Should caregivers be forced to starve dementia patients to death?

This article was published by National Review online on August 5, 2025.

Wesley Smith

By Wesley J Smith

First, Caplan discusses the potential withholding of feeding tubes (artificial hydration and nutrition, or AHN, in medical parlance), which is unquestionably legal because AHN is a medical treatment that involves surgery and medically prepared nutrients and — like other treatments, ranging from surgery to chemotherapy — can be ordered through advance directives to be withheld or withdrawn. Right or wrong, that’s a done deal. (He brings up the Terri Schiavo case, about which he and I significantly disagree, but let’s not relitigate that here.)

Then, however, Caplan takes the next step — which is currently on the cutting edge of bioethical discourse. From “Artificial Hydration and Nutrition in Dementia: Ethicist Weighs In”:

Is feeding by spoon the same as medical intervention with artificial forms of hydration and nutrition? I believe it is. I believe that when you say “no more food and nutrition,” it isn’t just the equipment. I’ll put it simply: It’s who’s on the end of the spoon. If nurses or doctors are feeding, it’s medical. It’s professional care, and you should be able to say no to that.

Spoon-feeding has always been considered humane care, akin to keeping patients warm, maintaining proper standards of hygiene, and turning patients to prevent bedsores. A redefinition of spoon-feeding, it seems to me, would be a radical change in medical ethics. Should a nurse’s cleaning a patient, for example, also now be considered a medical treatment? I can’t imagine it.

Spoon-feeding isn’t a medical procedure. It doesn’t take a medical professional’s education or training to do it. Food and liquids aren’t medicine. We are talking about canned peaches, cottage cheese, soup, or eggs. We are talking about water, juice, tea, and coffee. Good grief, I spoon-fed my mother when she was dying of Alzheimer’s, and it didn’t take any special skill or training on my part. Should I have been charged with practicing medicine or nursing without a license?

Next, Caplan believes that the desires of the once-competent person should rule, even if the now-incompetent person willingly eats:

I do think if someone says “I don’t want to eat or drink anymore,” their intent and their values are clear. You could certainly rediscuss it with the family and say she seems to be accepting food and swallowing, and ask if that changes their mind or makes them think she might have decided differently.

However, I think the wishes of the competent person, when they made the living will, are what should drive care if the person loses competency. They thought about it, they knew where they were headed, and I do think that’s the value that ought to dominate thinking about whether we have to continue to try food and water for nutrition.

Let’s think about this deeply. Wouldn’t this dehumanize the now-incompetent person by making him or her less than equal? And wouldn’t this be a real “gotcha,” because once a person became incompetent, then even in non-medical cases — many dementia patients really enjoy eating; Mom sure did — their desires and joys would matter not a whit?

We sure push hastened death these days. We have widespread legalization of assisted suicide. We have VSED — whereby doctors help people starve themselves to death. We have VSED “as a bridge” to assisted suicide/euthanasia, by weakening a patient so that he or she can qualify for hastened death. We have proposals to intentionally malnourish dementia patients, who desired it when competent, so that they die slowly over time. And now, a very influential bioethicist supports forcing caregivers to cause death by dehydration and starvation, even when a patient willingly eats.

Before we go down this road, shouldn’t we ask ourselves: Aren’t there some actions that we don’t have a right to demand from others? If so, isn’t starving and dehydrating a helpless patient who willingly eats — and who could even be asking for food — one such action?

If you did such a thing to a dog, you would go to jail. When will we say, “Enough: This is too much to ask”?

Previous articles by or concerning Wesley Smith (Link).