The Age Newspaper ran an article, yesterday, about the plight of an elderly Victorian woman with dementia whose family want to be able to hasten her death by cessation of oral nutrition and hydration.
Julia Medew’s article: A son's plea to Denis Napthine: This is no way for my mother to live (The Age 13 March) raises some interesting questions in regards to patient autonomy and the duty of patient carers to provide basic personal care.
According to the article, the woman in question is sedated for most of the day only being roused so that she can be fed. She seems to be unable to communicate verbally but, when offered food and fluids, she ‘opens her mouth like a baby bird’ and clearly swallows.
A recent court case in Canada parallels the situation of Mrs De Ravin. Mrs Margaret Bentley was living in a care facility and was suffering from dementia. She also had a living will – two in fact – the second of these being contested as part of a case taken by her family in the BC Supreme Court seeking a ruling that spoon feeding constituted ‘medical care’, not basic care and arguing, therefore, that the nursing home should cease to feed Bentley.
Yet Mrs Bentley would accept the normal prompts of a touch of a cup or spoon to her lower lip and would willingly accept food and fluids which she swallowed normally.
The court concluded that, by her behaviour, Mrs Bentley was expressing consent to be fed and that oral nutrition and hydration was basic personal care and not medical care. In other words, if Mrs Bentley continued to accept food and fluids in this manner, that it was proper to continue to provide it.
This is very different from a situation where a patient refuses oral nutrition and hydration or who has refused tube feeding.
The effect of ceasing to feed and hydrate Mrs De Ravin would be to bring about her death by dehydration. It would be, all other things considered, a direct action with the intention to kill and, therefore, in contravention of the Criminal Code.
The Age report says that Victorian Law (State of Victoria) ‘does not allow Mrs De Ravin or her power of medical attorney to order anything that would hasten of cause her death in her current state.’ The story further added a curious statement to the effect that Advance Care Directives or ‘Living Wills’ in other states do allow a patient to make such a request in advance.
I’m not able to comment directly on the laws in various states; however, it is blindingly clear that an action to cease oral hydration and nutrition is an act with the intention to kill. Certainly, a competent person can refuse to be fed; but asking via an Advance Directive that someone else (medical staff) cease feeding a person should they lose capacity is asking for that someone to break the law.
The autonomy that a person exercises by completing an Advance Care Directive cannot bind another person to exercise the patient’s autonomy for them. Such matters remain subject to the autonomy and professional judgement of medical staff and the law itself.
Many families have a similar experience to Mrs De Ravin’s loved ones, including my own. I have every sympathy for what they are going through. But not everyone sees the demise of a loved one in such a manner as the article suggests. This alone should tell us that this instance is not ipso facto an argument for euthanasia. The article suggests that Mrs De Ravin is being well cared for, something that we should all be grateful for.
Mrs De Ravin’s son, Mr Carnegie, asserts that the current legal situation leaves people with but one choice (‘an undignified suicide’). This is false. Yet Carnegie also seems to want his mother’s carers to make a choice to kill his mother by omission. He would be effectively asking them to make a judgement as to the value of her life; something that is entirely subjective and something none of us should ever want another person to do.
Pro-euthanasia Doctor, Rodney Syme supports law reform in this area and calls for a debate on refusal of feeding. He describes dementia in the worst possible light, even taking an ill-judged swipe at infants into the bargain (“It’s even worse than being an infant.”).
Like the proverbial snake oil salesman, Syme paints the worst-possible scenario to drive home his point and to bolster his argument. I believe that this kind of talk is irresponsible and may have the effect of spreading unnecessary fear in the community about dementia.
In the end, these are significant and difficult issues that cannot be divorced entirely from the personal grief of family members and the patient themselves. But the ‘dark place’ of killing people is precisely as Mr Carnegie describes it and changing the law will not change the reality.