In an Op-Ed piece in Sunday’s Denver Post (May 22, 2022), columnist Krista Kafer pushed a couple of my buttons. Those of you who have read my book or followed this blog from the beginning, know how much I dislike the terms “doctor-assisted suicide” and “physician-assisted suicide” when they are used to describe medical aid in dying. If you read the language in Colorado’s End-of-Life Options Act, or in any of the similar laws from the other US jurisdictions that allow medical aid in dying, you’ll see that both of the terms are misleading and factually incorrect because medical aid in dying is not suicide by definition. Medical aid in dying gives people a choice in how they die, not whether they die. So it didn’t help that Kafer’s column was headlined “Doctor assisted suicide for mental illness” in big, bold type. She didn’t even use a hyphen in the compound modifier “doctor assisted” (another of my pet peeves, but of a lower order of magnitude, of course).
Here’s what I want to know: Did Kafer know these words were inaccurate and chose to use them anyway? I suspect that only people who are opposed to medical aid in dying use terms that equate it with suicide.
Kafer’s column reports on a paper published in the Journal of Eating Disorders, where Dr. Jennifer Gaudiani describes the cases of three patients with anorexia nervosa and proposes clinical characteristics for determining when people with this illness should be considered terminal. What surprised me most about the paper was that these criteria had not been previously established. 10,000 people die each year of anorexia nervosa, so it seems about time that someone started the discussion about how to tell if someone is in the terminal stage.
As I read the three case studies, I was immediately reminded of our struggles to get my son to eat. In addition to his schizophrenia, Joshua suffered from OCD and an eating disorder. My 5’ 11” son once weighed 87 pounds when I took steps to get him into treatment against his will. He would spend time in a mental health facility where he would eat fairly normally. The entire time he was hospitalized, he would fret over the weight he was gaining, and as soon as he was released, he would start restricting calories and walking miles and miles each day to burn calories. Repeatedly. So I certainly understand the frustration and hopelessness of families who are dealing with someone with anorexia. And I can certainly imagine how hard it must be for the patient. How the anguish can be unbearable.
Dr. Gaudiani played a role in all three cases described in her paper, either as attending physician or consulting physician, to help the patients get access to a medical-aid-in-dying prescription. One woman died of her illness just hours before she planned to take the prescription, so it would be difficult to argue that she wasn’t terminal.
Kafer’s big concern is that allowing people with anorexia to take advantage of medical aid in dying puts us on a slippery slope that will lead to allowing people with other mental illnesses to choose to end their suffering using medical aid in dying. I understand her fear, but feel it is overblown. Anorexia is the only mental illness that will kill you in and of itself – from malnutrition, which can manifest as kidney failure, heart failure, and multiple bone fracture from the resulting osteoporosis. Kafer mentions her own depression and how it led her to consider stepping in front of a car. But that would have been an act of suicide, not a natural death caused by a disease process.
About Kafer’s concerns about higher suicide rates in locales that permit medical aid in dying: Please check out this peer-reviewed article that points out the errors in that speculation.
It’s time we had this discussion about anorexia and medical aid in dying. I urge you to read Dr. Gaudiani’s paper and even Kafer’s op-ed piece, and then tell me what you think about the issue. We need to discuss this topic rationally and avoid the fear mongering and selectively inaccurate language that’s designed to evoke emotional reactions.
Author’s note: After I wrote and published this blog, I discovered an insightful discussion on the DeathwithDignityPodcast.com where Andrew Flack interviews Dr. Gaudiani on this very topic. If you care about the idea of offering medical aid in dying to people with anorexia, the podcast will give you much deeper insight into Dr. Gaudiani’s thinking.