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Choosing to Stop Eating and Drinking at the End of Life (VSED)
Tuesday, 11 May 2010 18:31
What is VSED (Voluntary Stopping Eating & Drinking)?
This refers to the decision by a patient to stop eating food and drinking liquids when they have a terminal or life-limiting disease, so that their death can be hastened (and therefore their dying will not be prolonged).
Why would someone stop eating and drinking?
We know that up to 35% of patients in hospice programs have severe pain in the final week of life and 25% describe having shortness of breath that is “unbearable”. With such uncontrolled symptoms, they might say “I’m tired of this and I just want to go to sleep and not wakeup”. Particularly when a dying person has previously witnessed a friend or loved one dying in uncontrolled pain, they may want to ensure that this will not happen to them – that they have an option to control their own death. That may include a situation where, despite receiving appropriate and maximized palliative (comfort) care, they continue to have such pain, shortness of breath, or other symptoms that all meaning in their life disappears – they may believe that the only solution to their suffering is death. Because physicians cannot guarantee control of these symptoms, patients want to know what can be done. Since, physician-assisted death is not legal in most States and is opposed by many people, VSED is one option available to help patients escape from suffering.
Are there any other choices for a patient suffering at the end of life?
When symptoms at the very end of life cannot be controlled, Palliative Sedation is also available. Patients are given drugs to induce a “sleep state” to relieve extremes of distress and keep them comfortable. However, some people want more control over the end of their own life and VSED gives them that. And, if they develop uncontrolled symptoms in the last week, they can still receive Palliative Sedation.
Is VSED ethical? Is it suicide?
It is not suicide. If the goal is to alleviate or prevent suffering, it is considered ethically acceptable for someone who is capable of making an informed decision. VSED must be distinguished from the naturally occurring loss of appetite and interest in food or water that occurs at the end of life. This choice can be considered the equivalent of someone choosing to forego life-sustaining medical treatment, a right each of us has [the Principle of Autonomy]. Because it is completely patient choice, doctors are obligated to honor a patient’s refusal of treatment; whereas, they are not so obligated to honor a request for lethal injection. Some people feel it is also morally preferable to Physician-Assisted Death (an option available in the USA only in the States of Oregon and Washington).
Is it painful?
No. Although death is ultimately caused by their primary disease (e.g. cancer, Lou Gehrig’s Disease or ALS), people choosing VSED die in this situation from dehydration which, based on studies in Palliative Medicine, is not painful. The discomfort caused by dehydration is a dry mouth, which can be relieved with moistened sponges or small sips of water. [see the handout article “Myths of Dehydration and Starvation”] Symptoms related to their primary disease will still need to be treated: for example, morphine for pain or shortness of breath, Compazine for nausea, senokot for constipation.
How long will it take someone to die?
Most people die within 10days from the time they have no more fluids or food. Occasionally, someone who is relatively younger or is otherwise healthy (as when they have only one terminal disease and no other problems) may live more than ten days. [see the handout article “Caring for the Dying”]
Although neither Palliative Sedation nor VSED are perfect solutions for dying patients, they offer last-resort options to help them achieve a comfort goal allowing them control over suffering and death with dignity. And, if patients or families are worried that their doctors or hospitals won’t or aren’t able to keep them comfortable, they can be reassured because they will have this option.
Usually someone contemplating this option is already enrolled in hospice. If you are interested in this, please discuss it with everyone who might be affected by it and with the hospice nurse who will arrange a visit with the Medical Director.
1. Quill TE, Byock I. Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. Position Paper for the American College of Physicians-American Society of Internal Medicine End-of-Life Care Consensus Panel. Ann Intern Med. 2000;132:408-14.
2. Schwarz J. Exploring the option of voluntarily stopping eating and drinking within the context of a suffering patient’s request for a hastened death. J Pall Med. 2007;10:1288.
3. Quill TE, et al. Palliative treatments of last resort: choosing the least harmful alternative. Ann Intern Med. 2000;132:488-93.
4. Morrow A. The decision to stop eating at the end of life. About.com Dec.18,2008.
Last Updated on Tuesday, 29 March 2011 11:53
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