We're living through a time when there seems to be something new and alarming in the news every day. Our media cycle is dominated by the dramatic, and one consequence of this is that alarming events can unfold on the state and local level going unnoticed despite their ultimately national consequences.
One such example is before Oregon's state legislature. First introduced in January, an alarming bill, SB 494, would radically change the meaning of healthcare in that state, with the potential for national ripple effects.
SB 494 would put countless medically vulnerable persons at risk of a premature and untimely death, wiping out existing law that mandates food and water access for all patients who can naturally receive nutrition and hydration. In simple terms, patients who are awake, conscious, and aware could nonetheless be denied food and water—even by cup or spoon.
Oregon's SB 494 is radical because it would redefine food and water delivered by such basic means not as “basic and ordinary,” but as a regulated, physician-controlled form of “medical care.”
Indeed, it's important to underscore that this bill is not about food and water delivered by means of “feeding tubes,” but rather basic utensils like spoons. Whether we're sitting at our own breakfast table, or sitting with our mother in a hospital bed, food and water should be considering basic and ordinary.
It likely comes as no surprise to find out who is responsible for Oregon's dangerous bill. Gayle Atteberry, executive director of Oregon Right to Life, recently explained that the most enthusiastic supporter of "regulating" food and water is the health insurance industry.
On a purely financial basis, one understands the motives of insurers who would prefer to avoid any lengthy healthcare obligations. On an ethical and moral basis, however, the decision to fatally deprive food and water from a patient simply due to cost or circumstance is reprehensible.
Oregon's present effort to change their law stemmed from a recent case involving Bill Harris, a resident of Oregon and legal guardian of his wife, Nora Harris, who has Alzheimer's Disease. Mr. Harris petitioned the court to stop the nursing home from feeding his wife (who is able to eat, but needs help feeding herself) and the court ruled against Mr. Harris citing existing law that protects patients who are not actively dying from being starved or dehydrated to death in this way. Because of this ruling, elements within the Oregon state legislature have taken up the cause to change the law.
Reclassifying spoon feeding as a form of medical care or “extraordinary care” is not new, unfortunately.
According to Patients Rights Council, there have been two court cases as far back as the 1980s: Cruzan v. Harmon and McConnell v. Beverly Enterprises, both cases where experts testified that “artificial feeding” can be understood to include spoon feeding.
Incredibly, these cases even referred to the notion of food delivered to a patient by tray as “medical treatment,” based on the thin reasoning that the patient's diet required physician approval.
In 2013, Margot Bentley, an Alzheimer's patient in Canada, was the subject of a lawsuit filed by her family. They petitioned the court to order that her nursing home starve and dehydrate Margot to death by denying her spoon-fed meals. Like so many such cases, Margot was not actively dying and her situation only became an "end of life" case the moment that her family decided to try to end her life.
How did we reach this point?
It began decades ago, when the American Medical Association and prominent bioethicists determined that food and water delivered by means of a feeding tube would be re-classified from “basic and ordinary” care to “medical treatment.”
It's a little-known fact that in all 50 states it is presently legal to withhold or deny food and water by means of a feeding tube to patients who are not actively dying and not facing any active “end of life” issue.
This was the first definitive change in American healthcare that served to regulate something as simple as food and water by treating it as the equivalent of a medical MRI or on the level of a physician-approved surgery.
In accepting that food and water could be considered, in essence, “medicine,” the door was thrown open to regulate, ration, and ultimately to deny food and water to any patient a physician, insurance company, or impatient family might decide should die sooner rather than later.
As with the present effort to reclassify spoon feeding as medical care, feeding tubes were initially judged by what they provided: essential nutrition and hydration. Yet food and water (by spoon or tube) is no more a form of “artificial life support” for a mother with Alzheimer's than it is for a teenager in need of assistance with two broken arms or a family sitting down for their nightly supper.
Whatever happens with Oregon's odious SB 494, those of us who believe no one should die from a lack of food and water will need to keep speaking publicly on behalf of ethical and moral healthcare.
We'll need to continue speaking out against anyone who wants to prematurely end the lives of patients, from ration-minded governments to for-profit insurers to uncharitable family members.
Infamously, my own sister, Terri Schiavo, died from fatal starvation and dehydration. She was a brain-injury survivor, a candidate for rehabilitation, and required no machines or life support, but ultimately her estranged husband was allowed to end her life over the course of 13 days as she painfully dehydrated to death.
Sadly, my sister's case is no different than the patients who suffer these deaths every day thanks to a healthcare system that now treats this sort of “care” as if it were ethical, moral, routine, and unremarkable.
No official legislative approval or high dose of morphine for persons we starve and dehydrate to death changes the basic facts of the situation.
Those who die specifically from a lack of food and water aren't being “allowed to die,” rather they're being actively killed—deprived of the most basic form of care by their caregivers, their physician, their hospital or insurer, and perhaps all four working in perverse agreement that the best thing for the patient would be to die, prematurely.
We can do better, and it starts with a frank acknowledgement of what's actually happening when we deny food and water—whether by tube or spoon or tray—and rectifying our language in law, medicine, and culture.