Prospective Autonomy and Dementia: Ulysses Contracts for VSED

Abstract

Despite a dearth of affirmative judicial or legislative guidance, it is generally accepted that a capacitated individual may legally and ethically hasten his or her death by voluntarily stopping eating and drinking (VSED). In contrast, it is far more controversial whether an individual can VSED when s/he lacks capacity to do so contemporaneously.

It remains unsettled whether an individual may use an advance directive or surrogate decision-maker to restrain caregivers from offering food and fluids when s/he later reaches a pre-defined state of advanced dementia. Two new court decisions from the Canadian province of British Columbia are among the few in the world to address the legitimacy of advance VSED.

Keywords: VSED, VRFF, end-of-life, bioethics, dehydration

JEL Classification: K32, I18