Bioethical Advocacy to Compel Medical Help in Dehydration 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). 

British Medical Association Requires Doctors to Help Patients Commit Suicide by Dehyrdration.

This article was published by National Review online on August 19, 2026.

Wesley Smith

By Wesley J Smith

The subtitle of the revised and updated version of my book criticizing utilitarian bioethics, Culture of Death, is, “The Age of ‘Do Harm’ Medicine.” Helping patients kill themselves by self-starvation and dehydration — known in euthanasia parlance as VSED (for voluntary stopping eating and drinking) — certainly fits that designation.

Two major medical associations now have endorsed doctors assisting in such suicides by palliating the painful symptoms to help patients go all the way to death. The first was the American Academy of Hospice and Palliative Medicine (AAHPM) in 2023. This is especially notable because the organization shamefully went “neutral” on the legalization of assisted suicide, despite that action being the antithesis of the hospice philosophy enunciated by the great medical humanitarian Dame Cecily Saunders. The AAHPM’s journal also published a piece recently endorsing intentionally undernourishing dementia patients under certain conditions (MCF, or “minimal comfort feeding”) — VSED in slow motion, if you will.

Now, another “do harm” shoe has dropped. The British Medical Association has issued an ethical guidance that requires practitioners to participate in VSED when asked to do so by a patient. While the AAHPM guidance assumes that the act will only be done by terminally ill or seriously ill or disabled patients, the BMA guidance notably acknowledges that even those not in ill health can kill themselves in this slow manner — and that doctors must further the suicide palliatively. From the guidance (my emphasis):

We start from a position of understanding that: – patients with capacity are entitled to make decisions about treatment refusals and about their nutrition and hydration, including to voluntarily stop eating and drinking in order to hasten their death;– there is no requirement in the law that a patient needs to be ill or at the end of life to decide to voluntarily stop eating and drinking in order to hasten their death.

All doctors so requested are expected by the BMA to participate in VSED by assessing patients and easing symptoms; indeed, the guidance asserts that it is an ethical duty for doctors to be complicit in such suicides:

When an adult patient has made the decision to elect to VSED, the doctor’s initial responsibility is to assess the patient to check that: (1) the patient has the capacity to make the decision; (2) the patient’s decision is not a symptom of a mental disorder; and (3) the patient’s decision is being made free from coercion.

If the three criteria above are fulfilled, doctors have a professional duty to provide palliative care and symptom relief to their patient. The doctor’s role is not to consider whether the patient’s decision is rational, reasonable, or sensible. It is not for doctors to decide whether the patient should be permitted to end their life in this way. [Emphasis added.]

It’s one thing to say doctors can’t stop a suicidal patient from self-starvation — although one would think that suicide prevention would be on the table of which there is no mention in the guidance. But it is quite another to require doctors’ participation in such suicides.

A stunted conscientious objection clause is endorsed, but it is an essentially meaningless protection, with complicity in the preparation process still required.

Doctors cannot exercise a conscientious objection to seeing or having an initial consultation with their patient. However, some doctors may wish to exercise a conscientious objection to carrying out the detailed assessments (see section 3) and/or providing symptom relief, such as analgesics or palliative sedation (see section 4). Doctors exercising a conscientious objection must follow professional guidance and ensure that there is someone else available to take over the detailed assessments and the patient’s care without delay or detriment to the patient. This means that, with the patient’s consent, doctors must pass on their assessment and care to another doctor who is willing to provide that support. [Emphasis added.]

In other words, forced procurement of another doctor who is willing to help the patient commit suicide. And if the patient says no or another doctor can’t be found? It would seem that the original physician would have no choice but to provide whatever support is required to get the patient dead.

Suicide nihilism is exerting an ever-stronger gravitational pull in the West, with doctors increasingly expected to wield their expertise as so many death order-takers. The AAHPM’s and BMA’s blessing of physician participation in VSED deepens that darkness and strengthens the culture of death.

Bioethicists: ‘Terminally Sedate’ People Committing Suicide by Self-Starvation

This article was published by National Review online on May 25, 2026.

