Fran Smith and Sheila Himmel

Changing the Way We Die

Fasting to Death

Radio star’s surprise disclosure rekindles debate over aid in dying

Posted Jul 17, 2014

The disclosure came 43 minutes into the hour-long radio program about aid-in-dying laws. Diane Rehm, the 77-year-old public radio host whose call-in show reaches 2.5 million listeners, revealed that her ailing husband, John, had hastened his death by stopping eating and drinking.

She broke the news quietly, in a matter-of-fact way, and quickly returned to her guests–advocates for laws allowing doctors to prescribe lethal doses of medication for competent terminally ill patients, like her husband, who request it. But Rehm’s announcement, later amplified on NBC News, shed light on terminal fasting or VSAD (voluntarily stopping eating or drinking) as it is called in the medical literature. It’s a legal and surprisingly simple option for speeding up death. And people seem to do it more often than most of us realize, often with the support of doctors or hospice programs.

John Rehm had advanced Parkinson’s disease. “He no longer had the use of his arms, his legs, his hands,” Diane Rehm told her listeners. “He could no longer feed himself or walk.” He told his doctor he was ready to die.

The doctor said that legally, morally, and ethically, he could not prescribe drugs for John to end his life. So John did it by fasting and died in nine days, on June 23.

His wife called his decision “extraordinarily courageous,” even as she condemned the legal prohibitions that forced him to take that course.

Only five states–Oregon, Washington, Montana, Vermont and New Mexico–permit physician-assisted suicide, or aid-in-dying, as advocates prefer to call it. John Rehm lived in Maryland.

Law books do not say much about fasting to death, but courts have affirmed that patients have the right to refuse medical treatments, from CPR to kidney dialysis to run-of-the-mill antibiotics. Many ethicists and doctors, even many who oppose doctor-assisted dying, believe this right of refusal extends to nutrition and hydration as long as the patient is capable of making the decision. Basically, it’s your body. You decide what goes in and doesn’t.

VSAD does not have the ethical baggage of aid in dying in large part because the patient controls every step. No doctor has to write a prescription. No relative has to turn up the dial on a drug pump. But it generally takes 10 days to two weeks to die, so it’s slower than a deadly dose of medication.

And while death by VSAD isn’t nearly as grueling as most people might imagine and can actually be peaceful–dehydration changes body chemistry, leading to drowsiness and kidney failure–the process has its discomforts. Dry mouth is common. Some people experience hunger pangs initially or agitation or delirium near the end. John Rehm received the standard relief measures, including mouth swabs, lotion on parched lips, and low doses of morphine.

There are no good statistics on how many people give up food and water to die faster, though it’s not unusual for hospice doctors to see the occasional case. The only published study on the question surveyed 307 hospice nurses in Oregon. Forty-one percent said they’d had at least one patient who wanted to take this route, and most followed through.

It’s a small sample, skewed by geography. Oregon takes a more lenient view of these things than do many places in America. More people there sign advance directives and enroll in hospice than in the U.S. as a whole, and it was the first state to legalize physician-assisted suicide.

But it’s worth noting that, according to this study at least, more people opted for death by fasting than by a doctor’s prescription. Many patients naturally lose their appetite at the very end of life. By choosing to fast to death, some simply may be following a biological imperative.

Diane Rehm does not see her husband’s decision that way but as a forced choice because he had no alternative. After the quiet revelation on her show she turned up on NBC News calling for aid-in-dying laws “in every state across the country, in every city, in every county.” She said her husband felt “betrayed” by his doctor, who couldn’t help him die more quickly.

“We do not let our little animals suffer, and people shouldn’t have to suffer,” she told NBC’s Maggie Fox.

Her husband seemed to have suffered mightily as his disease progressively robbed him of his ability to walk, feed himself, or reach for his wife’s hand. But by her account, he did not suffer in his final days. She did. She said she longed to spoon applesauce into his mouth. But he seemed to feel no pain. He told her he was looking forward to the next journey.

Fran Smith

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