Voluntary Stopping Of Eating And Drinking Research Articles

Voluntary abstinence from food and fluid. The relatives' perspective: An integrative review

Voluntary abstinence from food and fluid. The relatives' perspective: An integrative review Abstract. Background: Unbearable states of suffering can cause a premature wish to die. Voluntary stopping of eating and drinking (VSED) offers a way to autonomously realize this wish. Relatives play a significant role in the process of realizing VESD. So far, it is unclear how relatives experience the supporting process. Aim: This review intends to systematically record experiences of accompanying relatives. Method: Within the framework of an integrative review, we conducted research in MEDLINE®, CINAHL® and PsychINFO®, as well as supplementary research. The selection was based on defined inclusion and exclusion criteria. For the synthesis, we used a thematic model. Results: From the four included studies, it emerged that the accompanying relatives accepted the family members' wish to die. They defended the realization of this wish with responsibility and advocacy until the death of the person wishing to die. As a result of their caring commitment, they neglected their own needs. Most relatives assessed the accompaniment as peaceful and dignified. Conclusion: Accompanying the VSED process represents an emotional tightrope walk with unfamiliar challenges for relatives. The results can contribute to a deeper understanding of relatives' needs. In this way, the findings can stimulate the derivation of suitable support offers.

Patients Who Seek to Hasten Death by Voluntarily Stopping Eating and Drinking: A Qualitative Study.

Voluntary stopping of eating and drinking (VSED) is a controversial method to hasten death. Little is known about why and how people come to VSED. This study assessed patients' motives, how patients decide on VSED, and the ways in which they prepare for VSED and involve others. We conducted a qualitative study in the Netherlands of 29 patients; 24 started VSED and 19 died. Thirteen patients were included before or during VSED and 16 afterward. We interviewed 17 patients, 18 relatives, and 10 professional caregivers. Inductive ideal-type analysis was used to describe typologies. Three patient groups emerged. The first group (12 patients) were older people who felt life was completed, for whom control was important. They prepared well for VSED, but could overlook the need for help and the emotional burden their decision could place on relatives. The second group (11 patients) were older care-dependent patients with a poor quality of life. They sometimes started VSED suddenly, and they relied heavily on (informal) caregivers to prepare and execute their plan. The third group (6 patients) were psychiatric patients with a long-standing but fluctuating death wish, most of whom were younger. They often prepared for VSED in secrecy or started VSED unprepared. Patients embarking on a trajectory toward VSED are a very diverse group, with different care needs. Guidance for care during VSED needs to be applicable to all 3 groups.

Challenges in Completing a Death Certificate after Voluntary Stopping of Eating and Drinking (VSED).

In recent years, health care providers and the general public in the United States have gained a greater awareness of Voluntary Stopping of Eating and Drinking (VSED) as a last resort option to escape from unbearable suffering, thanks to a growing number of publications, books, and documentaries. However, the challenges and issues that can arise in completing a death certificate after VSED are not well described in literature. In this article, we first present an example case of VSED in which the death certificate was issued listing suicide as the manner of death by the medical examiner. Then, we describe the challenges and issues related to death certificates in VSED cases. Because there is no consensus on whether VSED is natural death or suicide, the death certificate may need to be referred to a medical examiner in many jurisdictions, potentially resulting in suicide being designated as the manner of death. Such designations can cause reticence in providers and institutions that might otherwise support patients who choose VSED but are concerned about the legal or reputational implications of enabling a "suicide" at their facility. A suicide designation may also contribute to moral distress in health care staff and impose emotional and practical burdens on the patient's surviving loved ones. We suggest that there are 3 approaches to addressing challenges and issues associated with death certificates after VSED: (1) navigate the existing system with guidance developed by professional organizations, (2) make a legal exemption, and (3) change the death certification system. Debate involving a wide variety of experts is warranted.

Narrative for Part Five of the Ethical and Religious Directives

Part Five is in considerable need of revision. There have been many developments in medicine and health care that present serious moral challenges to the teachings of the Church. The recommendations below include new emphasis on palliative care and hospice, the right of Catholics to receive the sacraments and visits from the family during illness, further safeguards to protect those in a persistent vegetative state, the immorality of voluntary stopping of eating and drinking (VSED), the permissibility of do not resuscitate (DNR) orders, the limited use of palliative sedation, and the requirement that the standards for determining death be rigorously applied by medical professionals. Other minor recommendations seek to bring greater clarity to the existing directives.

Voluntary Stopping of Eating and Drinking in a Nursing Home with No Prior Experience

Voluntary stopping of eating and drinking (VSED) is a last resort to end one’s life when the suffering is unbearable. Since the VSED requires strong will to complete, its occurrence is rare. VSED in a long-term care setting is not well reported.

