Voluntary stopping of eating and drinking (VSED) as an unknown challenge in a long-term care institution: an embedded single case study

Nadine Saladin,André Fringer,Wilfried Schnepp

doi:10.1186/s12912-018-0309-8

Abstract

BackgroundChronically ill persons experience conditions of life that can become unbearable, resulting in the wish to end their life prematurely. Relatives confronted with this wish experience ambivalence between loyalty to the person’s desire to die and the fear of losing this person. Caring for a person during the premature dying process can be morally challenging for nurses. One way to end one’s life prematurely is Voluntary Stopping of Eating and Drinking (VSED).MethodsThis embedded single case study explored the experiences of registered nurses (embedded units of analysis: ward manager, nursing manager, nursing expert) and relatives who accompanied a 49-year-old woman suffering from multiple sclerosis during VSED in a Swiss long-term care institution (main unit of analysis). By means of a within-analysis, we performed an in-depth analysis of every embedded unit of analysis and elaborated a central phenomenon for each unit. Afterwards, we searched for common patterns in a cross-analysis of the embedded units of analysis in order to develop a central model.ResultsThe following central concept emerged from cross-analysis of the embedded units of analysis: As a way of ending one’s life prematurely, VSED represents an unfamiliar challenge to nurses and relatives in the field of tension between one’s personal attitude and the agents' concerns, fears and uncertainties. Particularly significant is the personal attitude, influenced on the one hand by oneˊs own experiences, prior knowledge, role and faith, on the other hand by the VSED-performing person's age, disease and deliberate communication of the decision. Depending on the intention of VSED as either suicide or natural dying, an accepting or dismissing attitude evolves on an institutional and personal level.ConclusionsTo deal professionally with VSED in an institution, it is necessary to develop an attitude on the institutional and personal level. Educational measures and quality controls are required to ensure that VSED systematically becomes an option to hasten death. As VSED is a complex phenomenon, it is necessary to include palliative care in practice development early on and comprehensively. There is a high need of further research on this topic. Particularly, qualitative studies and hypothesis-testing approaches are required.

Highlights

Ill persons experience conditions of life that can become unbearable, resulting in the wish to end their life prematurely
The focus of this model reflects the major concept of this study: Voluntary Stopping of Eating and Drinking (VSED) as an option of ending one’s life prematurely represents an unknown challenge in the field of tension between one's personal attitude and the concerns, fears and uncertainties of the agents
The results show that VSED in young persons is classified rather as a form of suicide, in contrast to implicitly renouncing eating and drinking in older persons

Summary

Introduction

Ill persons experience conditions of life that can become unbearable, resulting in the wish to end their life prematurely. Relatives confronted with this wish experience ambivalence between loyalty to the person’s desire to die and the fear of losing this person. Persons suffering from chronical diseases, e.g. multiple sclerosis, experience conditions of life which can become unbearable [1]. This may result in the wish to end one’s life prematurely [2, 3]. In 2014, 742 persons in Switzerland died by assisted suicide [6], accounting for 1.2% of all deaths [6]. In 2014, 742 persons in Switzerland died by assisted suicide [6], accounting for 1.2% of all deaths [6]. 94% of these persons were older than 55 years, most of them suffering from a chronic disease [6]

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Discussion

Conclusion