If a competent elder refuses food, water or essential medical treatment and dies as a direct result, is that death a suicide?
When a colleague brought up the topic recently, I realized that in 30 years, I’d never given the question enough thought. Consider several scenarios:
A 30-year-old man obsessed by a girlfriend who has left him says he will not eat until she returns. He’s found dead in his locked home along with a journal that chronicles several weeks without food.A 23-year-old athlete is severely injured in a motor vehicle accident. After enduring months of complications and unremitting pain, she leaves a rehab facility against medical advice. A couple of weeks later, she’s found dead at home with a note that says she “doesn’t want to live like this” and will neither eat nor drink until she dies.An 81-year-old with a litany of chronic health problems who is nevertheless quite active falls and breaks his hip. After several surgeries and endless complications, he tells his daughter and medical personnel that he “doesn’t want to live like this.” He refuses all food and dies three weeks later.Each person faced a situation that seemed too physically or psychologically painful to live with. Each made a conscious decision to forego sustenance and die. Nobody was “terminally ill.” Even the 81-year-old had quite a bit of physiological reserve as it took him three weeks to die. Had he persevered with medical treatment, he might well have lived for years.
For me, the first two deaths are obvious suicides. The third differs from the second only in the person’s age. Nevertheless, the initial reaction of most medical examiners, including myself, is to call the last death an accident related to a fall.
Many of us see a life-terminating choice differently depending on little more than whether the decision-maker is young or old. Do we make a distinction because we think late-in-life incapacity is an acceptable reason for self-destruction while other common motivators are not?
If anticipated length and quality of life are key considerations, where should we draw the line after which allowing nature to take its course is no longer suicide? How debilitated must a mentally competent individual be? How old? How short the anticipated remaining lifespan?
The more you think about the issue, the more questions come to mind.
The Academy of Psychiatry Law says “silent suicide” is “kill(ing) oneself by nonviolent means through self-starvation or noncompliance with essential medical treatment. It is the preferred method of self-destruction by the depressed, bedridden elderly.”
Faced with the determined choice of a seemingly competent person, well-meaning doctors and family members may decide not to push further medical treatment or insist on psychological evaluation. I sympathize with those decisions. I’m convinced I’d choose death in the face of incapacity that made me reliant upon others.
I support the right of competent people to refuse both treatment and sustenance. The only thing I question is the manner of death.
One of my colleagues argues that when the self-imposed starvation death of an elder is certified as something other than suicide, it demeans the value of older people’s lives. He says euphemistic certifications provide “cover” and make the failure to recognize and adequately treat depression in the elderly more palatable. He thinks suicide certifications would force doctors and societies to pay more attention to issues surrounding end-of-life care. The elderly would, in the long run, benefit.
Might he have a point?
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003 to 2012. She now lives in Florida and Maryland. Email her at firstname.lastname@example.org.