Wesley Smith

By Wesley J Smith

In a newly released paper in the prestigious journal Bioethics, three prominent bioethicists argue that when someone decides to commit suicide via self-starvation and dehydration — known in euthanasia movement parlance as “voluntary stop eating and drinking” (VSED) — doctors should be allowed to “terminally sedate” the person trying to die when necessary to prevent intractable suffering.

Patients who commit VSED are often not terminally ill. In fact, euthanasia organizations promote self-starvation to the elderly who are not dying and as a means of becoming eligible for assisted suicide where it is legal by making oneself “terminal” via lack of sustenance.

VSED must be distinguished from the common circumstance when actively dying people stop eating. That’s a natural process and often peaceful because the body cannot assimilate food as organs shut down. VSED, in contrast, deprives the body of sustenance it needs to remain alive toward the end of causing death, i.e., it is a suicide method.

Without palliation, many people attempting VSED would abandon the attempt. The bioethicists know this and claim that once the decision to commit suicide is made, doctors are duty-bound to medically ameliorate the suffering that inevitably results:

If a patient is adamant in their refusal of food and water, the same physician must respect the competent refusal by not force‐feeding the patient and should offer standard palliative care, as they would for any other dying patient. Medical support for patients undertaking VSED should be adequate and proportionate to their symptoms, as per any other form of palliative care. This is arguably not assisted suicide.

No, it is precisely that. First, but for the self-starvation, many people who undertake VSED would not be dying. Second, palliation permits the patient to complete the suicide that would otherwise be abandoned. Hence, the palliating doctor is facilitating the patient in becoming dead, i.e., it is a form of suicide assistance.

The authors acknowledge that if a doctor’s assurance of palliation factors into the decision to undertake VSED, that could be deemed assisted suicide:

We acknowledge that there may be some cases in which combining these two practices could amount to assistance in suicide. Jox et al. identify two key factors which, if present, arguably classify VSED cases as assisted suicide: (a) the promise of medical assistance is instrumental to the individual’s decision to pursue VSED, and (b) the physician shares, at least in part, in the individual’s decision to pursue VSED (amounting to some level of encouragement).

The authors next argue that VSED patients should be allowed to be rendered permanently unconsciousness if experiencing “refractory delirium”:

We propose the following criteria for VSED with TS in the setting of refractory delirium:
1. The patient is experiencing unbearable suffering.
2. The patient has lost decision‐making capacity.
3. The patient has previously stopped all fluids.
4. The patient has previously indicated that they would not wish for fluid to recommence if delirious.
5. Other measures to address confusion/distress have been attempted (or refused in advance), such as antipsychotics.

Ah, the old “strict guidelines protect against abuse” scenario.

Let’s discuss this in the real world. Strict restrictions rarely stay strict. For example, needle “exchange” to prevent the spread of HIV eventually slouched into outright needle give away, no used syringes required.

The same kind of slippage would happen if sedating people committing VSED were allowed. Eventually, such drugging would become a standard technique, its availability amplified by assisted suicide advocates.

The authors’ answer to this objection? Let doctors predetermine whether to facilitate the suicide with sedation:

We believe that this harm can be reasonably mitigated through a thorough pre‐assessment of individuals requesting VSED. Prior to initiating physician involvement in the VSED process, physicians should seek to confirm that the individual (a) has decision‐making capacity, and (b) expresses a genuine intention to end their life. This pre‐assessment should also seek to confirm that the individual is fully informed, their decision is voluntary, their decision is consistent with their known values, and that the individual is free from mental illness compromising their decision.

Wait: The authors wrote earlier that when “the promise of medical assistance is instrumental to the individual’s decision to pursue VSED, and “the physician shares, at least in part, in the individual’s decision to pursue VSED (amounting to some level of encouragement),” that it would amount to assisted suicide. Pre-assessment would fit those very criteria, no?

