Voluntarily Stopping Eating And Drinking Research Articles

Navigating Voluntarily Stopping Eating and Drinking in Hospice Settings: A Multidisciplinary Approach.

This article explores current global research on voluntarily stopping eating and drinking (VSED) and presents a detailed, deidentified case study of a patient who elected VSED in a hospice setting in the Southeastern United States. It highlights the collaborative efforts of health care professionals in effectively supporting the patient and family, sharing multiple perspectives from various health care team members who cared for the patient and family. It offers evidence-based recommendations to guide health care teams through the ethical, medical, and emotional challenges of VSED, ensuring compassionate and competent care. The article emphasizes the importance of structured protocols and empathetic care in hospice settings, advocating for the education and preparation of health care teams and families to address the complex challenges associated with VSED. By promoting open communication, interdisciplinary collaboration, and comprehensive support, hospices can respect the autonomy of patients and families choosing VSED, ensuring a compassionate and dignified end-of-life experience.

Medical aid in dying to avoid late-stage dementia.

Many patients with dementia want the option of using medical aid in dying (MAID) to end their lives before losing decision-making capacity and other abilities that impact their desired quality of life. But, for over two decades, it has been widely understood that these patients cannot (solely because of their dementia diagnosis) satisfy three statutory eligibility requirements in all U.S. MAID laws: (1) decisional capacity, (2) the ability to self-administer the life-ending medications, and (3) a terminal condition with 6 months or less to live. Now, because of recent statutory amendments together with the use of voluntarily stopping eating and drinking (VSED) to quickly advance to a terminal condition, this dementia exclusion from MAID might no longer apply. If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path. In this article, we begin to provide this guidance. First, we describe the recent case of an Oregon patient with early-stage Alzheimer's dementia who successfully used VSED to qualify for and use MAID. Second, we discuss prior barriers to using VSED as a bridge to MAID for people with dementia. Third, we describe recent legal changes that might make this path now possible.

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

Have Arguments For and Against Medical Aid in Dying Stood the Test of Time?

Clinical Guidelines for Voluntarily Stopping Eating and Drinking (VSED).

As the care of patients with serious illness increasingly emphasizes clarifying goals of care, exploring quality of life, and minimizing patients' symptom burden, voluntarily stopping eating and drinking (VSED) has emerged as a topic of increasing interest for patients who face a diminishing quality of life. It is an option for those with serious illness that is legal in every state in the country, but for which there are few published comprehensive guidelines-and none specific to the American medical system-even as public awareness and the number of inquiries regarding this action increase. In addition to the ethical questions raised by the practice and support of VSED, there are also clinical, logistical, institutional, social, religious, spiritual, and administrative considerations for clinicians who are asked to respond to patients' inquiries about VSED and who discuss this option in end-of-life care. With these clinical guidelines, we seek to provide practical recommendations for clinicians who consider providing support to their patients who contemplate and/or undertake this effort to hasten death.

Biathanatos revisited: Anabaptist perspectives on voluntarily stopping eating and drinking in the face of terminal illness.

IntroductionVoluntarily Stopping Eating and Drinking (VSED) is a legal means of hastening death through refusal of food and fluids – a topic rarely addressed in Christian Protestantism. Among this group, U.S. Mainline Protestants comprise nearly 15% of the population and are more likely to include social moderates and liberals who emphasize quality of life (over mere life) and may therefore be open to the practice.ObjectivesLeveraging the well-established and validated Theory of Planned Behavior – that posits a person’s intentions to carry out an action are motivated by one’s attitude, perception of subjective norms, and perceived behavioral control – this research elucidates clergy and congregants’ normative beliefs and anticipated tactical support for VSED, including their reactions to Christian-based justifications for this end-of-life option. Such reasoning includes that VSED is a “fast into eternal life” and is based on the example of Jesus Christ, who, in the face of ongoing suffering, determined the end of his own life when he stated, “It is finished,” and gave up his spirit – an insight originally argued by John Donne in Biathanatos (1647/1982).MethodsThis case study of one southern Anabaptist congregation employs a focus group and one-on-one interviews, capturing reactions to a vignette in which a hypothetical fellow parishioner intends to VSED in the face of ongoing suffering from a terminal illness.ResultsIn response to the presented vignette, study participants reported their affirmation of VSED. Responses to faith-based justifications for the practice varied widely.ConclusionIndividuals aiming to VSED in the face of terminal illness may have their intention affirmed by a church community, but will likely require additional caregiving support to achieve a hastened death. A nascent framework for future comparative studies of faith communities’ assessments of VSED is also proposed.

Voluntarily Stopping Eating and Drinking: Conceptual, Personal, and Policy Questions.

