Voluntary stopping of eating and drinking (VSED) is the decision of a competent individual to stop taking hydration and nutrition with the intention of hastening death. VSED is different from the anorexia due to a progressing terminal illness, and different also from the diminished oral intake due to a psychiatric disease.
How often VSED occurs is unknown; one survey reported a median time from stopping eating/drinking to death of seven days.
The scarce available data suggest that VSED is not associated with any exclusive symptom burden; pain, dry mouth, thirst, dyspnea, and agitation/delirium are commonly reported, but hunger is not a common symptom
. Symptom management is the same as with other palliative care patients.
Ethical, legal, and practical concerns
• VSED is considered to be different ethically and legally than physician assisted suicide, as VSED can be completed without any clinician involvement or knowledge.
• VSED is also considered by many to be ethically different than suicide. A medically healthy individual who stops eating and drinking as a result of a psychiatric illness could have psychiatric treatment and medical nutrition forced upon them. However, many terminally ill patients participating in VSED are not psychiatrically ill. Forcing artificial nutrition against the will of a palliative care patient would be an extraordinary intervention with small benefit.
• Some ethicists argue that even the limited clinician participation in VSED — by providing counselling or managing symptoms — cannot be distinguished from assistance for hastening death and thus should not be done.
• Other ethicists argue that while a clinician may judge VSED to be unethical, it is still important that clinicians continue to provide proper care and palliation for patients dying due to VSED.
Health professionals should not underestimate the complexity and challenges of caring a patient who is pursuing VSED; those who want to support the patient should be prepared to coordinate ethical, legal, and psychiatric input.
Basically, a clinician’s responsibility is to ensure that the decision is well-informed; that it is made by a non-coerced patient with decision-making capacity; and that methods to reduce suffering are not restricted.
Furthermore, the clinician should engage the patient in a thorough discussion of what VSED looks like, including symptom burden, expected duration, and any alternatives available to the patient.
See reference for more information.
Adapted from Chargot J, Rosielle DA, Marks A. Voluntary stopping of eating and drinking. Palliative Care Network of Wisconsin. Fast facts and concepts # 379. Internet. Accessed on June 1, 2018.