So, we see the slippery slope slip-sliding away in the very article calling for allowing sedation under strict guidelines to prevent abuse. If this proposal is implemented, the next step will be to quit beating around the bush and get on with the lethal jabs.

Why write about this, Wesley? Articles in professional journals are a means of constructing future public policy and people need to be warned about what is being planned before it is imposed from on high. Or to put it another way, these issues are too important to be left to the bioethicists.

Dementia Patients and Death by Intentional Undernourishment

This article was published by National Review online on April 30, 2026.

Wesley Smith

By Wesley J Smith

Last year, I wrote here warning about a bioethics paper that advocated restricting the amount of orally received food and water given to dementia patients, an intentional undernourishment approach that the authors labelled “minimal comfort feeding.”

Well, the idea of death by intentional undernourishment has now hit the big time in the popular media with a long New York Times piece telling the story of a dementia patient who died under that regimen. I expect it to spark a national conversation. (I make a brief appearance in the piece. The reporter, Kate Raphael, could not have been more cordial and presented my views accurately. Also, she offers plenty of objections from medical professionals, so this response should not be deemed a criticism of her work.)

The title of the piece asks: “She Didn’t Want to Live with Advanced Dementia. So Why Was She Being Kept Alive?” It quotes the daughter of the dementia sufferer:

“We were never interested in prolonging her life just for the sake of prolonging her life,” Ms. Hendrickson remembered telling the doctor. “We wanted her to just be happy and comfortable.”

The doctor, who was not employed by the memory care unit, had a suggestion. She had recently read a paper that put forward a new approach, called “minimal comfort feeding,” in which providers stop scheduled feedings and instead offer dementia patients just enough food and liquid to ensure comfort, and only when the patient shows signs of hunger or thirst. The idea was that someone with advanced dementia with no interest in food, or limited interest, might be allowed to die once they begin to refuse enough hydration and calories to sustain them.

We must be very clear here. The issue is not about patients who refuse hydration and calories or who have no interest in food, but of not providing as much sustenance as they may want: intentionally undernourishment. Indeed, the original bioethics paper offers this definition:

Minimal Comfort Feeding: Only as much food and liquid as necessary to avoid discomfort . . .

MCF is the provision of only enough oral nutrition and hydration to ensure comfort (Table 1). With MCF, eating and drinking is not scheduled; rather, caretakers offer food and liquids only in response to signs of hunger and thirst. Patients are neither wakened for regular mealtimes nor encouraged to eat or drink. Instead, they are offered frequent, fastidious mouth care, continued social contact, therapeutic touch, sensory distraction, and medications to relieve distress associated with apparent thirst or hunger before being provided with minimal amounts of liquid or food.

In other words, if the patient shows signs of hunger, kill the urge by medication (sedation?). If the patient still wants to eat, sufficient food and drink to sustain them will be withheld.

The ultimate point isn’t comfort but hastening death. Where a dementia patient might live years if properly nourished with scheduled meals, under MCF, the “time to death” is “weeks to months.” The original paper even suggests that surrogates be allowed to decide to slow-motion starve patients in the absence of a signed directive so requesting:

Therefore, oral nutrition and hydration sufficient to sustain life may be declined by the individual for themselves in the future via advance directive or, in the absence of an advance directive, via a surrogate exercising substituted judgement.

The issues presented by this question are easily conflated and confused, but distinctions are important in ethical deliberation. The following actions and omissions are not what we are talking about by supporting full nutritional support for dementia patients who willingly eat or ask for food:

• Forced feeding: This should never be done to a dying patient. When patients are dying — whether of cancer, dementia, or another malady — refusing sustenance is often a natural part of the dying process.
• Feeding tubes: This is a medical treatment that involves surgery and a medically constituted formula. As a medical treatment, it can be refused in an advance directive. In contrast, spoon feeding when a patient willingly eats is a form of humane care of the same category as keeping patients warm, clean, and turning to avoid bed sores. Traditionally, humane care cannot be withheld.
• Forced medical treatment: This entails keeping patients alive for as long as possible regardless of their desires. Dementia patients may already have DNRs placed on their charts, refuse antibiotics, kidney dialysis, chemotherapy, respirators, and other life-sustaining medical interventions.

