Voluntary stopping of eating and drinking: is medical support ethically justified?

Ralf J Jox,Isra Black,Johanna Anneser,Gian Domenico Borasio

doi:10.1186/s12916-017-0950-1

Abstract

BackgroundPhysician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified.ArgumentIn our opinion, this view is flawed. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process). Second, we demonstrate, on the basis of paradigmatic clinical cases, that medically supported VSED is, at least in some instances, tantamount to assisted suicide. This is especially the case if a patient’s choice of VSED depends on the physician’s assurance to provide medical support.ConclusionThus, for many jurisdictions worldwide, medically supported VSED may fall within the legal prohibitions on suicide assistance. Physicians, lawmakers, and societies should discuss specific ways of regulating medical support for VSED in order to provide clear guidance for both patients and healthcare professionals.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0951-0.

Highlights

Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America
Patients may resort to another option to hasten their death – voluntary stopping of eating and drinking (VSED) [5] – wherein patients deliberately and voluntarily cease eating and/or drinking to bring about their own death earlier than it would have occurred naturally [6]
We have shown that VSED should be regarded as a discrete form of suicide and that medical support in the context of VSED can be equivalent to suicide assistance, depending on the form of support and its relation to the patient’s decision

Summary

Introduction

Healthcare professionals often express moral uncertainty as to whether medical support in the context of VSED constitutes suicide assistance [16]. We argue that supporting patients who embark on VSED amounts to assistance in suicide, at least in some instances, depending on the kind of support and its relation to the patient’s intention. B. The physician promises to provide symptom relief or any other kind of support after stopping eating and drinking and the patient would choose this way of dying only because of having received this promise beforehand (promise).

Results

Conclusion