Perspectives of people accompanying a person during voluntary stopping eating and drinking: a convergent mixed methods study

Abstract

Background: Voluntary stopping eating and drinking (VSED) is an option for people wishing to bring about premature death. In Switzerland, VSED is considered a controversial action at the end of life in the guidelines for "Management of dying and death," which states that the decision to support or oppose VSED must be made individually by health care professionals; so far there are no instructions for action. The aim of this research was to explore the experiences of people who play an important role in VSED accompaniment, and to explain how the people involved in the process deal with VSED.Methods: This convergent mixed methods study included a national survey (n=1,681) and five focus group interviews (n=47). Data integration was conducted using the four-stage pillar integration process.Results: Given Swiss society interest, VSED has already established itself in the health system without the institutions having addressed the issue, whereupon health professionals make individual decisions when a person willing to die comes to them with a VSED wish. Health professionals are open to VSED, but are also ambivalent and would like to know more about it before being confronted with a VSED case. Conclusions:In Switzerland, VSED has become a rare but desired option for ending life prematurely.While health professionals are already being confronted with the phenomenon, there is a lack of discussion at the level of health institutions about how to deal with it.

Patients Who Seek to Hasten Death by Voluntarily Stopping Eating and Drinking: A Qualitative Study

“…There is an increasing call for clinical guidelines for professional caregivers in different countries, similar to the Dutch and American guidelines. 7,[32][33][34] In our study, we found a need for guidance among patients and relatives as well. It is important that professional and patient guidelines apply to the full spectrum of patients considering VSED.…”

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

“…Constructivist researchers acknowledge that data, analyses and methodological strategies are constructed and take into account the research context and the perspectives of researchers in their interpretations [ 55 ]. The grounded theory was underpinned by a pragmatic philosophical perspective, which assumes that our knowledge is developed through our actions and interactions, which are shaped and developed by our social environment [ 57 , 58 ]. Since the phenomenon under investigation in this study was little known internationally at the time of the investigation and had not been researched in Switzerland until then, the recruitment of participants was challenging, which is why theoretical sampling as an instrument of theoretical saturation could not be implemented in this research.…”

“…This study is a research strand integrated in a convergent mixed method [ 59 ], which was pre-recorded in a study protocol. [ 60 ] Since at this stage the mixed-methods study could already be published [ 58 ], there are some overlaps in the description of the method. However, the method had to be greatly shortened in mixed-methods article, so that the same contents had to be taken up in this paper, but described in more detail for better comprehensibility.…”

“…Of the 50 participants in the event, n = 47 participants decided to participate in the focus groups, which was recorded in a written declaration of consent. Three participants did not take part in the focus groups without giving any reason and left the event [ 58 ]. The participants’ characteristics were collected using a one-page written questionnaire and are shown in Table 1 .…”