The need to distinguish between different forms of oral nutrition refusal and different forms of voluntary stopping of eating and drinking

Stängle, Sabrina; Schnepp, Wilfried; Fringer, André

doi:10.1177/1178224219875738

Cited by 12 publications

(21 citation statements)

References 26 publications

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“…VSED is the free decision of a person to refuse the intake of food and fluids with the intention of ending their life prematurely (Bernat et al, 1993; Byock, 1995; Ivanović et al, 2014; Mattiasson & Andersson, 1994; Quill et al, 1997). It is not equivalent to, for example, loss of appetite during the dying process, refusal to eat due to mental illness (e.g., dementia, anorexia), eating disorders (e.g., dysphagia), or hunger strike (Stängle et al, 2019c). According to the definition of Ivanović et al (2014), an essential prerequisite for being able to carry out VSED is the ability of the person to wish to die (Grisso, & Appelbaum, 1998).…”

Section: Introductionmentioning

confidence: 99%

Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

Stängle

Schnepp²,

Büche

et al. 2021

GeroPsych

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Abstract. Besides physician-assisted suicide, there is another end-of-life practice under discussion: voluntary stopping of eating and drinking (VSED). In this study, we assess the occurrence of VSED in outpatient care and evaluate nurses’ attitudes about it. We recruited 395 nurses (24% response rate) in our online survey. The occurrence of VSED in Switzerland lies at 0.5%. Most nurses (84.6%) were aware of VSED, and 39.5% had experienced it with patients. VSED was mostly (70.3%) regarded as a natural death, and nearly all (95.1%) were willing to care for these patients; however, about one-quarter (26.5%) expressed moral concerns. Our results show that VSED occurs in rare cases, and that nurses are willing to accompany patients during this VSED, but express moral concerns.

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Section: Introductionmentioning

confidence: 99%

Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

Stängle

Schnepp²,

Büche

et al. 2021

GeroPsych

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“…VSED is an option when a person consciously and voluntary decides to bring about death by stopping eating and drinking (1,13). It differs significantly from other forms of food refusal (14), where the person has no intention of dying (13,15,16). In Switzerland, VSED was first included in the Swiss Academy of Medical Sciences' (SAMS) guidelines for "Management of dying and death" in 2018 (17).…”

Section: Introductionmentioning

confidence: 99%

“…Many participants had accompanied people during VSED; overall, patients are granted the right to medical and nursing care, and VSED is often considered an autonomous and "good" way to die (1,8,11,12,32). Although there are few qualitative studies (13), previous research indicated that accompanying a person during VSED is an individual decision (33), and that there is an implicit or unspoken form of VSED where the person does not talk about their intention or even hides it from others (14). The existing evidence is not sufficient to derive practical recommendations for health professionals.…”

Section: Introductionmentioning

confidence: 99%

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

Stängle

Fringer

2021

Ann Palliat Med

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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.

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“… 5 , 9 , 20 , 21 VSED must be clearly distinguished from artificial feeding, 22 from external influences that impair food intake (e.g., pain, malnutrition ), 23 – 25 and from psychological impairments (e.g., dementia, depression). 26 , 27 People choosing VSED are mostly women (62%) and can be found in all age groups; however, most individuals who opt for VSED (48%–70%) are aged 80 years or older. 3 , 7 , 19 , 28 …”

Section: Introductionmentioning

confidence: 99%

Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

et al. 2020

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Objective We aimed to determine how often patients who choose voluntary stopping of eating and drinking (VSED) are accompanied by Swiss family physicians, how physicians classify this process, and physicians’ attitudes and professional stance toward VSED. Methods We conducted a cross-sectional study between August 2017 and July 2018 among 751 practicing family physicians in Switzerland (response rate 74%; 70.7% men; average age 58 (±9) years). We used a standardized evidence-based questionnaire for the survey. Results VSED is well-known among family physicians (81.9%), and more than one-third (42.8%) had accompanied at least one patient during VSED. In 2017, 1.1% of all deaths that occurred in Swiss nursing homes or in a private home were owing to VSED. This phenomenon was classified as a natural dying process (59.3%), passive euthanasia (32.0%), or suicide (5.3%). Conclusions Although about one in three Swiss family physicians have accompanied a person during VSED, family physicians lack sufficient in-depth knowledge to address patients and their relatives in an appropriate manner during the process. Further training and development of practice recommendations are needed to achieve more standardized accompaniment of VSED. International Registered Report Identifier: DERR1-10.2196/10358

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The need to distinguish between different forms of oral nutrition refusal and different forms of voluntary stopping of eating and drinking

Cited by 12 publications

References 26 publications

Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

Voluntary Stopping of Eating and Drinking in Swiss Outpatient Care

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

Family physicians’ perspective on voluntary stopping of eating and drinking: a cross-sectional study

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