Although voluntarily stopping eating and drinking (VSED) as a way to hasten one's death is not yet a widely recognized practice in the United States, it has received increasing attention in the medical and bioethics literature in recent years. After a brief review of the broader context of human death and dying, this article poses and examines 11 conceptual, personal, and public policy questions about VSED. The article identifies essential features of VSED and discusses whether VSED is a type of suicide. It identifies reasons why people may or may not choose VSED, and it considers responses by family members and professional caregivers to people who have chosen VSED. It also considers how public policies may permit and regulate or restrict the practice of VSED. Examination of these questions is designed to increase understanding of VSED and to inform moral evaluation of this practice.

Voluntarily Stopping Eating and Drinking (VSED)

Abstract. Most cases of voluntarily stopping eating and drinking (VSED) occur in the context of severe underlying diseases with concomitant dwindling needs for food and fluids. In these cases, VSED resembles the rejection of a medical treatment. While this is the leading difference to suicide, however, there are also situations within VSED in which aspects of suicide prevention must be considered. After defining the relevant terms and presenting a literature review, we outline options of dealing with different death wishes and provide recommendations oriented toward the possibilities of suicide prevention in the context of abstaining from food and fluids.

Experience of Caregivers Supporting a Patient through Voluntarily Stopping Eating and Drinking.

Background: Voluntarily stopping eating and drinking (VSED) is an ongoing voluntary choice to forego food and hydration in an effort to hasten death. Ongoing caregiving is necessary as patients become weak and lose focus as a result of dehydration, but little is known about the process of supporting a patient through VSED. Objective: To explore the experiences of caregivers who supported a patient through VSED. Methods: Qualitative study with thematic analysis of transcripts of semistructured interviews with 24 U.S. caregivers for 20 individuals who had attempted VSED. Results: Analysis produced four themes: (1) Caregivers believe that VSED is the best death available to the patient. (2) Caregivers act as advocates and worry that the patient's goals will be challenged by health care professionals, the community, or legal authorities; obtaining support from a hospice is an important way to legitimize VSED. (3) Through the VSED process itself, caregivers carry the responsibility for the patient's success as the patient becomes weaker and loses focus. (4) Because there is no social script to guide the VSED process, caregivers choose what roles to play during VSED, such as focusing on physical care or being emotionally present as the patient's spouse or child. Conclusions: Caregivers face unique challenges in helping patients undertake VSED. Many are uncertain about whether they will receive support from clinicians or the community. Support from health professionals may improve caregiver confidence and reduce worry.

Doing and Allowing in the Context of Physician-Assisted Suicide

Supporting the (active) rational suicide of a patient with a terminal disease is opposed by a majority of German doctors, whereas assistance in such patients’ hastening their death by voluntarily stopping eating and drinking (VSED) is predominantly judged to be acceptable. Are these two positions compatible? It is argued that the normative differentiation cannot be justified by the fact that the assistance in active suicide is itself active, whereas assistance in VSED is merely passive. Even in "letting die" a patient from hastening death by refusing nutrition and hydration there is an active element in the doctor's/the palliative care team's assurance that they will provide palliative support in case of need. Nor can the difference in evaluation be justified by relevant differences in the causal situation. Enabling a patient to perform VSED and assisting a patient's active suicide under the same circumstances are, as far as causal relevance is concerned, on a par. This holds, at least, on a condition view of causality in the tradition of John Stuart Mill. Finally, the paper discusses whether there are other morally relevant dimensions by which actively and passively supporting a patient suicide under the relevant circumstances differ, again with a negative result.

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

•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.

Stopping Eating and Drinking by Advance Directives: Choose Your Injustice

Stopping Eating and Drinking by Advance Directives: Choose Your Injustice

Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities.

Some residents of long-term care (LTC) facilities with lethal or serious chronic illnesses may express a wish to hasten their death by voluntarily stopping eating and drinking (VSED). LTC facility clinicians, administrators, and staff must balance resident safety, moral objections to hastened death, and other concerns with resident rights to autonomy, self-determination, and bodily integrity. Initially, requests for hastened death, including VSED must be treated as opportunities to uncover underlying concerns. After a concerted effort to address root causes of suffering, some residents will continue to request hastened death. Rigorous resident assessment, interdisciplinary care planning, staff training, and clear and complete documentation are mandatory. In addition, an independent second opinion from a consultant with palliative care and/or hospice expertise is indicated to help determine the most appropriate response. When VSED is the only acceptable option to relieve suffering of residents with severe chronic and lethal illnesses, facilitating VSED requests honors resident-centered care. The author offers practice suggestions and a checklist for LTC facilities and staff caring for residents requesting and undergoing VSED.

Ethical Challenges for an Understanding of Suffering: Voluntary Stopping of Eating and Drinking and the Wish to Hasten Death in Advanced Patients.

Some persons with advanced disease but no significant cognitive impairments consciously decide to stop taking food and fluids orally, even though they remain physically able to do so. The question is to what extent voluntarily stopping eating and drinking (VSED) may be considered an expression of a wish to hasten death, in the sense that the latter has been defined recently. We analyze the data reported in some studies in relation to primary care patients who died as a result of VSED and examine their results in light of the qualitative findings of patients that expressed a wish to die. In our view, VSED can be understood as a response to physical/psychological/spiritual suffering, as an expression of a loss of self, a desire to live but not in this way, a way of ending suffering, and as a kind of control over one’s life. Thus, VSED is consistent with the wish to hasten death. Prior to interpreting this act as a deliberate expression of personal autonomy, it is important to explore all possible areas of suffering, including physical symptoms, psychological distress, existential suffering, and social aspects. Failure to do so will mean that we run the risk of abandoning a fellow human being to his or her suffering.

