DEHYDRATION---as a method of choosing voluntary death

VOLUNTARY DEATH BY DEHYDRATION QUESTIONS & ANSWERS 2. HOW LONG WILL IT TAKE TO DIE? 3. WILL I GET HUNGRY OR THIRSTY? 4. WOULD IT BE WISE TO HAVE EMPTY INTESTINES? 5. WHAT ABOUT MOUTH CARE DURING THE PROCESS OF VDD?

DEHYDRATION---as a method of choosing voluntary death

VOLUNTARY DEATH BY DEHYDRATION
QUESTIONS & ANSWERS

1.  WHAT SAFEGUARDS SHOULD BE FULFILLED
     TO MAKE SURE THAT VDD IS THE BEST COURSE OF ACTION?

2.  HOW LONG WILL IT TAKE TO DIE?

3.  WILL I GET HUNGRY OR THIRSTY?

4.  WOULD IT BE WISE TO HAVE EMPTY INTESTINES?

5.  WHAT ABOUT MOUTH CARE DURING THE PROCESS OF VDD?

6.  IF I CHANGE MY MIND ABOUT DYING BY DEHYDRATION,
     WILL THERE BE ANY LASTING DAMAGE TO MY BODY?

7.  IS VOLUNTARY DEATH BY DEHYDRATION A LEGAL OPTION?

8.  SHOULD I COMBINE VOLUNTARY DEATH BY DEHYDRATION
     WITH OTHER METHODS OF CHOOSING DEATH?



9.  WHERE CAN I FIND MORE INFORMATION
     ABOUT VOLUNTARY DEATH BY DEHYDRATION?

    Preliminary note for possibly-suicidal readers:

    Nothing on this portal supports committing irrational suicide.
Voluntary death by dehydration contains its own inherent safeguards
to
prevent irrational suicide:
Because it takes about 100 re-affirmations of the choice to die
over a period of several days,

the 'reasons' for irrational suicide will often disappear before death occurs.

    If you are uncertain whether your wish to die
is closer to
voluntary death or to irrational suicide,
read this essay: Will this Death be an "Irrational Suicide" or a "Voluntary Death"?:

https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-IS-VD.html

    And beginning to fulfill the following recommended safeguards
might prove to be a good operational method
for separating the urge toward a harmful irrational suicide
from the wish for a wise and compassionate voluntary death.
See 26 recommended safeguards for life-ending decisions:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-A-Z.html

    Another resource specifically applies these 26 safeguards
to the the process of considering a voluntary death by dehydration:
"Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-VDD-SG.html

    Anothermore philosophicaldiscussion of the 'reasons' for suicide appears here:
"Depressed? Don't Kill Yourself!":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-DEP-K.html

   
If you are considering voluntary death by dehydration near the end of your life,
the following essay might help you to clarify your thinking:
"Completed Life or Premature Death?":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CT-CLPD.html

    You can receive instant help for any suicidal urges by calling: 1-800-SUICIDE.

    In short, Voluntary Death by Dehydration
is NOT being recommended as a method of committing suicide.

VOLUNTARY DEATH BY DEHYDRATION
QUESTIONS & ANSWERS


by James Leonard Park


    Voluntary death by dehydration (VDD) is a life-ending option.
When we are near the end of our natural lives,
we can decide to shorten the process of dying
by giving up water and other fluids.

    The lack of water will cause death before the lack of food.
Thus, this method of choosing a voluntary death
should not be called "starvation".
"Dehydration" is the most accurate description
of this means of choosing a wise and compassionate death.

    This Internet portal offers an outline for the process of choosing VDD.
When death is chosen compassionately and wisely,
it should not be difficult to find medical professionals
to help with each element of choosing death by dehydration.

    In fact, the most open-minded hospice programs
already have extensive experience with patients who choose this means
of drawing their lives to a peaceful and painless close. 
Persons who are most serious about using this method of voluntary death
should seek hospice programs nearby
that will help them along this pathway towards death.
Some of the specific problems that might arise
can best be dealt with by professionals
who know how the human body reacts to lack of water.


1.  WHAT SAFEGUARDS SHOULD BE FULFILLED
     TO MAKE SURE THAT VDD IS THE BEST COURSE OF ACTION?

    Voluntary death by dehydration
is an option that can be used by anyone, anywhere.
Because it will take a week or longer to die,
this method of choosing death
is not likely to be used to commit irrational suicide.
But in those cases where there might be some question
about the wisdom of dying now
rather than waiting for death at some later time,
some simple safeguards can help everyone to know
that this was a truly voluntary death and not an irrational suicide.
Another way to make this point:
Wise safeguards will prevent premature death.

