It is defined as a self–initiated effort to accelerate dying in the contexts of suffering refractory to aggressive disease and symptom management, a perception of prolonged dying, or progressive functional decline that the patients finds intolerable; they may be seriously ill but not necessarily in the dying period.
Voluntary stopping of eating and drinking (VSED) is different from illness–associated anorexia–cachexia, which reflects the natural history of certain diseases.
- It is physiologically similar to discontinuation of artificial nutrition but differs in the anticipatory guidance for families and in the ethical foundations (because it is not withdrawal of invasive medical intervention).
- It is also uniquely accessible: and palliative sedation may be inappropriate because of absence of severe symptoms.
- It can be performed in almost any environment and may be not legally questioned because of strongly supported principles such as the right to privacy and self–determination.
- I further differs from other palliative measures of last resort such as palliative sedation because it can be accomplished without physician participation and may be implemented in a patient with a serious but not imminently lethal illness (e.g., early dementia).
However, health care professionals need to participate in the process because they should be in charge of the initial assessment, the anticipatory guidance, and control of suffering once VSED is started.
Depending on an individual's overall health and adherence to the method, the dying process secondary to VSED tends to last 10 days to 2 weeks. This time may allow for reflection, family interactions, and potential reversibility early in the process.
Most patients considering VSED are aged 80 and older, have a significant burden of disease and depend on others for daily care. Their reasons for bearing in mind the method include 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 majority of patients will explore VSED it only as a hypothetical option and will be satisfied knowing of its possibility as a means to get away of their situation.
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Adapted from Medscape News & Perspective. Voluntary stopping eating and drinking. Available at https://www.medscape.com/viewarticle/894008_1 . Accessed on May 2, 2018. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.