Primary Care Patients Hastening Death by Voluntarily Stopping Eating and Drinking

Abstract

PURPOSELittle is known about the role family physicians play when a patient deliberately hastens death by voluntarily stopping eating and drinking (VSED). The purpose of this study was to gain more insight for family physicians when confronted with patients who wish to hasten death by VSED. We aimed to describe physicians' involvement in VSED, to describe characteristics and motives of their patients, and to describe the process of VSED in terms of duration, as well as common symptoms in the last 3 days of life. METHODSWe undertook a survey of a random national sample of 1,100 family physicians (response rate 72%), and 500 of these physicians received questions about their last patient who hastened death by VSED. RESULTSOf the 978 eligible physicians, 708 responded (72.4%); 46% had cared for a patient who hastened death by VSED. Of the 500 physicians who received the additional questions, 440 were eligible and 285 (64.8%) responded; they described 99 cases of VSED. Seventy percent of these patients were aged older than 80 years, 76% had severe disease (27% with cancer), and 77% were dependent on others for everyday care. Frequent reasons for the patients' death wish were somatic (79%), existential (77%), and dependence (58%). Median time until death was 7 days, and the most common symptoms before death were pain, fatigue, impaired cognitive functioning, and thirst or dry throat. Family physicians were involved in 62% of cases.CONCLUSIONS Patients who hasten death by VSED are mostly in poor health. It is not unlikely for family physicians to be confronted with VSED. They can play an important role in caring for these patients and their proxies by informing them of VSED and by providing support and symptom management during VSED.

Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

“…This prevalence is similar as that reported by nurses working in hospices in Oregon,2 and less than that by Dutch family physicians 8. In this survey, we revealed that Japanese patients were also trying to implement VSED to hasten their deaths themselves.…”

“…Physicians confronted with VSED may experience moral conflict in respecting the patient’s self-determination and allowing patient suicide, and could be reluctant to support the patient in a path leading to death 8. Supportive interventions, such as continuous deep sedation (CDS), have been debated in regards to reducing patients’ refractory symptoms and suffering associated with hunger and fatigue during the VSED process 8–10…”

Voluntary Stopping of Eating and Drinking (VSED), Physician-Assisted Death (PAD), or Neither in the Last Stage of Life? Both Should be Available as a Last Resort

“…Even in environments where PAD is legally available, some patients will still preferentially choose VSED. 6 The psychological impact of voluntarily choosing VSED among a range of other last resort possibilities is very different from having this choice imposed upon a patient who would have preferred PAD. Although A.A. appreciated having an escape from suffering under his control, he found VSED to be more cruel and absurd than meaningful.…”

“…There are also important differences: (1) VSED takes longer and is harder to accomplish, as patients get very thirsty as it unfolds; (2) the doctor's role in VSED is more indirect (38% of patients in the study by Bolt et al had no physician involvement), 6 where physician involvement is more direct in PAD (doctor provides the means but the patient must independently take the medication); (3) the esthetics of the processes are different; VSED usually takes 1 to 2 weeks with a series of medical and social challenges, whereas PAD is a definitive medical intervention with death expected in minutes to hours; and (4) if PAS is chosen in states where it is illegal, both the clinician and the family must keep a major secret to prevent legal complications, potentially complicating grief, whereas VSED can be openly and legally practiced anywhere in the United States.…”

Voluntary Stopping Eating and Drinking

“…VSED is physiologically similar to discontinuation of artificial nutrition but presents unique symptom management, anticipatory guidance for families, and ethical underpinnings (because it is not withdrawal of invasive medical intervention). VSED further differs from other palliative measures of last resort such as physician‐assisted dying or proportionate palliative sedation because it can be accomplished without physician input and may be implemented in an individual with a serious but not imminently terminal illness (e.g., early dementia) . This is not to say that clinicians should be inactive in the process because they should be part of the initial assessment, provide anticipatory guidance, and work to alleviate additional suffering once VSED is initiated.…”