DEATH BY DEHYDRATION:
TO MAKE SURE IT IS A WISE CHOICE
When we are approaching the natural end of our lives,
we might choose to give up eating and drinking
in order to shorten the process of dying.
Voluntary death by dehydration is a special pathway
If this way of ending our lives appeals to us,
we can begin a careful process of planning several months in advance.
If our choice is wise and rational,
then we will receive help and
cooperation from others.
Because voluntary death by dehydration is legal everywhere
we can be open about
our planning for the last year of our lives.
A NEW PATHWAY TOWARDS DEATH: VDD
SAFEGUARDS FOR VOLUNTARY DEATH BY DEHYDRATION
3. APPLYING THE BEST SAFEGUARDS TO OUR OWN SITUATIONS
DEATH BY DEHYDRATION:
TO MAKE SURE IT IS A WISE CHOICE
James Leonard Park
When we decide to draw our lives to a close by
this is a plan we can share with everyone who cares about us.
Family and friends might mention reasons for us to live a bit longer.
Will a new baby soon be born? Is someone getting married?
Do we want to complete some meaningful projects before we die?
year to plan our own deaths
will enable us to make a number of wise practical decisions.
For example, we will not
authorize elaborate medical
if we know that we have begun the last year of our lives.
If death comes before we give up eating and drinking,
then we can accept that accident as a gift instead of resisting it,
as would be the normal medical response to any
Even more explicitly, if we have chosen our best
date of death,
we will carefully execute Do-Not-Resuscitate orders with our doctors,
so that just in case we have a heart-attack during our last year,
we will allow that event to run its course, resulting in our
rather than using the medical means at our disposal
to save us from death caused by a failing heart.
1. A NEW PATHWAY TOWARDS DEATH: VDD
The choice to end our lives by dehydration
has been discussed under a number of other names:
Stopping Eating and Drinking—STED
Voluntary Stopping Eating and Drinking—VSED
Voluntary Medical Dehydration—VMD
No matter what name we prefer, the process is the
We decide to give up eating
We refuse all further offers of food, water, or other fluids.
Even people who are completely paralyzed
able to move even one finger—
can still choose to end all nutrition and hydration.
Depending on the amount of water stored in our bodies
and any health problems we might have,
the process of dying by dehydration will take up to two weeks.
We can choose this means of voluntary death at home.
Any location will work.
We can choose the best setting for ourselves
and for everyone else who will be present for our last days.
Hospice care would be one helpful choice,
since hospice workers already know how to deal with the problems
that usually arise when a patient chooses VDD.
Hospice care can be given at home or in some health-care institution.
If we are already hospitalized or in a nursing home,
then staying in that setting might be the easiest choice.
Because VDD is a legal and honorable end-of-life
we do not need to keep secret our chosen pathway towards death.
We should tell everyone who cares about us
that we are now proceeding with our plans for death by dehydration.
There will be a variety of responses from the people who know us.
And we will consider reasonable requests to postpone our deaths.
But if we are making wise end-of-life plans,
most reasonable people will be supportive.
But just to make as certain as possible
that we are making wise
the following safeguards will ask for the opinions of several other
who will be involved with our last days.
2. SAFEGUARDS FOR
VOLUNTARY DEATH BY DEHYDRATION
The following safeguards adapt the 26
which could be used for any
And the title of each safeguard is hyperlinked
to the complete explanation of that safeguard.
FOR MEDICAL CARE
If we are planning to end our lives by voluntary
this option should be affirmed in the section
of our Advance Directives devoted to life-ending decisions.
The fact that we created such plans several years in advance
would be strong proof that we are not being irrationally swayed
by any factors that have recently emerged in our lives.
When we first create our Advance Directives for Medical Care,
we usually do not know what medical problems will cause our deaths.
Rather, we are explaining our settled values
concerning how we want to conduct the last year of our lives.
When we have decided to put our long-held plans into
we can ask all who will be affected by our deaths
to write their own
statements of cooperation and understanding.
When we ask for such written statements endorsing our plans for VDD,
this will be an opportunity for the people closest to us
to review our reasons for choosing death now rather than later.
And their willingness to cooperate in our death-planning process
should be strong evidence that our choice of death is reasonable.
DEATH FROM THE
When we choose our best date to die,
we will put these plans into writing in a number of ways.
But if we are under some form of medical care,
we will ask our care-givers to support our chosen means
When we put our plans into writing, having our requests
this should preempt second-guessing from people
who have no reason to participate in planning our deaths.
We will have formal,
written requests for death,
which will be shared with everyone legitimately involved.
CONSULTANT EVALUATES THE PATIENT'S ABILITY TO MAKE MEDICAL DECISIONS
Even if there is little doubt that we are making
rational end-of-life plans,
it will be easy to have a conversation with a psychological
who will issue a written statement confirming our
to end our lives by giving up eating and drinking.
The consultant will confirm that
we have a good grasp of reality:
We know that we will certainly die as a result of giving up food and
Furthermore, the psychological consultant can confirm
that we are not being manipulated into making a foolish
decision for death.
