Voluntarily Stopping Eating and Drinking (VSED): A Viable, Lesser Known Palliative Option of Last Resort (SA504)

Abstract

•Identify two clinical circumstances where VSED might be a viable option and two clinical contraindications to the practice.•Name two ethical principles that would support this practice as well as two ethical principles that might prohibit the practice, as well as the current status of the law around this practice in the US.•Understand how VSED might be consistent with some cultural practices toward the end of life, and how it might be morally prohibited in others.•Explore how the clinical, ethical and cultural aspects of VSED play out within a diverse group of real cases. Voluntarily Stopping Eating and Drinking (VSED) has recently gotten attention as a viable “last resort” palliative option for patients who want to escape their current medical situation through a self initiated death, but might not qualify for a physician assisted death or might not want it even if they did qualify. VSED is primarily under the patients own control, and it requires a tremendous amount of discipline and persistence to successfully complete. Physicians are not direclty needed to carry out VSED, but they should be a central part of the evaluation process to ensure decision making capacity, and then part of the support process to help palliate symptoms and respond to challenges. We will explore the clinical, ethical, legal, moral and cultural challenges and opportunities of this practice both in theoretical terms, and then through three real clinical cases; 1) a patient with early to moderate alzheimer who wanted no part of the later stages; 2) a patient with advanced cancer and paralysis who wanted PAD but lived in NY where it is illegal, and 3) a patient with advanced terminal disease and complex cultural issues around eating and intentionally hastening death. Opportunity for interaction and exploration of the clinical, ethical and cultural elements of process itself, as well as how it unfolded in each of the cases will be provided.