Abstract and Introduction
Abstract
Some hospice and palliative care organizations are considering the merits of creating written policies to guide clinicians' responses to patient requests for information and support for a voluntarily stopping eating and drinking (VSED)–related hastened death. How hospice clinicians understand the meaning of a request to hasten dying and the legality and morality of the VSED option will determine their responses. Some may view a plan to intentionally hasten dying by fasting as an act of suicide that should be discouraged; others may regard VSED as an ethically appropriate decision to forego an unwanted life-prolonging measure. A discussion of the ethical and legal pros and cons of this option will be presented within the context of a case of a patient who requested hospice support for her decision to VSED. This case will illustrate a range of beliefs among team members and the potential benefit of having a written policy to help mediate interteam conflict.
Introduction
Even with the best of palliative care, terminally ill patients with advanced disease occasionally think about dying and may wish for death to come sooner. It is also not uncommon for some patients to ask a trusted clinician for help in hastening death. How hospice team members understand the meaning of the request and the nature of the assistance they are asked to provide will determine how they respond. Although hospice clinicians frequently encounter patients who stop eating and drinking as a natural consequence of advanced disease, until recently, it was less common to meet patients who intentionally chose to fast in order to hasten their dying. As an increasing number of such cases are described in professional and lay literature, hospice clinicians will likely encounter more requests for information and support for voluntarily stopping eating and drinking (VSED). Given the diversity of views about the morality and/or legality of VSED, hospice and palliative care organizations will be challenged to respond in an organizationally coherent and clinically consistent fashion in the absence of clear written procedures and guidelines. A case study is presented of a patient who was neither imminently dying nor experiencing great physical pain when she requested hospice support for her decision to forego food and fluid as a means to hasten her death.