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Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Hastening Death by Voluntarily Stopping Eating and Drinking: Legal Perspective Seattle University Oct. 14, 2016 Thaddeus Mason Pope, JD, PhD

  1. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Hastening Death by Voluntarily Stopping Eating and Drinking: Legal Perspective Seattle University • Oct. 14, 2016 Thaddeus Mason Pope, JD, PhD Mitchell Hamline School of Law Disclosures I have no conflicts of interest or relevant financial interests. 1

  2. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts 25 min Learning Objectives 2

  3. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Describe four legal foundations of a patient’s right to contemporaneous VSED Understand the challenges and risks for families and clinicians in implementing an advance VSED decision for a now incapacitated patient Compare legal distinctions between VSED, on the one hand, and medical aid in dying and withholding or withdrawing life- sustaining treatments, on the other hand Definition VSED 3

  4. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Physiologically able to take food & fluid by mouth 4

  5. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Voluntary, deliberate decision to stop Intent: death from dehydration 5

  6. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts >50% at 8d >80% at 14d Legal concerns Legal analysis 6

  7. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Legal concerns Uncertainty & reluctance among providers 7

  8. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Prohibited Unsure Permitted Almost never: express prohibition Legal & ethical expert support nearly universal 8

  9. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts RCWA specifically & expressly prohibits lots of things Not VSED BUT Absence of a red light not good enough 9

  10. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Clinicians want express permission No green light from Olympia 10

  11. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts No green light anywhere 11

  12. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Little precedent & not supportive No red lights No green lights Lack of clarity & guidance 12

  13. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Cinderalla pic again neglected in academic & policy circles 13

  14. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Providers still ask Is VSED legal? 14

  15. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Is VSED illegal? Wrong questions 15

  16. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Law is rarely binary Risk assessment 16

  17. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Measure Mitigate Legal analysis 17

  18. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts case types 18

  19. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts VSED now with capacity Ability to understand significant benefits, risks & alternatives Ability to make & communicate decision 19

  20. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Advance directive for VSED later (when lack capacity) 20

  21. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Patient with capacity requests VSED now Extremely low risk of sanctions – criminal, civil, regulatory 21

  22. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Right to refuse medical interventions 22

  23. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Right to refuse non -medical interventions Not assisted suicide 23

  24. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Not elder neglect 24

  25. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Right to refuse medical interventions Well established > 3 decades 25

  26. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts “A competent patient may refuse treatment . . .” Right to refuse medical 26

  27. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Vent Dialysis CPR Antibiotics Feed tube VSED Vent Dialysis CPR Antibiotics Feed tube 27

  28. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Cinderalla pic again ICD Vent Dialysis CPR Antibiotics Feed tube 28

  29. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts VSED Vent Dialysis CPR Antibiotics Feed tube Not DTC Not DIY 29

  30. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Contrast VSED 30

  31. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Part of a broader treatment plan Supervised by licensed healthcare professionals 31

  32. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts “the number of cases will increase. Since the concept of fasting is not taught in medical schools, we will produce a guide to support doctors.” Harvard CEC 32

  33. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts PAVSED “Palliated and Assisted Voluntarily Stopping Eating and Drinking” PAVSED Highlights medical role in palliating symptoms Highlights the direct care staff role in providing assistance 33

  34. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Medical b/c not “typical human” 34

  35. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts treatment 35

  36. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts unwanted Does not matter whether food & fluid are “medical treatment” 36

  37. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts “The common law right to be free from bodily invasion is an alternative basis ...” Battery 37

  38. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Unwanted contact Even if clinically beneficial 38

  39. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts “Every human being of adult years and sound mind has a right to determine what shall be done with his own body . . . . ” Patient Physician consented operated to left ear on right ear Mohr v. Williams (Minn. 1905) 39

  40. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Force feeding is a battery “It seems odd that your bodily integrity is [not] violated . . . by sticking a spoon in your mouth.” 40

  41. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Move now from legal bases, grounds for right Responding to main objections 41

  42. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts VSED is not assisted suicide 42

  43. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Alleged risk RCWA 9A.36.060 (1) A person is guilty of promoting a suicide attempt when he or she knowingly causes or aids another person to attempt suicide. (2) Promoting a suicide attempt is a class C felony. 43

  44. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Active Passive 44

  45. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts 45

  46. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts VSED is not abuse or neglect Alleged risk 46

  47. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts “The facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.” 42 C.F.R. 483.25(j) Tag F0327 47

  48. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts 48

  49. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Tag 242 Over -treatment just as risky as under-treatment 49

  50. Hastening Death by VSED - 10-14-2016 Keynote Presentation - Legal - Pope - PowerPoint Handouts Bucilla Stephenson Now leave contemporaneous VSED 50

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