Bioethical Advocacy to Compel Medical Help in Self-Starvation Suicides

This article was published by National Review online on August 31, 2026.

Wesley Smith

By Wesley J Smith

Many Western countries and jurisdictions are legalizing euthanasia and assisted suicide. That opens up a problem for the death pushers. Since states aren’t going to get into the wet work of the actual killing, medical professionals and caregivers are going to be conscripted to do the deadly deeds — even if that means violating their religious beliefs and moral consciences.

Instead of resisting this rank authoritarianism, the medical and bioethics establishments are increasingly going along. This proposed coercion includes requiring doctors’ participation in suicides when patients starve and dehydrate themselves to death — known as VSED for “voluntary stop eating and drinking.”

As I wrote a few weeks ago here, the British Medical Association just so opined. And now, following closely in that guidance’s wake, a major article in the Journal of Health & Biomedical Law argues similarly — using dementia patients as the prime example — that doctors have to both inform patients about their right to commit suicide by VSED and ease the process by providing palliative care against the agony that killing oneself in that manner causes.

(It is important to emphasize at this point that we are not discussing the common phenomenon of patients who stop eating as a natural part of the dying process when the body can no longer assimilate nourishment. That isn’t suicide. VSED is. That’s a big difference both morally and factually.)

The article’s definition of VSED is skewed to promote the propriety of facilitating such deaths (citations omitted):

VSED is “a deliberate, voluntary, self-initiated action to hasten death by a patient with decision-making capacity who is suffering from an irreversible illness or prolonged dying that the person finds intolerable.”

But as the BMA guidance stated, refusing food and water onto death isn’t limited to dementia cases but can be decided upon for any reason at all. Indeed, the euthanasia pushers Compassion and Choices used to advertise this method of suicide for elderly people who are not seriously ill but “simply done.”

The article claims that clinicians have the obligation to inform patients who inquire about the process of committing VSED:

Health care professionals are ethically obligated to inform their patients of relevant health care information. This is to help patients make informed decisions: “Respecting the principle of autonomy oblige the physician to disclose medical information and treatment options that are necessary for the patient to exercise self-determination and supports informed consent, truth telling, and confidentiality.”

But eating and drinking isn’t a medical act. Receiving nourishment orally in a health-care context isn’t a treatment. In fact, the VSED itself isn’t any more “medical” than asphyxiating oneself by running a car in a closed garage. Should doctors have to teach patients how to die by that means? Of course not. Nor should they with VSED.

The article argues that people diagnosed with dementia should not be encouraged to pursue that means of death but should be provided written information about VSED among other data provided, which really means encouraged subtly, as the text below makes clear:

Referenced sources in such a compendium can then direct patients and their families to the more detailed information they should consider, such as, for example, that simply stating in an advance directive that they do not want artificial nutrition and hydration may not be adequate to ensure care and support during VSED. Links and references to VSED should include an explanation of the importance of a VSED-appropriate advanced directive if patients plan to VSED as well as templates for such advanced directives. The referenced sources should direct individuals to prepare a video explaining why they chose to VSED, and how they want their health care proxy and caregivers to respond if the patient asks for food or fluid as they become befuddled during their VSED process.

By “befuddled,” the author means: Even if the patient asks for food or drink it should be refused if previously instructed, an idea also being pushed in bioethics advocacy as “VSED by Advance Directive.” Can you imagine forcing caregivers to deny patients who ask for nourishment? Because that is what is being increasingly advocated here and elsewhere in bioethics discourse.

The article further claims that doctors must palliate the agony that comes with starving and dehydrating oneself to death — even when it violates their moral consciences — based on the principle of non-abandonment: 

The second limitation on providers’ right to conscientiously object to providing patient care is the principle of non-abandonment. No provider is permitted to abandon a suffering patient: “The duty to relieve pain and suffering is central to the physician’s role as healer and is an obligation physicians have to their patients.” Providers are ethically and legally obliged to provide care to a suffering patient even if doing so violates their personal beliefs unless they assist the patient in transferring to a provider who will provide such proper care.

But surely patient autonomy has its limits. If a patient wants to burn themself with cigarettes, are doctors require to numb the flesh to make that easier? No.

We may not be able to legally prevent VSED deaths. Nor can we prohibit doctors from palliating such cases. Indeed, VSED is often touted by activists as a loophole to get around laws banning assisted suicide.

But requiring doctors to participate is to force them to assist in suicide. And that is just plain wrong. I can’t think of a more efficient way to drive pro-life and Hippocratic Oath medical caregivers out of the professions. In fact, I believe that is a big part of the point.

Where next with this darkness? Once the false premises of VSED are accepted and such suicides become normalized, people will eventually say, “Why make people die slowly by something as awful as self-starvation? Just get it over with by allowing doctors give them a lethal jab” — and ethical guidelines will soon require doctors to do that too (already the case in Ontario, Canada).

Finally, people sometimes ask why I pay such close attention to the discourse in professional journals. This particular article is a good example of the importance of that focus. Its opinions are justified by citing earlier pro-VSED journal articles, thereby bootstrapping the author’s opinions to greater authority. And the next such article will likewise cite this piece to add to its authority. And on and on it goes.

That is precisely how radical proposals in bioethics discourse move from hypothetical examples to implemented public policy. Once the “experts” reach a consensus, the law tends to go along.

Previous articles on this topic:

British Medical Association requires doctors to help patients commit suicide by dehydration (Link).