There are other issues to consider. What would the impact on caregivers be if they could be legally required to refuse nourishment that a patient wants? I think it would drive many caring nurses and aides out of the industry.

What about the chances for abuse by greedy relatives who would benefit from an earlier death or by assisted-care facilities receiving government payments? And think about the temptations to discard the vulnerable in a society — while calling it empathy — that seeks to save medical resources. And how would defining dementia patients as killable affect their perceived inherent equality? The list could go on and on.

These are not abstract questions. I have up-close and personal experience with the dilemmas associated with terminal dementia, as my mother died from the affliction. Mom was receiving hospice support at my home. At one point, she refused all food and I thought it was the end — until Helen, her saintly Visiting Angel, brought her some canned peaches. My mother took one look, quickly scarfed them down and asked for more! She soon began eating other meals too, particularly enjoying bowls of cereal. “This is delicious!” she repeatedly exclaimed. In other words, the joy of eating what she wanted, and as much as she wanted, brought her greater comfort than would have medicating her to deprive her of proper sustenance.

“Minimal comfort feeding” is just a euphemism for slow-motion euthanasia. If allowed, it would eventually lead to cases where advanced-stage dementia patients are getting lethally jabbed — all in the name of even greater “compassion” and “comfort,” of course. Do we really want to go down that path?

Alex Schadenberg, Executive Director: Euthanasia Prevention Coalition.

Note: We regularly receive calls from family members who have a loved one who is living in a hospital or care home with dementia and are often being pushed to withhold or withdraw food and fluids. Withholding or withdrawing food is discouraged but less concerning than withholding or withdrawing fluids. Death by dehydration happens within 10 - 14 days while death by starvation takes a long time. We encourage people to maintain small amounts of nutrition and hydration, enough to maintain the human body, but not so much as to cause problems.

We believe that one should never cause death, but enabling natural death is encouraged. There can be a difficult question when someone is approaching the terminal phase but not yet dying. When someone is not dying, the reason for withholding or withdrawing food and fluids is to cause death by dehydration. 

The Euthanasia Prevention Coalition considers intentional death by dehydration to be ethically the same as euthanasia, but is a slower process with the same outcome.

Previous article:

• Mild stroke led to forced death by dehydration (Read).

At Last! A Fair Shake for Terri Schiavo’s Brother in the New York Times

This article was published by National Review online on April 13, 2026.

Wesley Smith

By Wesley Smith

My friend Bobby Schindler, the late Terri Schiavo’s brother, is one of the kindest, humblest, most decent people I know. And yet, because he dared to stand up for the inherent value of his sister’s life and against the injustice of her court-ordered dehydration — and has continued to fight on behalf of brain-injured people and their families — journalists and bioethicists often look down their noses at him as someone just beyond the pale of sophisticated society.

But in a story in this Sunday’s New York Times Magazine reciting how many allegedly unconscious patients are actually aware — I refuse to use the term “vegetative” as it is a dehumanizing denigration of intrinsic human value — much to my delighted surprise, Bobby is treated fairly and with respect by journalist Katie Engelhart.

Bobby Schindler

As the head of the Terri Schiavo Life and Hope Network, Bobby toils as a patient advocate for people who are being pressured to end the lives of their cognitively disabled loved ones. It is in this context that a woman fighting for her husband’s life meets Bobby:

One day, someone in the group told Tabitha that she should contact a man named Bobby Schindler, a patient advocate who helped people like Aaron.

Tabitha messaged Schindler through his website, and he called her the next day. He listened as if he really cared. Schindler told Tabitha that her hope for Aaron was right and just. That it was correct to resist the doctors’ appeals for “comfort care.” He offered to introduce Tabitha to a lawyer he knew, so that, in dealings with the hospital — for instance, if the hospital wanted to discharge Aaron to a nursing home before she felt he was ready — she could say, “My lawyer will handle this.” And Schindler seemed to understand everything that Tabitha was going through, because of what had happened to his sister, Terri Schiavo.

