Voluntarily deciding to stop eating and drinking is defined as a self-initiated effort to accelerate dying in the following contexts: refractory suffering due to aggressive disease, symptom management, the patient's perception that the dying process is prolonged, or a progressive functional decline that the patient finds intolerable. A patient who makes this decision 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 both anticipatory guidance for families and ethical foundations (because it is not withdrawal of an invasive medical intervention).
- It is uniquely accessible, including when palliative sedation may be inappropriate due to the absence of severe symptoms.
- It can be enacted in almost any environment and may avoid legal entanglements in jurisdictions where the principles of right to privacy and self-determination are strongly supported.
- VSED 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 initial assessment, anticipatory guidance, and the 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 considering the method include: readiness to die, their perception that continued life is "pointless," poor quality of life, a desire to die at home, and the wish to control the circumstances of their own death.
The majority of patients who explore VSED do it only as a hypothetical option, and are satisfied knowing that is a future possibility as a means to escape their situation.
See reference for more information.
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.