"Ethically and legally, there is no difference in withholding or not continuing a given therapy if started, whether this is hemodialysis, ventilator withdrawal or voluntary cessation of eating, as long as this decision is based on a patient/individual's decision," said Dr. Mohana Karlekar, director of palliative care at Vanderbilt University.
The main issue here is liberty, said Rosamond Rhodes, professor of bioethics at Mount Sinai School of Medicine.
"The Federal Patient Self-Determination Act assures competent individuals the right to refuse medical interventions, and it protects their right to determine when to discontinue medical treatment," said Rhodes. "People can decide for themselves to discontinue medical treatment, including artificial nutrition and hydration, even when that choice can be expected to hasten their death."
Dr. Joanne Lynn, director of the Center on Elder Care and Advanced Illness for Altarum Institute in Washington D.C., has argued against physician-assisted suicide as poor public policy and suggested that refusal of food and water is an alternative.
"Most ways of causing an end of life require the active participation of someone else, but stopping eating and drinking does not," said Lynn. "We allow people to do many very risky things, and we allow adults to refuse life-sustaining treatment. We have to allow this course, though whether the assisted living center or any other particular setting has to cooperate is much more challenging."
While starving of hunger and thirst may sound frightening to most, end-of-life specialists said it's actually a fairly painless way to end.
"Most individuals who voluntarily stop eating after several hours stop feeling hungry," said Karlekar. "They sometimes will feel euphoria due to metabolic changes in the body. And so, yes, it is a peaceful way to go."
Stopping Eating, Drinking Is 'Natural'
Rhodes said that several philosophers, including Bernard Gert, K. Danner Clouser and Charles Culver, have argued for refusing food and drink as a means of ending one's own life.
"The advantages are that it demonstrates autonomy, it imposes no burdens or dangers on others and it provides a peaceful death," said Rhodes. "And ... it is natural. Dying people often naturally start to refuse food and fade away."