Advice and care for patients who die by voluntarily stopping eating and drinking is not assisted suicide

Andrew Mcgee,Franklin G Miller

doi:10.1186/s12916-017-0994-2

Andrew Mcgee, Franklin G Miller

Open Access

https://doi.org/10.1186/s12916-017-0994-2

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Abstract

BackgroundA competent patient has the right to refuse foods and fluids even if the patient will die. The exercise of this right, known as voluntarily stopping eating and drinking (VSED), is sometimes proposed as an alternative to physician assisted suicide. However, there is ethical and legal uncertainty about physician involvement in VSED. Are physicians advising of this option, or making patients comfortable while they undertake VSED, assisting suicide? This paper attempts to resolve this ethical and legal uncertainty.DiscussionThe standard approach to resolving this conundrum has been to determine whether VSED itself is suicide. Those who claim that VSED is suicide invariably claim that physician involvement in VSED amounts to assisting suicide. Those who claim that VSED is not suicide claim that physician involvement in VSED does not amount to assisting suicide. We reject this standard approach.ConclusionWe instead argue that, even if VSED is classified as a kind of suicide, physician involvement in VSED is not a form of assisted suicide. Physician involvement in VSED does not therefore fall within legal provisions that prohibit VSED.

Highlights

A competent patient has the right to refuse foods and fluids even if the patient will die
We instead argue that, even if voluntarily stopping eating and drinking (VSED) is classified as a kind of suicide, physician involvement in VSED is not a form of assisted suicide
While there are good reasons for claiming that VSED is a form of suicide, there are good reasons for claiming that physicians are not assisting suicide when offering palliative care for VSED or when providing advice about the availability of this option

Summary

Introduction

A competent patient has the right to refuse foods and fluids even if the patient will die The exercise of this right, known as voluntarily stopping eating and drinking (VSED), is sometimes proposed as an alternative to physician assisted suicide. There is ethical and legal uncertainty about physician involvement in VSED. Many commentators and some instances of case law address this by taking the view, often dogmatically, that VSED does not constitute suicide [9, 10]. The logic behind this position is that, if VSED is not suicide, it follows that physician involvement is not assisted suicide.

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