The Right to Die in the United States

This review article is intended to introduce clinicians in Japan to the four types of medical procedures associated with the right to die in the United States and their ethical background. The four types of procedures are as follows: forgoing life-sustaining medical treatment, palliative sedation and intensive symptom management, physician-assisted suicide, and euthanasia. This article discusses the difference between negative and positive rights and how they apply to these four procedures. In addition, it discusses the reason why withdrawing ventilation is considered ethically equal to its withholding. Other topics that are covered include the principle of double effect and proportionality in palliative sedation, the practice of physician-assisted suicide in the US, and controversies regarding euthanasia. Additionally, this article mentions the voluntary stopping of eating and drinking (VSED) as another category of the right to die. Ethics and laws are specific to the region and the culture. The author encourages Japan, where the withdrawal of life-sustaining treatments is still not part of usual practice, to advance ethical discussions among its population so that more options for the right to die will be available to the patients in its society.

Voluntary stopping of eating and drinking in the age of medical assistance in dying: ethical considerations for physicians.

Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients’ wishes to hasten death (WTHD). In contrast to MAiD, the literature on the voluntary stopping of eating and drinking (VSED) is very limited and there are no standards of practice or legal guidance to support HCPs. In this article, the legal and ethical literature as regards VSED is critically reviewed and new standards of practice are proposed.

Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

Abstract. Besides physician-assisted suicide, there is another end-of-life practice under discussion: voluntary stopping of eating and drinking (VSED). In this study, we assess the occurrence of VSED in outpatient care and evaluate nurses’ attitudes about it. We recruited 395 nurses (24% response rate) in our online survey. The occurrence of VSED in Switzerland lies at 0.5%. Most nurses (84.6%) were aware of VSED, and 39.5% had experienced it with patients. VSED was mostly (70.3%) regarded as a natural death, and nearly all (95.1%) were willing to care for these patients; however, about one-quarter (26.5%) expressed moral concerns. Our results show that VSED occurs in rare cases, and that nurses are willing to accompany patients during this VSED, but express moral concerns.

Family physicians' perspective on voluntary stopping of eating and drinking: a cross-sectional study.

ObjectiveWe aimed to determine how often patients who choose voluntary stopping of eating and drinking (VSED) are accompanied by Swiss family physicians, how physicians classify this process, and physicians’ attitudes and professional stance toward VSED.MethodsWe conducted a cross-sectional study between August 2017 and July 2018 among 751 practicing family physicians in Switzerland (response rate 74%; 70.7% men; average age 58 (±9) years). We used a standardized evidence-based questionnaire for the survey.ResultsVSED is well-known among family physicians (81.9%), and more than one-third (42.8%) had accompanied at least one patient during VSED. In 2017, 1.1% of all deaths that occurred in Swiss nursing homes or in a private home were owing to VSED. This phenomenon was classified as a natural dying process (59.3%), passive euthanasia (32.0%), or suicide (5.3%).ConclusionsAlthough about one in three Swiss family physicians have accompanied a person during VSED, family physicians lack sufficient in-depth knowledge to address patients and their relatives in an appropriate manner during the process. Further training and development of practice recommendations are needed to achieve more standardized accompaniment of VSED.International Registered Report Identifier: DERR1-10.2196/10358

The Voluntary Stopping of Eating and Drinking: Dying with Dignity?

To die with dignity is a common wish but not one that is easily granted. Professor Dr André Fringer and Mrs Sabrina Stängle, both of the Zurich University of Applied Sciences, are investigating the voluntary stopping of eating and drinking (VSED) as a means to hasten death as an alternative to active euthanasia. Their work is driving forward our understanding of the medical and ethical ramifications of this practice.

Long-term care nurses' attitudes and the incidence of voluntary stopping of eating and drinking: A cross-sectional study.

To assess the incidence of voluntary stopping of eating and drinking (VSED) in long-term care and to gain insights into the attitudes of long-term care nurses about the VSED. A cross-sectional study. Heads of Swiss nursing homes (535; 34%) answered the Online-Survey between June - October 2017, which was evaluated using descriptive data analysis. The incidence of patients who died in Swiss nursing homes by voluntarily stopping eating and drinking is 1.7% and 67.5% of participants consider this phenomenon highly relevant in their daily work. Most participants (64.2%) rate VSED as a natural death accompanied by health professionals and patients are also granted the right to care (91.9%). This phenomenon is expected by the participants less at a young age and more in old age. Participants' overall views on the VSED are very positive, whereas it is assumed that VSED is a phenomenon of old age. Professionals still lack sufficient knowledge about this phenomenon, which could be clarified through training. Voluntary stopping of eating and drinking is much discussed interprofessional, but there is a lack of knowledge on how this is perceived in the context of long-term care and about the incidence of the phenomenon. Voluntary stopping of eating and drinking is rare but noticeable end-of-life practises that is considered by professionals to be mainly dignified and peaceful, although moral concerns make it difficult to accompany. These findings call on long-term care institutions to discuss VSED as an end-of-life practice. Positioning on the issue provides clarity for staff and patients and promotes to develop standardized care. International Registered Report Identifier (IRRID): DERR1-10.2196/10358.

