. An adult may prepare a written statement known as a living will to control the health care treatment decisions that can be made on that person’s behalf, INCLUDING:



A few thoughts.

First: The language in this bill is way too imprecise to know exactly what it means by “health care treatment.” But it has a provision that could allow caregivers to refuse sustenance to a patient who willingly eats without fear of a lawsuit or criminal penalty — even if that is not what the authors of the bill intended:

A health care provider who makes good faith health care decisions based on the provisions of an apparently genuine living will is immune from criminal and civil liability for those decisions to the same extent and under the same conditions as prescribed in section 36-3205.

Since the term “health care treatment” isn’t defined in the bill, a caregiver could claim a “good faith” belief that an order directing the withholding of food orally came within the provisions of the law. So, we could see people starved who beg for food. (It’s happened before with feeding tubes.)

Second: In contrast to feeding tubes, spoon feeding has not traditionally been considered a medical treatment. Rather, giving people food and water is humane care, akin to keeping a patient warm or clean.

But many in bioethics and the euthanasia movement — such as Pope — want to change that distinction. Nevada already passed a law that could permit the refusal of wanted food and water from an incapacitated person if ordered ahead of time when competent.

Third, providing oral feeding is not forced feeding. That is not what VSED by Advanced Directive is about.

Fourth: It also isn’t about when people stop eating and drinking as a natural part of the dying process. Rather, it is making them stop eating and drinking by withholding sustenance.

Fifth: People should not be able to order themselves starved to death when they willingly take sustenance. It is not only cruel to their future selves but to caregivers forced, in essence, to kill the patient in a way that, if done to a sick dog, would be rightly considered animal cruelty.

Sixth, the ultimate cynical goal here is to get people to accept lethally injecting the incapacitated if they ask to be killed in an advance directive as already happens in Canada, the Netherlands, and Belgium.

“After all,” the argument will go, “Why force people to die painfully when we can simply put them to sleep?” The rejoinder to that, of course, is that we shouldn’t make people die at all.

HB 2254 needs a lot of work done to clarify what it means by “under what circumstances the ingestion of food and liquids may be limited.” The issue is literally life and death and, hence, too important to be passed in its current vague iteration. If the provision would include withholding orally taken food and water, it should be rejected out of hand.

Editor’s note. Wesley’s great columns appear on National Review Online and reposted with his permission.

Categories: Euthanasia