    Here is a list of 26 recommended safeguards


    Each of these should be considered at least briefly
in any process of choosing a voluntary death.
Some will seem more appropriate and relevant to the situation at hand.
And if the time is short until natural death in any case,
then only a few of these safeguard would be useful.
    See a chapter explaining how these 26 recommended safeguards
apply to voluntary death by dehydration:
Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice


2.  HOW LONG WILL IT TAKE TO DIE?

    Voluntary death by dehydration will normally take a week or longer.
The exact length of time between taking the decision to die
and when your body finally gives out
will depend on the amount of water stored in your tissues
and on how much water you use
to cope with the worst symptoms of dying by dehydration.

    You are probably considering voluntary death by dehydration
because you have some terminal illness or fatal condition.
And when some parts of your body are already beginning to shut down,
this will shorten the process of dying by dehydration.
Your death-certificate will probably record


your terminal illness as
the cause of your death
rather than your choice to shorten the process by giving up water.
A complete explanation of your death could include all the relevant facts.

3.  WILL I GET HUNGRY OR THIRSTY?

    Yes, there will be a period, especially at the beginning,
when your body will declare that it needs water and food.
But this period of time should last only 1-3 days.
After awhile, the body adjusts to the fact of not getting any more food.
It begins to use fat cells to maintain itself.
And these fat cells also contain lots of water,
which will be used by your body
to maintain itself for as long as possible.
This is how camels can live for long periods of time
in the desert without food or water:
They live on the fat stored in their humps and elsewhere.
But the human body does not have as much storage capacity.

    According to people who have tried this method of voluntary death
and according to others who have observed such deaths,
the period of hunger and thirst passes relatively peacefully.

    And if you are receiving medical help

as in a hospice program
the medical professionals can assist you to control
all undesirable side-effects of your choice to die by dehydration.
And if you would rather be asleep most of the last few days,
sedatives can be provided in whatever pattern works best for you.

4.  WOULD IT BE WISE TO HAVE EMPTY INTESTINES?

    Yes.  Some experts recommend that the patient
begin with some effective means of bowel-cleansing
before beginning the process of voluntary death by dehydration.
Because you will not be taking in any more food or water,
your suffering will be less if you have a clean digestive tract.
There will be no particles of food turning into gas in your intestines.

    Any laxative would be helpful in this process.
But the kind of bowel cleansing
used before a colonoscopy would be ideal.
However, if you are already in such a fragile condition
that rigorous bowel preparation might be difficult,
you might choose just to follow a liquid diet for four days,
followed by a laxative of your choice.
Then you could begin your period of dying by dehydration.

    And psychologically, this period of bowel-cleansing
would also be a period of time to think more clearly and deeply
about your choice of voluntary death by dehydration.
No damage will be done to your body if you change your mind
and start eating and drinking again
after any period of cleaning your intestines.
Other people will probably know about your plans to die by dehydration.
And they will help you with the process.
Their involvement will be an additional 'reality-check'
on your reasons for wanting to die.


5.  WHAT ABOUT MOUTH CARE
     DURING THE PROCESS OF VDD?

    Mouth care is a very important element
of any plan to die by dehydration.
Your mouth will suffer drying and cracking
unless some effective methods are employed.
One simple method is to use ice chips to keep your mouth moist.
Or you could rinse your month with water as often as you please
and spit out the water instead of swallowing it.
Drinking small amounts of water
will slightly delay the process of dying.

    And perhaps during your last days of life,
you will value each additional day.
On balance, extending your dying process might not be a bad choice.
While you are still conscious and able to decide,
you can control your precise glide-path towards death,
by controlling the exact amount of water you drink.

    If you are enrolled in a hospice program while you are dying,
the professional care-givers will have
even more methods of taking care of your mouth.
Since they have helped others to die by dehydration before,
they know exactly what to expect

and how best to deal with each problem as it arises.

    Other physically-painful and psychologically-distressing
symptoms of dehydration might occur.
There are medical methods for dealing with all of these if they arise.
What forms of sedation would you find acceptable?

    See more details about mouth-care and dealing with thirst here:
http://www.thirstcontrol.com/


6.  IF I CHANGE MY MIND ABOUT DYING BY DEHYDRATION,
     WILL THERE BE ANY LASTING DAMAGE TO MY BODY?

    The first few days without food or water
will do no permanent damage to your body.
If you change your mind about dying by dehydration,
you can carefully resume eating and drinking.
And you body will be able to assimilate water and food once again.
People have come back from experimental fasts without harm.
And others have survived
unavoidable deprivation of food and water for several days.

    Each day you must decide again
to continue your chosen method of dying.
This is one of the strongest, built-in safeguards of VDD.
When you choose to die by dehydration,
this is a choice you must make over and over again,
perhaps as many as 100 times during the process of dying.

