“Discussion or silent accompaniment: a grounded theory study about voluntary stopping of eating and drinking in Switzerland”

Abstract

Background Voluntary stopping of eating and drinking as an option to end life prematurely is gaining international attention, and health care professionals are increasingly confronted with the wish to die through voluntary stopping of eating and drinking by individuals. While to date, there are no guidelines in Switzerland to orient professional support, it is of interest how professionals and other people involved react to the situation. The aim of this qualitative study was to explore how health care professionals in Switzerland accompany individuals during voluntary stopping of eating and drinking and to analyze this decision-making process. Methods Charmaz's grounded theory constructivist methodology uses guidelines for systematic, theory-driven data analysis underpinned by a pragmatic philosophical perspective. Data were collected in autumn 2016 as part of a regional palliative care conference on voluntary stopping of eating and drinking. All participants of the expert meeting (N = 50, including nurses, counsellors, ethicists, medical doctors, politicians, volunteers, and relatives) were invited to the focus group interviews, of which N = 47 participated. We conducted five focus group interviews, each lasting one hour. Results The results showed that the accompaniment of those willing to die during voluntary stopping of eating and drinking was either discussed and cleared with one another or was unspoken and silently accompanied. Conclusions The demands of participants for more knowledge must be heeded, and there is also a need for systematic instructions on how to proceed in the case of voluntary stopping of eating and drinking support and what needs to be considered.

Ethical challenges around thirst in end-of-life care –experiences of palliative care physicians

“…The most common symptoms before death were pain, fatigue, impaired cognitive functioning, and thirst and dry throat [ 2 ]. After patients VSED, health care professionals may not question patients decision but automatically interpret it as a natural dying process [ 3 ]. In palliative care (PC), death is seen as something natural [ 4 , 5 ]; 63% of health care professionals in Switzerland perceived the VSED to be natural for a dying patient [ 6 ].…”

First-Hand Recommendations for Nursing Management to Support Nurses Involved in the Process of Hastened Death: A Systematic Review of the Qualitative Evidence

“…It has been argued that the fear of hastening death by increasing the dose of morphine raises ethical issues [1]. Uncoordinated voluntary abstention from food and drink can also be a source of moral distress [2]. Especially chronically ill people sufering from cancer, neurological diseases (mostly motor neuron diseases), or end-organ failure (mostly heart failure and lung disease) express the wish for hastened death.…”