Legal aspects to consider in voluntary refusal to eat, drink

(HealthDay)—Voluntarily stopping eating and drinking (VSED) is a course that patients may choose to hasten their death, although there are clinical, ethical, and legal aspects to consider, according to a special communication published online Nov. 6 in JAMA Internal Medicine.

Timothy E. Quill, M.D., from the University of Rochester Medical Center in New York, and colleagues discussed VSED as a course that patients may choose among death-hastening options.

The researchers note that VSED has a distinct time frame allowing patients and families to say goodbye and work on issues relating to life closure. The initial states of VSED are mainly under the patient's control, and most of the process is driven and executed by the patient. However, disadvantages include the fact that the process is too long to effectively respond to those with severe immediate physical suffering. Clinician participation is needed in terms of initial assessment and ongoing management, including ensuring that patients have decision-making capacity, that the decision is not influenced by mental illness, that the patient is fully informed of the risks and alternatives, and that the choice is voluntary. Patients should be aware of other alternatives and should understand that VSED may be difficult.

"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," the authors write.

One author disclosed receiving fees for lectures about end-of-life options including VSED and receiving royalties from books written on this topic.

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