If this psychological consultant has any doubts about the process,
these should be resolved before the plans for death go forward.
OF CONDITION AND PROGNOSIS
Basic to any life-ending decision is the medical
that is leading us to choose voluntary death by dehydration.
Putting these medical facts into a written and signed statement
will make explicit the medical reasons for choosing death this year.
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
And because our life-ending decision is so final and
a second doctor, perhaps a specialist in our disease or condition,
should issue a separate medical opinion about what is happening to us.
Any differences in these professional medical analyses
should be resolved before death-planning goes forward.
OF TERMINAL ILLNESS OR INCURABLE CONDITION
If we are choosing death because of a disease
that cannot be cured,
that terminal prognosis can be added to the doctors' written
Or a separate document could be created stating our terminal condition.
Some forms of medical help—such as hospice care—
require an official declaration by a doctor of a terminal illness
are choosing a
voluntary death by dehydration
because of some kind of suffering that makes life intolerable,
then we should explain our suffering in our requests for
But if our suffering has not yet been explicitly stated,
then a new statement from our own perspective as the suffering person
should be created so that all who have a right to know
will more fully understand how suffering is leading us to
And even if part of our suffering is inward or
we can explain why those problems are leading us to choose death
rather than merely allowing nature to take its course,
resulting in a more normal death at some random time in the future.
Often opponents of the right-to-die say that good
is a better alternative than choosing death.
And the most reasonable reply to this criticism
is that we have already tried
all available means of treating our
and we now find life intolerable even under the best palliative care.
Using all of our most careful thinking, we now prefer death
over continued existence even with palliative care.
CONSENT FROM THE PATIENT
The other documents created in planning for death
will usually show that we have good information about our
and that we have considered the alternatives.
We are now giving our informed
consent to a process
that will lead to our death within a few days after we give up all
FROM THE PROXIES
If our own capacity to give informed consent for VDD
then our proxies can request the withdrawal of all
food and water,
with the certain knowledge that such withdrawal will
lead to death.
We might create a joint request, signed by both ourselves and our
HOSPITAL OR HOSPICE
Even tho hospitalization is not required for VDD,
if we are already being cared for in any medical facility,
this will be further evidence that our physical condition has
to the point where we cannot easily be cared for in a
more home-like setting.
The medical records of the hospital or hospice program
will be further evidence of the conditions leading us to choose death.
HOSPITAL OR HOSPICE STAFF MEMBERS
And if we are receiving professional
medical care at the end of our lives,
then our care-givers might be asked to add their own written statements
of understanding and support for our decision to choose VDD.
Such care-givers have no
veto power of our decision for death,
but if they understand our decision and cooperate with our plans for
then distant critics will have less reason
that we chose a wise and meaningful way to end our lives.
AFFIRMING OR QUESTIONING CHOOSING DEATH
Family members (or others at the bedside)
also be asked to write their own personal statements
affirming the choice of voluntary death
When they have put their words on paper,
it might allow them greater peace with the life-ending decision
and their own roles in helping voluntary death by dehydration.
APPROVES OR QUESTIONS CHOOSING DEATH
If we have any important connections with organized
we might ask for our choice of voluntary death by dehydration
to be reviewed by a professional
religious leader we trust.
If we get religious support for our decision to die by dehydration,
this will help us to be more certain that we are making a wise choice.
OR OTHER MORAL PRINCIPLES
APPLIED TO THIS
Even more explicitly, we might have reason to
request a written statement
of how our religious principles apply to the situation at hand.
Especially if we are very religious, we might want to be assured
that our decision to die by dehydration does not conflict with our
ETHICS COMMITTEE REVIEWS THE PLANS FOR DEATH
If we are receiving our terminal care in any medical
that has a formal ethics committee to review such cases,
we might also ask for their professional evaluation
of our decision to end our lives by dehydration.
Since these people have much experience with life-ending decisions,
they should be able to issue an unbiased opinion
concerning our reasons and plans for death.
IF INVITED BY
THE PATIENT AND/OR THE PROXIES
When we are choosing our own date of death for our
we are probably not suffering discrimination of
But if someone might raise such a doubt,
then our death-planning process could be reviewed
by an advocate drawn from our own identity group.
PROSECUTOR BEFORE THE DEATH TAKES PLACE
And the most superfluous review might be done by the
Perhaps there is some family member who is under the false impression
that cooperating in our voluntary death by dehydration
could result in some form of prosecution.
If so, the public prosecutor could review the complete death-planning
and issue a written statement assuring all involved
that no crime will be
committed by anyone if the plans are carried forward.
CRIMINAL PENALTIES FOR CAUSING PREMATURE DEATH
But because there is always a remote possibility of criminal behavior
disguised as a voluntary termination of food and water,
civil and criminal penalties should remain in place
to punish anyone who causes a premature death.
PERIODS FOR REFLECTION
But it might be wise to require meaningful
to allow everyone to review the plans and their participation in them.
Rushing into a voluntary death by dehydration would never be wise.
