Terminally ill opt for suicide by starvation

From The Sunday Times [1]

March 8, 2009

Given no other way to end their lives, patients are choosing an Euthanasia agonising death with the help of GPs

TO AVOID the legal ban on medically assisted dying, doctors are helping patients starve and dehydrate themselves to death.

The retired GPs have advised patients who are terminally ill, or suffer from a degenerative disease, that they can refuse food and drink if they are unable or unwilling to travel to a Swiss clinic to receive a fatal dose of medication.

The doctors admit the process of starving and dehydrating to death is “horrific” — with one woman being on “hunger strike” for 25 days before she died – but say patients have no alternative as long as euthanasia is illegal in Britain.

The doctors are members of the campaign group Friends at the End (Fate), which lobbies for the introduction of assisted dying in Britain and gives practical advice on suicide.

They warn patients determined to dehydrate themselves to death not to succumb to the temptation to rinse their parched mouths with water or ice, because this merely prolongs the agony.

Tuson’s death in less than a week was relatively swift compared to some patients. Lily, 75, from Scotland, who had advanced motor neurone disease, took 25 days to starve and dehydrate to death, cared for by her family in her own home.

Wilson mentioned the possibility of death by starvation and dehydration to Lily when she called the organisation for suicide advice.

By then Lily had accepted that it would take too long to complete the administrative process necessary to be accepted by one of the Swiss suicide clinics. Her family feared that she would be too disabled to travel by the time she secured an appointment and even incapable of swallowing the lethal barbiturates unaided.

Lily ate her last bite, homemade raspberry ice cream, on a beautiful afternoon in late August last year. Her family hoped she would pass away within days. As the days turned to weeks, however, Lily became distraught. Using a communication aid, she wrote, “You wouldn’t put a dog through this; you would put it down; you would give it a lethal injection.”

Local GPs administered small doses of morphine to combat cramps and a sedative to relieve “emotional anxiety”.

One of her daughters, Jenny, 40, recalls: “That worked well enough until day 18 and day 19. They were two of the most horrific days of my life. By then my mother was suffering from severe dehydration . . . She was howling with anguish.

“At that point we pushed the GPs and the palliative care specialists . . . They agreed to up the dosage of her medication very strongly at that point, so within 24 hours she had slipped into a coma.” It took five further days for her to die.

Wilson, who was in contact with Lily during the 25 days, added: “She took a bit longer to die than expected but then we discovered that she had been sucking ice cubes. She had also been frequently rinsing the mouth with water. I was telling her not to do that. She was prolonging the process by these extra bits of fluid.”

The campaigners believe that starvation and dehydration are the only options for many people. Dr Michael Irwin, a retired GP from Surrey and member of Fate, says he suggested the method to a couple of patients who were terminally ill.

Irwin said: “You have to have a good team of doctors and nurses who are willing to give sedation and respect your wishes by not sneaking in behind someone’s back to give you a glass of water.”

Doctors’ duty

Wilson: suicide advice

Discussing with patients death by dehydration and starvation could put doctors at risk of being struck off, according to the General Medical Council (GMC). A patient should instead be offered counselling or pain management.

If a patient insists on refusing food and drink, however, the GMC says doctors have a duty to relieve the suffering . It allows doctors to prescribe pain relief and sedation and to relieve unpleasant symptoms.

It is illegal to aid and abet a suicide and anyone convicted faces up to 14 years in prison. However, every case is judged on its merits.

No one has ever been prosecuted for helping someone to attend a Swiss suicide clinic and campaigners think it highly unlikely that anyone would be prosecuted for suggesting refusal of food and drink or advising on the best way to do this.

The group has sent out copies of a book called A Hastened Death by Self-Denial of Food and Drink , which gives detailed advice on how to starve to death, to about 30 British patients in the past four months.

It has also distributed a leaflet with tips on starvation and dehydration, including advice on relieving symptoms such as a dry mouth, cramps, headaches and agitation.

The leaflet, written by Dr Libby Wilson, a retired GP from Glasgow and medical adviser to Fate, and Nan Maitland, from London, assistant editor of the group’s newsletter, says: “Once a person has decided to stop eating and drinking, it is essential that all relatives and carers in touch with the patient agree to support the decision made and abide by the ‘no liquids’ rule.

“Sometimes well-meaning people have given a drink which delays the end.”

In May the group will hold a meeting in London to promote a voluntary refusal to eat or drink as a legal way of committing suicide in Britain.

The families of two women who recently turned to Fate for help with starving and dehydrating to death told The Sunday Times of their anger and distress that their mothers had to end their lives in this way.

Efstratia Tuson, an 85-year-old retired teacher from Middlesex, began refusing food and drink in January. It took her five agonising days to die.

Tuson was terminally ill with a rare malignancy in the stomach. A firm believer in euthanasia, she had wanted a quick death by a lethal dose of barbiturates, but her doctors were forced to refuse.

Her decision to refuse food and drink initially horrified her family but they came round to the idea when they saw how distraught she became after being told she would have to wait a month for an appointment to die at a Swiss clinic.

It was Maitland who told the family about starvation and dehydration as mean of suicide. She said last week: “Efstratia couldn’t bear to wait for another month . . . I said to the family, ‘Do you want me to tell her about the one alternative’, and they all said yes.”

Tuson’s daughter Pamela was at her mother’s hospital bedside throughout the five-day hunger strike . She described how her mother faded away in front of their eyes.

“Her body mass reduced, her face became drawn, her skin very dry and, of course, the mouth very dry. She was dying of thirst; it was like being in the desert.

“I feel my mother was tortured until she died. She had been asking since June for doctors to end her life, every time one came into the room.”