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.

Self-Starvation to qualify for Assisted Suicide

This article was published by National Review online on February 7, 2024.

Wesley Smith

By Wesley J Smith

There are never enough assisted suicides for the euthanasia movement. So, while they will promise “strict guidelines to protect against abuse,” they don’t mean it — and are ever on the hunt to liberalize laws to make it easier for people to get help becoming dead.

Assisted-suicide laws in the U.S., almost uniquely in the world, require six months or less to live to qualify for a lethal prescription. That limitation will be discarded as soon as the movement thinks it can get away with it politically. In the meantime, they are ever searching for ways to find loopholes to allow more assisted suicides.

Here’s one that is just gaining traction: If you are not terminally ill under the law, just stop eating and drinking long enough for a doctor to be able to diagnose you as dying. From the McKnights story (taken from a study co-authored by the bioethicist and assisted-suicide proponent, Thaddeus Mason Pope):

People with dementia haven’t been able to use MAID [“medical aid in dying”] because they don’t meet eligibility requirements including decisional capacity, the ability to give themselves life-ending medications, and having a terminal condition with six months or less to live.

“When they still have capacity, persons with dementia are not yet terminally ill with less than six months to live based solely on their dementia diagnosis. Conversely, by the time they are terminally ill, they no longer have capacity to elect MAID,” the authors explained.

That could change because of new laws and the use of voluntarily stopping eating and drinking (VSED), which can make a terminal condition worse yet pave the way for MAID approval.

“If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path,” authors said in a report published Feb. 5 in the Journal of the American Geriatrics Society.

This would be a means to extend assisted suicides to people who are not terminally ill:

“We must develop guidelines and standards for allowing VSED to qualify a patient for MAID, for example, by limiting this to patients with another serious, irreversible, intolerable condition leading them to VSED in the first place,” the authors wrote.

A few points: First, if one can starve oneself to qualify for assisted suicide, how can it be restricted to people with early dementia who have years to live? Why not also allow people with disabilities, chronic non-terminal illnesses, the healthy elderly (targets of VSED advocacy already), and the mentally ill to make themselves weak enough to obtain prescribed poison? Indeed, that last quote would seem to advocate just such a course.

Second, self-starvation/dehydration is not an “illness” that is reasonably likely to lead to death in six months regardless of treatment, which is the usual definitional requirement for assisted-suicide qualification. Rather, it is a suicide attempt that can be stopped simply by eating and drinking again. That being so, it seems to me that lethally prescribing under those conditions would break the laws as currently written — not that anything would ever be done about it.

So, once again, the assisted-suicide movement shows itself to be public-policy promise breakers of the most egregious kind and raw zealots for the death agenda.