Bobby is not in it for himself, but to help:

In the 20 years since he established the Terri Schiavo Life & Hope Network, Schindler has never advertised his services. “I think just the fact of Terri’s name is enough for people to find us,” he says. Most of the time, people wanted his advice. Or the name of a good lawyer. Or money. Almost everyone wanted more time. They called from the I.C.U. to say that doctors had started talking about comfort care, about organs.

Schindler would tell the callers what he had come to believe in the years since his sister died one of the most litigated deaths in U.S. history: that there might be hope for their loved ones. That they could fight hospital administrators. That the persistent vegetative state diagnosis was “subjective.”

This is what he does. When Bobby stood shoulder-to-shoulder with Jahi McMath’s mother at a news conference when she was fighting against a brain death diagnosis for her daughter in Oakland, he saw a mother’s pain. Behind the scenes, to my shame, I counseled him against getting involved. Fighting brain death is not the policy hill to die on, I said. Nothing can prevent Jahi from being taken off life support.

I was doubly wrong. In the end, Jahi was not taken off life support but moved to New Jersey, and it turned out, she was catastrophically disabled but not dead. I witnessed it myself. (She later died of complications from intestinal surgery.)

In any event, one can disagree with Bobby’s beliefs and his family’s valiant struggle (in my view) to save Terri’s life. But I am pleased that — finally — a mainstream journalist treated Bobby with the respect and fairness he deserves. And in the New York Times, no less. Will wonders never cease.

Bioethicist: Let Surgeons Kill Patients During Organ Harvesting

This article was published by the National Review online December 28, 2025.

Wesley Smith

By Wesley J Smith

The “dead donor rule” (DDR) is a legal and ethical mandate that requires vital organ donors to be truly dead before their body parts are procured. A corollary to the rule holds that people cannot be killed for their organs. The DDR promotes trust in the system and protects the vulnerable — but is flexible enough to permit living donations of one kidney and parts of a liver from altruistic donors.

Utilitarian bioethicists have long argued against the DDR and its corollary based on the notion that killing those who are dying or want to donate will relieve the suffering of people who want to live and need an organ. And here we go again. The Journal of Medical Ethics — out of Oxford — has published a long and complicated piece by Ohio bioethicist Lawrence J. Masek arguing that patients who want to donate should be able to be killed during — or as a direct result of — the organ-procurement process.

First, the author pulls a typical switcheroo often seen in bioethical discourse. Here’s a relevant example: We were assured over many years that brain dead is “dead.” Now, that this is accepted widely, many bioethicists are claiming that actually, it isn’t. If they are right, the DDR would preclude organ procurement from such patients. But these bioethicists claim instead that procuring organs from those diagnosed as brain dead also means that we can harvest comatose patients whose brains are clearly functioning.

See how that works? Rather than stick to the rule, expand it and pretend it is not being stretched.

This is Masek’s tactic too. He claims that since taking one kidney in an altruistic living donation harms the patient through reduced kidney function without violating the DDR, it is also okay to take the liver of a patient that will lead to death a few hours later.

Similarly, he suggests surgery to save a fetus harms the mother through incisions and the like, which she accepts as of less importance than the life of her baby. He also says an emergency C-section that will likely lead to the death of the mother to save the baby is an example of harm caused that should also permit doctors to procure vital organs while the donor is still alive. From the article (citations omitted):

Performing the c-section would cause blood loss, which would be the cause of the woman’s death, so the do-not-kill principle prohibits the c-section in this case, even though the only alternative is allowing both the woman and her child to die. I see the fact that a principle requires allowing two patients to die instead of saving one patient as a problem for the [DDR do not kill] principle.