As said earlier, up to a year
might be a reasonable period of time
for planning a good death by dehydration.
FOR THE PATIENT TO RESCIND OR POSTPONE ANY LIFE-ENDING DECISIONS
In the process of planning our own deaths by
there will be specific turning-points at which we can change
For example, we might easily find that we want to extend our lives
if our physical and mental conditions remain stable or improve.
As long as we have taken no irrevocable actions,
we can continue to live for as long as we find meaning in life.
Postponing our plans
for a voluntary death by dehydration
is not the same as abandoning
But, of course, we could also change our minds so completely
that we will not
choose to go ahead with our death as planned.
Instead, we will allow some
other death-dealing process to unfold.
REVIEW THE COMPLETE DEATH-PLANNING RECORDS
If we are planning our own deaths with the
cooperation of a physician,
then it might be wise to have this terminal-care physician
review all of the documents created in the
There probably were no mistakes.
But just in case there might be some doubts,
the physician in charge of our care might discover the error
in time to prevent a premature death.
Death at a later time
might be best of all concerned.
RECORDING AND SHARING OF ALL MATERIAL FACTS AND OPINIONS
When we are carefully planning our deaths by
we can collect and share all the documents created in the process.
Who should receive copies of the planning statements?
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
In the situation of a voluntary death by
we would not expect to remain fully conscious until the last moment.
This raises the explicit question
of what to do after we have
Normally this is the way that the death by dehydration occurs:
After a few days without water, our ability to think deteriorates.
We spend more time asleep.
And then we become completely unconscious.
We might have authorized sedation to make the process easier.
If we are not conscious up until the last moment,
this should not overturn our plans.
We put our trust in the people caring for us at the end of our
They will carry forward our plans for death by dehydration
even when we can no longer actively
DEATH-PLANNING COORDINATOR ORGANIZES THE SAFEGUARDS
If we want the record of our death to be complete,
we will arrange for someone to collect all the documents in one
The last chapter of our lives will be written by others.
3. APPLYING THE BEST
SAFEGUARDS TO OUR OWN SITUATIONS
When we are approaching the natural end of our
we might decide to shorten the process of dying
by giving up eating and drinking.
We can do this in cooperation with several other people
who are close to us at the end of our lives.
The more safeguards we fulfill,
the more professional and personal opinions we will gather.
If we would
like to count up the number of different people
who will be involved in our end-of-life plans,
here is another essay that makes those numbers explicit:
The Number of
People Reviewing a Life-Ending Decision
Using the 26 Recommended Safeguards.
Safeguards are less important for choosing VDD
as for other kinds of life-ending decisions
because the very process of dying by giving up fluids
contains its own
safeguard of stretching out
in which we die to several days,
during which we can re-think our plans for death
if our plans were somewhat misguided
or poorly conceived.
But the more other people we involve with our
the more certain we and others will be
that this was a truly voluntary
rather than some form of irrational
or a process that will result in a premature death.
And when the laws regarding the recording of deaths are changed
to recognize the differences between irrational suicide and voluntary
then choosing death by dehydration will be recorded as voluntary death.
If we take several months to plan our own
deaths by dehydration,
we will call upon several other people
mentioned in the safeguards discussed above.
The more completely we fulfill the safeguards,
the better our claim will be that we chose a voluntary death.
August 26, 2011; Revised 9-13-2011; 10-27-2011;
2-3-2012; 2-27-2012; 3-18-2012; 7-6-2012; 7-26-2012; 8-26-2012;
James Leonard Park is an existential philosopher
and advocate of safeguards for all life-ending decisions.
He is the founder of a website called
Safeguards for Life-Ending Decisions:
Much more about him will be found on his personal website,
which is called An Existential Philosopher's Museum:
This 'museum' now has more than 1,000 'rooms'.
review above of safeguards for life-ending decisions
they apply to the choice of voluntary death by dehydration
also Chapter 38 of How
to Die: Safeguards for Life-Ending Decisions:
Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice".
Here are a few related essays also by James
Why Giving Up
Water is Better than other Means of Voluntary Death .
Losing the Marks of Personhood:
Discussing Degrees of Mental Decline .
Live Well Now, Omit the Last Month .
Taking Death in
Stride: Practical Planning .
A Paradigm for Life-Ending Decisions .
Secure the Right to Die:
Laws Against Causing Premature Death .
to Right-to-Die Laws:
Granting Permission and Banning Harms .
Directives for Medical Care:
24 Important Questions to Answer
for Life-Ending Decisions
Will this Death
be an "Irrational Suicide" or a "Voluntary Death"?
Will this Death
be a "Mercy-Killing" or a "Merciful Death"? .
Methods of Choosing Death .
Books on Voluntary Death
Books on Preparing for Death
on Terminal Care
Books on Helping Patients to Die
Best Books on
Go to the Right-to-Die
Go to the Book
to discover 350 book reviews
organized into more than 60 bibliographies.
Return to the DEATH
Go to the Medical Ethics
Go to other
cyber-sermons by James Park,
organized into 10 subject-areas.