The need to distinguish between different forms of oral nutrition refusal and different forms of voluntary stopping of eating and drinking.

Voluntary stopping of eating and drinking (VSED) is a well-known phenomenon among palliative care professionals. This study intent to distinguish between different forms of VSED. In a qualitative interview study 18 relatives were interviewed about their experiences of caring a person during VSED. Different forms of oral nutrition refusal and different forms of VSED were found and described. The study results help members of the multidisciplinary team to manage the situation appropriately.

Collaboration with Voluntary Stopping of Eating and Drinking

Voluntary stopping of eating and drinking (VSED) is an increasingly popular method by which patients are choosing to hasten death when life feels unbearable. This formal act of suicide often leads to distressing symptoms, for which patients then seek palliation by medical professionals. The intentional act of hastening death is always an evil act. A Catholic physician must understand the moral implications of participating in any phase of the patient’s planning and execution of the VSED process, including cooperation in evil and scandal. The Catholic physician must strive to develop a well-formed conscience and then be prepared to exercise his or her right to conscientious objection while offering an example of true compassion for the sick, the suffering, and the dying.

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

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.

Voluntary Stopping Eating and Drinking.

Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support. Before initiation of VSED, clinicians should carefully screen for inadequately treated psychiatric conditions, unaddressed symptoms, existential suffering, and evidence of coercion-consultation from palliative medicine, psychiatry, or ethics is often indicated. The most common symptoms encountered after starting VSED are extreme thirst, hunger, dysuria, progressive disability, delirium, and somnolence. Although physiologically similar to cessation of artificial nutrition and hydration, the onset and management of symptoms is often different. We propose an organized system for evaluating individual appropriateness for VSED, anticipatory guidance, and management of symptoms associated with VSED. A brief review of ethical and legal considerations follows.

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

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.

Voluntary Stopping of Eating and Drinking (VSED), Physician-Assisted Death (PAD), or Neither in the Last Stage of Life? Both Should be Available as a Last Resort

A.A. was a 60-year old man with refractory metastatic cancer who requested a palliative care consultation to explore potential future access to physician-assisted death (PAD). (I recommend using the term “physician-assisted death” because from a meaning point of view this practice has nothing to do with “suicide.” In fact, for patients like A.A., this option has more to do with self preservation than self destruction.) I initially responded that I could not provide this option because of legal restrictions in New York, but that I would help him find a solution when and if the time came. We explored other legally available “last resort” possibilities1,2 including potentially voluntarily stopping eating and drinking (VSED). He initially thought that this latter option was nothing a humane society would put its dying patients through, and we agreed to do our best to address whatever the future held for him.

Voluntary stopping of eating and drinking at the end of life – a ‘systematic search and review’ giving insight into an option of hastening death in capacitated adults at the end of life

BackgroundThe terminally ill person’s autonomy and control are important in preserving the quality of life in situations of unbearable suffering. Voluntary stopping of eating and drinking (VSED) at the end of life has been discussed over the past 20 years as one possibility of hastening death. This article presents a ‘systematic search and review’ of published literature concerned with VSED as an option of hastening death at the end of life by adults with decision-making capacity.MethodsElectronic databases PubMed, EBSCOhost CINAHL and Ovid PsycINFO were systematically searched. Additionally, Google Scholar was searched and reference lists of included articles were checked. Data of the included studies were extracted, evaluated and summarized in narrative form.ResultsOverall, out of 29 eligible articles 16 were included in this review. VSED can be defined as an action by a competent, capacitated person, who voluntarily and deliberately chooses to stop eating and drinking with the primary intention of hastening death because of the persistence of unacceptable suffering. An estimated number of deaths by VSED was only provided by one study from the Netherlands, which revealed a prevalence of 2.1% of deaths/year (on average 2800 deaths/year). Main reasons for patients hastening death by VSED are: readiness to die, life perceived as being pointless, poor quality of life, a desire to die at home, and the wish to control the circumstances of death. The physiological processes occurring during VSED and the supportive care interventions could not be identified through our search.ConclusionsThe included articles provide marginal insight into VSED for hastening death. Research is needed in the field of theory-building and should be based on qualitative studies from different perspectives (patient, family members, and healthcare workers) about physiological processes during VSED, and about the prevalence and magnitude of VSED. Based on these findings supportive care interventions for patients and family members and recommendations for healthcare staff should be developed and tested.

Responding to Suffering: Providing Options and Respecting Choice

Voluntary stopping of eating and drinking (VSED) as a legal means to hasten death has been discussed by some as an option for persons who wish to end their lives. A case is presented of a woman who elected to forgo eating and drinking to end intractable suffering. The potential for benefit and harm in physicians discussing VSED is discussed. Physicians working with terminally ill patients need to consider the discussion of VSED as a therapeutic tool in their support and care of patients with intractable suffering.