He also claims palliation at the end of life as another example:

Another objection to the do-not-kill principle is that it prohibits lethal palliation [misnomer alert!], such as the use of an analgesic that relieves pain but also has the side-effects of slowing respiration and causing death. Lethal palliation is widely accepted even among proponents of the DDR

And, he even claims that volunteering to have one’s organs taken to save others is akin to other “heroic” life sacrifices:

If people may jump on a grenade to save other soldiers or jump in front of a speeding motorcycle to save a child, then they may sacrifice their lives by donating a heart or other vital organ. I agree that sacrificing one’s life to save another by jumping on a grenade or in front of a motorcycle is analogous to sacrificing one’s life to save another by donating a vital organ.

But these examples are utterly sophistic. The (stacked deck) medical hypotheticals Masek offers either do not kill the patient, or if death comes in the C-section hypothetical and end-of-life palliation [which is not known as “lethal palliation”] examples, they would be cases of death as undesired and unintended side effects (which can happen in any medical procedure). (This is the principle of double effect, which Masek misapplies in his piece.)

Moreover, in the C-section and palliation examples–as well as refusing life support–the patient might not die as a result of the care. You never know.

Jumping on a grenade to save other soldiers is not the same as the soldiers throwing that person on the grenade, which would be more akin to a surgeon killing for organs. Because whether death happens immediately, say by taking a heart, or takes hours after taking a liver, harvesting vital organs from a living person is intended to kill that patient to save the life of another. Besides, such extraordinary exigencies as the grenade example cannot be the basis of reasoned public policy.

Transforming doctors into killers would open the door to all sorts of gruesome policies, such as euthanasia by organ harvesting. Yes, Masek goes there:

Another reason to accept the DDR is the belief that anyone who denies the DDR must defend euthanasia. Permitting lethal organ procurement would enable patients to commit suicide by donating their vital organs, but the same is true of permitting lethal palliation and the refusal of life support. That a person could do X (eg, donate vital organs, take a lethal painkiller or refuse life-support) as a means of killing oneself does not mean that anyone who does X intends to kill. (I do not defend organ donation euthanasia, which is donating a vital organ in order to end one’s life in order to end suffering, which would be an example of intending death as a means of relieving suffering, because I have argued that lethal organ procurement is not necessarily an example of intending death.)

Please. Take a liver and there can be only one outcome. The patient would know it. The doctors would know it.

Besides, euthanasia conjoined with organ harvesting is already allowed in Belgium, New Zealand, Australia, Netherlands, and Canada–and in some cases that has been an inducement for choosing to be killed or affected the timing of when the death facilitation would take place–to widespread media applause.

Why do I bother to discuss this and other such articles here? Isn’t professional discourse akin to arguing about how many angels can dance on the head of a pin?

No! Public policy is often formulated through this very kind of back and forth in professional journals. This kind of top-down policy making is why feeding tubes can be legally withdrawn from unconscious patients and gender-confused children can be administered puberty blockers in many jurisdictions.

Which is why I try to bring these ivory-tower discussions into the public square. People need know what is being planned for them. Because as I always say, if you want to see what is going to go very wrong in society next, read bioethics, medical, and science journals. Some of the articles published there will curl your toes.

Will We Care For or Kill People with Dementia?

This article was published by National Review online on September 19, 2025.

By Wesley J Smith

I understand that people are terrified of dementia. Believe me, I get it. My mother died of Alzheimer’s. But I can’t wrap my head around the fact that advocacy for killing/suicide as the answer to the difficulties caused by the condition is becoming ubiquitous.

Noted bioethicist and lawyer Thaddeus Mason Pope has written an essay, to be published in an edited volume, on this very issue. It lists eleven ways people can “avoid late-stage dementia,” and almost all involve intentionally ending life.

Remember when we were told that advance medical directives are the key to not receiving life-extending treatment one does not want? They are, but that’s not good enough for Pope, because it doesn’t guarantee death:

This strategy is risky and uncertain. While patients with dementia can refuse antibiotics, they might never get an infection requiring antibiotics. In other words, advance directives for patients with dementia may be impotent because no triggering condition in their advance directive is ever satisfied. They may never need treatment they have refused. Consequently, traditional advance directives cannot reliably achieve the goals of patients seeking to avoid late-stage dementia.

