Voluntarily Stopping Eating and Drinking: A Lesser Known, Widely Available Palliative Option of Last Resort (TH154)

• Published in: Journal of pain and symptom management 2022-05, Vol.63 (5), p.798-798
• Main Authors: Quill, Timothy, Horowitz, Robert, Pope, Thaddeus, Menzel, Paul, Schwarz, Judith
• Format: Article
• Language: English
• Subjects: Assisted suicide; Change agents; Death & dying; Decision making; Delirium; Deterioration; End of life decisions; Expectations; Hydration; Liquids; Mouth; Palliative care; Relatives; Sedation; Strength; Suffering
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2022.02.233

Outcomes 1. Ability to name two clinical indications for considering voluntarily stopping eating and drinking (VSED) as an option toward the end of life 2. Identify and think through two potential ethical justifications for VSED and two potential ethical objections 3. Understand that there are currently no clear legal prohibitions to the practice of VSED Voluntarily stopping eating and drinking (VSED) is a death-hastening option potentially available to all seriously ill patients with decision-making capacity who find themselves in an unacceptable current circumstance or who anticipate future deterioration that they would experience as worse than death. Unlike other death-accelerating measures (eg, physician-assisted death), VSED is not legally prohibited and therefore does not require changes in the law to be openly available. Many seriously ill patients who fear serious suffering before death will find the possibility of VSED reassuring even if they never initiate the process. Those who do want to initiate VSED should be carefully evaluated as to their current decision-making capacity, the reasons they are requesting this option at that moment, the presence of potentially treatable suffering that might initiate a change of mind, and the involvement and awareness of close family members. Those who qualify and still want to move forward with the VSED process should be fully informed about what is involved and generally referred to hospice programs if available for added support. Involvement of close family members is recommended if feasible. Symptoms such as dry mouth, thirst, weakness, and eventually delirium should be anticipated and expertly managed when then emerge. The VSED process generally takes 10 to 14 days from initiation until death depending on hydration status at the start and the ability to not swallow liquids used in palliation of dry mouth, among other factors. Patients are usually alert for most of the process, although delirium and some sedation are likely to be present late in the process for most patients and should be anticipated.