What is VSED and why should it matter to us?

Fr. Tadeusz Pacholczyk

More than 20 years ago, Dr. David Eddy, writing in the Journal of the American Medical Association, described how his mother, though not suffering from a terminal illness, chose to end her life through VSED (voluntarily stopping eating and drinking). She was “very independent, very self-sufficient, and very content.” When she began to be afflicted by various ailments, including rectal prolapse, she talked with her physician-son about “how she could end her life gracefully.”

When she asked him, “Can I stop eating?”, he told her that if it was really her intention to end her life, she could also stop drinking since, “without water, no one, not even the healthiest, can live more than a few days.” After a family bash celebrating her 85th birthday, she “relished her last piece of chocolate, and then stopped eating and drinking.” She died of dehydration six days later, with her son arranging for pain medications to be administered during her final days and hours.

Choosing not to eat or drink can be packaged as a noble and well-intentioned way to avoid intense pain and suffering, but VSED ultimately represents a flawed choice. It subtly draws us into the mistake of treating the objective good of our life as if it were an evil to be quelled or extinguished. We have a moral duty to preserve and protect our life and to use ordinary means of doing so. Suicide, even by starvation and dehydration, is still suicide and is never morally acceptable.

For some critically-ill patients, continued attempts to ingest food and liquids may cause significant complications, including severe nausea, vomiting, or complex problems with elimination. Such patients may find themselves effectively incapable of eating or drinking. This is not VSED, but a direct manifestation of their advanced disease state, and does not raise any of the ethical concerns associated with VSED.

As disease or severe illness advances, and a patient draws near to death, various bodily systems may begin to fail, and a natural decrease in appetite can occur. This is also different from a voluntary decision to stop eating and drinking—VSED refers specifically to a conscious, elective decision on the part of a patient not to eat or drink when eating and drinking would be anticipated to provide benefit to them without undue burdens.

As people are dying, the real evil that often needs to be quelled or extinguished is pain, and severe pain is properly addressed by non-suicidal means, that is to say, through effective pain management and palliative care strategies.

Some have sought to suggest that patients who choose VSED may feel less pain because the nervous system becomes dulled and the body may end up releasing chemicals which provide natural analgesia or pain relief: “What my patients have told me over the last 25 years is that when they stop eating and drinking, there’s nothing unpleasant about it — in fact, it can be quite blissful and euphoric,” said Dr. Perry G. Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization in Arlington, Va. “It’s a very smooth, graceful and elegant way to go.”

Such claims, however, remain highly controversial and strain credulity.

Dehydration and starvation constitute a form of assault against the integrity of the body and the whole organism, and if the body reacts by releasing chemicals, this is a form of “shock” response to an escalating traumatic situation. As noted for Dr. Eddy’s mother, pain medications were required to control the significant suffering and discomfort that would otherwise have ensued from her dehydration and starvation.

Even those who promote VSED advocate uniformly for concurrent pain control. In fact, Helga Kuhse, a well-known advocate of assisted suicide, once argued that when people see how painful a death by starvation and dehydration really is, then, “in the patient’s best interest,” they will soon come to accept active euthanasia through, for example, a lethal injection.

By its nature, VSED appears to be defined by the intent to cause death by forgoing the most basic requirements to conserve human life.  Intentionally engaging in such damaging and self-destructive behaviors, by foisting dehydration and starvation onto our mortal frames so as to shutter our earthly existence, can never represent an ordered kind of human choice.

 

COMING UP: Nothing about us without us

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The slogan “Nothing about us without us” was used by Solidarity in the 1980s in Poland, borrowing a royal motto from the Polish-Lithuanian Commonwealth in the mid-second millennium. Then, it was expressed in Latin: Nihil de nobis sine nobis. Later, it appeared in Polish on the banners of 19th-century Poles fighting their country’s partition by Russia, Prussia, and Austria: Nic o Nas bez Nas. Today, it’s often used by disability activists asserting their claim to be fully participant in society.

“Nothing about us without us” also applies to the Special Assembly of the Synod of Bishops for the Pan-Amazon Region, which will meet in Rome in October.

That Synod will involve seven bishops’ conferences from nine Latin American countries who will consider their pastoral situation under the theme, “Amazonia: new paths for the Church and for an integral ecology.” As is usually the case in these meetings, the bishops at the Synod will work with materials drafted in Rome. Early indicators from the Synod’s preparatory document suggest that the Amazonian Synod will be longer on environmentalism than on theology. International media attention will doubtless focus on the Synod’s discussion of climate change and its relationship to Amazonian deforestation.

Recent synodal history suggests, however, that more will be afoot at the Amazonian Synod than what its announced theme suggests.

The 2014 and 2015 Synods were called to consider the crisis of marriage and the family throughout the world. Yet they became the occasion for powerful churchmen to try to deconstruct Catholic moral theology and sacramental discipline, according to the tried-and-failed theologies and pastoral practices of the 1970s. The 2018 Synod, summoned to discuss youth ministry and vocational discernment, began with an effort by the Synod general secretariat to enshrine the world’s language of sexual plasticity (and the lame understandings of happiness that underwrite that language) into an official Church document. When that failed, Synod-2018 became the occasion for the Synod general secretariat to promote an ill-defined notion of “synodality” that struck more than a few bishops present as a prescription for local-option, choose-your-own-doctrine Catholicism on the model of the (imploding) Anglican Communion.

This pattern seems likely to continue at the Amazonian Synod. There, the deeper agenda will be the ordination of mature married men — viri probati — to the priesthood. Proponents will argue that this dramatic change in the Church’s longstanding tradition of a celibate priesthood (which, contrary to much misinformation, antedates the early Middle Ages by hundreds of years) is necessary because Amazonia is a Catholic area deprived of the Eucharist by a lack of priests. One hopes that the counterclaims — that Amazonia is mission territory requiring wholesale evangelization, and that Amazonia’s lack of priests reflects racial and class divisions in Latin American Catholicism that discourage priests of European pedigree from working with indigenous peoples — get a serious hearing.

Proponents of ordaining viri probati in Amazonia, including retired Brazilian Cardinal Claudio Hummes, OFM, have insisted that any such concession there would have no implications for the universal Church. That cannot be, however. Should the Amazonian Synod request the Pope to grant a dispensation from the discipline of celibacy for that region, and should he grant it, it will be just a matter of time before bishops conferences elsewhere — Germany, Switzerland, Belgium, and Austria come immediately to mind — make similar requests, citing pressing pastoral needs. On what ground would those requests be denied?

In a year-end interview with Vatican News, the Synod’s general secretary, Cardinal Lorenzo Baldisseri, insisted that the Amazonian Synod would not discuss environmental issues only, but would also confront “ecclesial themes” — and would do so in a way that Amazonia could be “a model for the whole world.”

We can be grateful to the cardinal for his candor in, however unintentionally, letting the celibacy cat out of the synodal bag. Any decision to ordain viri probati in Amazonia would inevitably have major consequences for the entire Church. A decision of this magnitude cannot be taken by an unrepresentative segment of the Church and then turned into a “model” for everyone else.

That is why the principle of “Nothing about us without us” must apply here. Whatever else “synodality” may mean, it surely must mean that decisions bearing on everyone should involve as broad a consultation and as global a reflection as possible. Bishops who agree should make their concerns known now, not after the Amazonian synod meets.

Featured image by Vatican Media | CNA