Not only that, but he barely touches on the kind of compassionate care that can be provided to dementia patients, such as hospice, properly delivered. He even damns hospice with faint praise:

While physical suffering is usually sufficiently addressed with hospice and palliative support, this long duration imposes a burden on the patient and their family. And it imposes a significant financial cost, as the patient typically has nursing and doula support.

Get it? This is an argument not to avoid suffering but to not be a “burden” and to put oneself out of loved ones’ misery.

I should also note that hospice is covered by Medicare, Medicaid, and private insurance, which costs the patient very little. As to additional expenses, when my mother was dying, we also had a “visiting angel” kind of service to provide companionship. It cost some money, sure, but it wasn’t prohibitive and the service made my mother extremely happy, even toward the end. Besides, given the troubles the hospice sector is currently experiencing, we need better promotion of its proper application, not an “easier” way out that involves killing. 

In his essay, Pope pushes euthanasia (eventually chosen by a surrogate), suicide (assisted and otherwise), killing by self-starvation (VSED), death by inert gasses, going to a suicide clinic in Switzerland, being denied spoon feeding, and intentional malnourishment, among other gems.

So why do I give this awfulness publicity? I believe that people need to be aware of the darkness that is deepening, and that unthinkable actions once (properly) deemed abandonment are now being advocated at the highest levels of cultural influence. People with dementia need to be assured that they are valued and will be cared for, not deemed a killable caste.

It is all so discouraging. We are moving from do no harm to “do harm medicine,” and the question must be asked: In coming years, will we care for or kill dementia patients? I believe that the morality of society will depend on the answer to that question.

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).

Story of an assisted death without request or consent.

Alex Schadenberg

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

The following story was shared on X by Samantha Smith on July 2, 2025.

Canada's euthanasia law does not allow killing without consent, but the story does not suggest that this was a legal act. 

I have been asked if it is a true story? (published below) I can't answer the question but we have published a true story about a similar tragic death. (Link to Aunt Mary's Story)

Medical decisions are regularly made to intentionally deny food and fluids to a person who is not otherwise dying, resulting in death by dehydration. Morally, this is euthanasia (slow euthanasia or euthanasia by dehydration) but legally it is not euthanasia because food and fluids have wrongly been defined as "medical treatment." 

Withdrawing food and fluids from someone who is not otherwise dying is different than withdrawing food and fluids from someone who is dying and nearing death. The first act causes death by dehydration, the second act recognizes that the person's body is unable to benefit from food and fluids and the withdrawal is part of a natural death.

Based on the post by Samantha Smith this man appears to have been dehydrated to death. The medical community might state that they were withdrawing treatment, in fact they killed someone by dehydration who was not otherwise dying.

Terri Schiavo with her mother.

Terri Schiavo was killed by dehydration, even though she was not otherwise dying.

There is a error with the comment that 40% of the Netherlands euthanasia deaths are done without consent. The 2021 government death study found that 517 assisted deaths were done without consent which is not 40% of the assisted deaths but rather 5.2%.

Link to the story by Samantha Smith on X.

A family member of mine is a nurse in Canada.

They performed several assisted dying procedures at the care home they worked at, before refusing to continue.

In one case, the family of a mentally disabled man decided they wanted him to be euthanised.

He didn’t want to die.

But my family member was legally forced to end his life.

They held his hand while he told them “I’m hungry” and “I’m thirsty”.

That poor man didn’t understand what was happening to him as he was pumped full of medication that would end his life, and my family member wept for the soul that was being lost unnecessarily.

He wasn’t terminally ill.

He wasn’t particularly old.

He wasn’t dying.

He didn’t want to die.

But he didn’t have a choice.

Because his life was deemed dispensable by his family, and the Government gave them the power to end his life regardless of his needs or wishes.

And when my family member told their workplace that they couldn’t continue performing these procedures — that their conscience wouldn’t allow it — they were told that it was their “legal duty” as a nurse.

They still refused.