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

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.

Voluntarily Stopping Eating and Drinking: A Normative Comparison with Refusing Lifesaving Treatment and Advance Directives

Refusal of lifesaving treatment, and such refusal by advance directive, are widely recognized as ethically and legally permissible. Voluntarily stopping eating and drinking (VSED) is not. Ethically and legally, how does VSED compare with these two more established ways for patients to control the end of life? Is it more questionable because with VSED the patient intends to cause her death, or because those who assist it with palliative care could be assisting a suicide?In fact the ethical and legal basis for VSED is virtually as strong as for refusing lifesaving treatment and less problematic than the basis for refusing treatment by advance directive. VSED should take its proper place among the accepted, permissible ways by which people can control the time and manner of death.

Honing the Emerging Right to Stop Eating and Drinking

Some medical patients facing fatal or serious degenerative conditions seek to hasten their demise by voluntarily stopping eating and drinking (VSED). This short piece explains why and when there is a right to follow that fatal course despite lurking overtones of suicide. The piece also compares the status of stricken medical patients with that of otherwise healthy people who undertake a terminal fasting process.

VSED Narratives: Exploring Complexity.

In this article three palliative care physicians review narratives about the complicated experience of voluntarily stopping eating and drinking (VSED). Despite consensus about its legality, the decision to end life by VSED is emotionally and ethically challenging for patients, family members and clinicians. Each VSED story is unique, and the individual perspectives within a single story may diverge, conflict, and evolve over time. The narratives differ substantially in the range of suffering described, from acute, graphic, physical symptoms to primarily anticipatory and psychological distress. The narrators' conclusions about the meaning of VSED also vary, some perceiving it to be an irrational act of suicide, others describing it as an affirmation of personal autonomy, and most with a mixture of sometimes conflicting reactions in between these edges. The authors conclude with observations drawn from the narratives about the potential in VSED for benefit, harm and conflict for all involved.

The Ethics of Voluntarily Stopping Eating and Drinking

Encouraging VSED (voluntarily stopping eating and drinking) to hasten a patient’s death is immoral. The practice results in an obvious conflict between the autonomy of the patient and the principles of beneficence and non-maleficence that must guide the physician and other health care workers. Because VSED is an act of passive euthanasia, it harms the patient and thus compromises the integrity of the physician–patient relationship. Health care providers must avoid any involvement in VSED, whether by providing information about the practice or by administering palliative care while a patient is voluntarily starving and dehydrating himself to death. Instead of cooperating in the evil of euthanasia, health care providers need to advocate for the patient by refusing to do any harm and by addressing the reasons why the patient is requesting a hastened death.

Introduction: Voluntarily Stopping Eating and Drinking.

This symposium includes twelve personal narratives from those who have personally participated in voluntarily stopping eating and drinking (VSED). This issue also includes three commentaries on these narratives by experts in philosophy, palliative care, and hospice medicine. The successes, challenges, and observations described by these narrative and commentary authors will not only inform the academic debate about the legitimacy of VSED but will also inform much needed practical guidance for patients, clinicians, and family members on how they can best implement and support VSED.

Primary care patients hastening death by voluntarily stopping eating and drinking.

Little is known about the role family physicians play when a patient deliberately hastens death by voluntarily stopping eating and drinking (VSED). The purpose of this study was to gain more insight for family physicians when confronted with patients who wish to hasten death by VSED. We aimed to describe physicians' involvement in VSED, to describe characteristics and motives of their patients, and to describe the process of VSED in terms of duration, as well as common symptoms in the last 3 days of life. We undertook a survey of a random national sample of 1,100 family physicians (response rate 72%), and 500 of these physicians received questions about their last patient who hastened death by VSED. Of the 978 eligible physicians, 708 responded (72.4%); 46% had cared for a patient who hastened death by VSED. Of the 500 physicians who received the additional questions, 440 were eligible and 285 (64.8%) responded; they described 99 cases of VSED. Seventy percent of these patients were aged older than 80 years, 76% had severe disease (27% with cancer), and 77% were dependent on others for everyday care. Frequent reasons for the patients' death wish were somatic (79%), existential (77%), and dependence (58%). Median time until death was 7 days, and the most common symptoms before death were pain, fatigue, impaired cognitive functioning, and thirst or dry throat. Family physicians were involved in 62% of cases. Patients who hasten death by VSED are mostly in poor health. It is not unlikely for family physicians to be confronted with VSED. They can play an important role in caring for these patients and their proxies by informing them of VSED and by providing support and symptom management during VSED.