Voluntarily stopping eating and drinking (VSED) offers some seriously ill patients who wish to hasten their death a “last resort” option, according to a new special communication in JAMA Internal Medicine.
And just knowing that they can choose VSED often eases the minds of dying patients, Timothy E. Quill of the University of Rochester Medical Center, in New York, told Reuters Health in a telephone interview.
“Some people, knowing that they could do this, allows them to live longer, because they don’t feel as trapped,” he said. “They feel they can hang in there longer because they know they have an escape.”
Patients will usually die about 10 days after VSED begins
Dr Quill and his colleagues wrote the current article after participating in a 2016 conference in Seattle on the legal, ethical, religious and family issues surrounding hastening death with VSED.
“I don’t think there’s a wide awareness of this,” he said, noting that not all doctors would support the approach.
Depending on where a person lives in the US, his or her options for potentially hastening death may include treatment with opiates for severe pain and dyspnea - or stopping or not beginning life-sustaining therapy (both legally and ethically accepted); palliative sedation potentially to unconsciousness (legally accepted but ethically questionable if intent is to speed death); VSED (legality has not been tested, ethically controversial) and physician-assisted death, which is legal in six US states, illegal in more than 30 and of uncertain legality in other states, the researchers explain.
Advantages of VSED for patients include that it is under their control, at least early in the process, and that it gives them and their families “a distinct time frame for patients and families to come together, ‘say goodbye,’ and work on life closure issues,” Dr Quill and his team note.
Patients will usually die about 10 days after VSED begins. Disadvantages include that it cannot immediately ease physical suffering, the researchers add. Thirst as VSED progresses is the most difficult symptom to address, they note, and leads some patients to choose not to continue.
“People get quite thirsty in the process, and so you need a plan for how to deal with that,” Dr Quill said. “You have to have significant willpower to carry through. Most of the people who are considering this are people who want to be in charge of the last part of their lives, so they tend to be strong-willed.”
It gives them and their families “a distinct time frame for patients and families to come together, ‘say goodbye,’ and work on life closure issues
While VSED does not in theory require assistance from a clinician, “in practice in my opinion physicians should really be involved, particularly in the evaluation process, to make sure that the patient is not depressed or they are not suffering on other ways that could be relieved,” Dr Quill said.
The physician also helps work with the patient and their family to ensure that they have really thought things through, he added, including having a plan for what to do if the patient becomes delirious and calls for something to drink. Medications such as Haldol can help quell delirium and also the physical symptoms of thirst, Dr Quill and his colleagues note.
They conclude: “Patients embarking on VSED will need expert palliative care to manage the associated thirst, and substantial caregiver support to respond to progressive debility. Although patient, family, and clinician participation in VSED is probably not illegal in the United States, its legality has not been tested, and it remains ethically controversial.”