But not everyone will have the moral fibre or bravery of my family member.

The road to hell is paved with good intentions, and this is exactly what the Assisted Dying Bill opens the door to.

It starts with “choice” and “dignity”.

But suicide isn’t only done “when the patient wants it”. And the countries where it is already legalised have shown us the grim reality.

In the Netherlands, 40% of euthanasia deaths occur without patient consent. In Canada, it has been offered to Paralympians who only asked for a mobility aid.

If it can happen there; it will happen here.

People 𝙬𝙞𝙡𝙡 be killed against their will. 

More articles about euthanasia without explicit request (Articles Link)

More articles about euthanasia by dehydration (Articles Link).

Bioethicists Get Legacy of Terri Schiavo Death Wrong

This article was published by National Review online on March 18, 2025.

Terri's Mom, Dad and sister (right)

By Wesley J Smith

Twenty years ago today, Terri Schiavo’s feeding tube was withdrawn with court approval, commencing a cruel deprivation of sustenance that resulted in her death by dehydration 13 days later.

For those who may not remember, the case became the most hotly contested bioethics issue since Roe v. Wade as Terri’s husband Michael fought in courts and in the media with her parents and siblings over his desire to remove all Terri’s food and fluids. In the end, he won — and Terri died.

Now, two bioethicists on the influential Hastings Center blog decry the case as wrongly brought. They get some facts wrong and omit crucial information — like that Michael was living with another woman with whom he fathered two children during the litigation — but let’s not relitigate the case here. (Read this post for a more complete discussion)

The authors, Arthur Caplan and Dominic Sisti, and I do agree that the Schiavo case was a cultural “canary in the coal mine,” but for diametrically opposing reasons. They complain that it has empowered the wrong cultural forces into political prominence:

In retrospect, Schiavo launched a new, emboldened prolife movement, one that would eventually lead to conservative rule in state houses across the U.S. and the election, twice, of Donald Trump. The seeding of a new ultraconservative judiciary would support a strategic assault on medical privacy that would eventually lead to the end of legal abortion protection in Dobbs.

The Schiavo case did not “embolden” the pro-life movement. It was thriving when the case hit the headlines. Moreover, some of the most vociferous opponents of dehydrating Terri to death were disability rights activists — who, generally speaking, are politically liberal and not pro-life on abortion.

Caplan and Sisti complain that the case led to intrusive health-care policies.

We hear the echoes of Schiavo’s death in today’s debates over reproductive rights, end-of-life care, transgender care, vaccinations, and medical privacy more generally. The end of Roe v. Wade, the continued attacks on gender-affirming care, and the looming threats to contraceptive access all stem from the foundational fight over Terri’s bodily autonomy. Today’s autocratic playbook remains unchanged from those days: intrude upon and weaponize deeply personal medical decisions, rally the support of a mob, enact draconian regulations, ignore what medicine and science have to say.

Few knew it then, but the case of Terri Schiavo was a canary in the coal mine, warning us of bad things to come. The fight to honor Terri’s values in death was won, but the broader battle over government intrusion versus health care privacy rages on.

Good grief, no: 

• The Schiavo case did not cause the overturning of Roe v. Wade. Rather, the key precedent was an assisted-suicide case called Glucksberg v. Washington.
• “Gender-affirming care” for children is not supported by “what medicine and science have to say.”
• Vaccine mandates impede the making of “personal medical decisions.” Indeed, Covid vaccine mandates (supported by Caplan) were “autocratic” and — as the thousands of fired members of the military, medical personnel, and others will attest — forced people to take jabs or lose their jobs. How’s that for “weaponized deeply personal medical decisions”?
• And if closing schools for so long weren’t “draconian regulations,” I don’t know what were.
  

The Schiavo case was a tragedy, but not for the reasons Caplan and Sisti claim. Before Schiavo’s death, most people were shocked that feeding tubes could be removed from disabled people who can metabolize food and water. After the case, polling majorities supported doing so. With that, people with severe brain injuries became a disposable caste.