    After 4 or 5 days, your mind might not be working well.
So it would be important to have helpers
who will assist you in choosing death by dehydration.
You certainly should not put yourself into a situation
in which care-givers might reverse your decision to die
once you become unconscious.

    This method of drawing life to a close
is clearly a voluntary choice at the beginning.
You are expressing your settled values
in this decision to die by dehydration.
But you should make sure that other people involved support your decision.
This will usually have been worked out in great detail
when you are fulfilling the safeguards
intended to prevent irrational suicide or any other form of premature death.

{See the first questionabout safeguards.}

    But after you become unable to express your settled values

in this case your determination to die by dehydration
then continuing the process of dying by refusing food and water
will be controlled by others around you.
We might say that the process has shifted
from being a voluntary death to being a merciful death
because other persons are the primary agents
for continuing the process.

    For example, you would certainly not want to be in any hospital
where the default medical choice is always to give fluids artificially
once a patient has become unconscious or otherwise unresponsive.
That would defeat the whole process of dying by dehydration.
You might be kept 'alive' by tubes indefinitely.

    If you have solid medical reasons for choosing death at this time,
it should not be difficult to get your hospital to cooperate.
Withdrawing food and water will probably be part of the process
of discontinuing all forms of life-supports and curative medications.
Of course, all hospital or hospice staff and volunteers
will want to be assured by the safeguards you have already fulfilled
that death at this time is the best option for you.

Voluntary Death by Dehydration:
Safeguards to Make Sure it is a Wise Choice




7.  IS VOLUNTARY DEATH BY DEHYDRATION
     A LEGAL OPTION?

    Yes, everywhere on the Earth
you have a legal choice to give up eating and drinking.
The only exceptions to this would be situations
in which the patient has been declared incompetent
to make medical decisions
(including decisions that would lead to death)
and the decision-making power has passed to others.
The process of declaring you not capable of making medical decisions
will probably involve an evaluation by a psychiatrist.
So you could head off any such attempts to block your plan for death
by seeking your own psychological evaluation
before you give up water and all other fluids.

    You can prevent any such intervention by relatives or medical authorities
by having fulfilled strong safeguards before beginning the process of dying.
These safeguards are intended to make sure
that you are making a wise decision for death.
The opinions of several other people are collected
in creating your death-planning record.
If there is going to be any legal challenge
to your capacity to make life-ending decisions,
such questions will arise at several places
in the process of fulfilling safeguards.

    In short, you should prove
that you are making a wise and competent choice
to end your life by dehydration before you begin the process.

    Even in societies without complex legal systems,
the right to discontinue eating and drinking is universally recognized.
Some societies have traditions that honor
this choice to die by giving up food and water.
Only under the most exceptional circumstances
would others have the legal power to force you
to eat and drink against your will.


8.  SHOULD I COMBINE VOLUNTARY DEATH BY DEHYDRATION
     WITH OTHER METHODS OF CHOOSING DEATH?

   

Yes, it would be entirely appropriate and effective
to combine VDD with other legal means of ending your life.
If you are choosing death for reasons that others can agree with
such as terminal illness and/or advancing dementia
family members and the medical profession
will aid you in the dying process.
If you are already being cared for in a hospital or hospice,
everyone there will be familiar with your life-ending decision.
And they will cooperate (within their procedures)
to begin (or end) the following medical treatments (or non-treatments).

    Increasing your pain-medications might be entirely appropriate.
If you are already receiving any drugs to control any forms of suffering,
they should be continued and perhaps increased.
You can be made more comfortable by methods known to medical science,
even if these treatments will shorten the process of your dying.
You have already decided that your life has come to its end.
Thus, life-prolonging medical efforts are no longer appropriate.
And new (or increased) forms of symptom-control can be used.

    Induced terminal come is another method of choosing death
that might be ordered by your doctor.
With your permission (and/or the permission of your proxies),
the physician in charge of your terminal medical care
can order that sufficient drugs be administered continuously
so that you will never have another moment of consciousness.
This would be especially appropriate if your suffering is  so terrible
that you want to avoid even one more moment of such suffering.
Terminal sedation (sometimes called "palliative sedation")
is clearly a life-ending decision.
But these drugs will not bring death immediately.
Your brain will be kept permanently asleep
while the normal processes of dying take place.
You are guaranteed to die in your sleep.
Normally, the medical order to induce terminal coma
will also include giving up all food and fluids.

    Ending curative treatments and life-supports
is now a very common way for a human life to end.
When you cannot be saved from death by further medical treatments,
your doctor will order the end of all such medical support. 
You will continue to receive comfort care.
But all of the now-failed medical treatments can be discontinued.
If you have any form of life-supports

machinery or medications
these will also be disconnected or discontinued.
And if death will not come immediately,
then it is also relevant to order the ending of food and water.
For example, this method of dying
might include removing a feeding-tube.

    These four legal methods of choosing death
are more fully described here:

Methods of Choosing Death is a Right-to-Die Hospice

9.  WHERE CAN I FIND MORE INFORMATION

     ABOUT VOLUNTARY DEATH BY DEHYDRATION?
This life-ending choice has been discussed under a number of names:
VSED—Voluntary Stopping Eating & Drinking
VFRR—Voluntary Refusal of Food & Fluid
VTD—Voluntary Terminal Dehydration
VDD—Voluntary Death by Dehydration
MDD—Merciful Death by Dehydration
STED—Stopping Eating & Drinking
SED—Stopping Eating & Drinking

PRNH—Patient Refusal of Nutrition & Hydration
MD—Medical Dehydration
TD—Terminal Dehydration
VTD—Voluntary Terminal Dehydration

Any of these terms can be used to search on the Internet.


    ARTICLES ON THE INTERNET:
(These on-line articles are organized by quality, beginning with the best.)

Voluntary Death:
A Comparison of Terminal Dehydration
and Physician-Assisted Suicide

a medical-journal article supporting the option of terminal dehydration
by Franklin G. Miller & Diane E. Meier.

VDD:
Why Giving Up Water is Better than other Means of Voluntary Death
a short article by James Leonard Park,
exploring the advantages of this form of exercising the right-to-die.

VOLUNTARY DEATH BY DEHYDRATION:
Safeguards to Make Sure it is a Wise Choice

an on-line article exploring 26 recommended safeguards
by James Leonard Park.

Voluntary Terminal Dehydration
a chapter by Alan D. Lieberson, an author who is both a doctor and a lawyer,
summarizing the literature exploring the medical, legal, & ethical dimensions
of voluntarily giving up eating and drinking as a reasonable means of choosing death.
The on-line book is entitled: Treatment of Pain and Suffering in the Terminally Ill.

Will this Death be an "Irrational Suicide" or a "Voluntary Death"?

Is the death helpful, rational, well-planned, & admirable?
a short article by James Park.

Will this Death be a "Mercy-Killing" or a "Merciful Death"?
Is the death harmful, irrational, capricious, & regrettable?
a short article by James Park.

Stopping Eating and Drinking
an excellent article by Judith K. Schwartz, PhD, RN
especially written for nurses, about all aspects of VDD,
with reference to a specific 100-year-old women
who chose to give up eating and drinking
even tho her various forms of physical deterioration
did not yet constitute 'terminal illness'.
This article appears at a few places on the Internet,
the URL's of which are too long.
So find it by searching for the exact title:
"Stopping Eating and Drinking".
As a side-benefit, such a search will lead you to similar articles.

Four Legal Methods of Choosing Death
Voluntary death by dehydration is one of these methods.
The others are: increasing pain medication (comfort-care only),
induced terminal coma, & withdrawing life-supports.
a short article by James Park.

The Decision to Stop Eating at the End of Life:
Many Stop Eating to Regain Control

a short article by Angela Morrow, RN.

Choosing to Stop Eating & Drinking at the End of Life (VSED)
a short article by Robert J Webb, MD.

Tube Feeding Options at the End of Life
This comprehensive website explores the medical, ethical, legal, & religious dimensions
of the decision to use, forgo, or withdraw various forms of tube-feeding at the end of life.
The assumed context for these decisions is a patient in a hospital, nursing home, or hospice.
The decision about tubes is taken by the doctors, the patient, and/or proxies for the patient.

    DVD:

"Dying Wish: A Dying Doctor's Decision to Stop Eating and Drinking and Die"
This is a 29-minute DVD documentary of the last month of Dr. Michael Miller.
Because he was dying of cancer,
he decided his best pathway towards death was to give up eating and drinking.
This DVD shows the whole process,
including the participation of family, doctors, & hospice workers.
It took Dr. Miller almost two weeks to die after he stopped all liquid intake.
    This DVD is available from Amazon.com.


BOOKS SUPPORTING VOLUNTARY DEATH BY DEHYDRATION:

    First Books on Voluntary Death by Dehydration.

    BEST BOOKS ON VOLUNTARY DEATH

This bibliography reviews several books about people who have chosen voluntary death.

Created January 30, 2009; Revised 2-15-2009; 2-18-2009; 3-6-2009; 6-15-2009; 11-27-2009;
1-4-2010; 1-6-2010; 1-9-2010; 5-17-2010; 7-11-2010;10-17-2010; 8-24-2011; 8-25-2011; 8-27-2011;
5-17-2012; 3-19-2014; 5-18-2015; 5-21-2015; 9-14-2018; 11-6-2019; 8-21-2020;


Go to the Right-to-Die Portal.
This portal leads to many additional resources, including several bibliographies.






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