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April 8, 1998

Palliative Options at the End of Life—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(14):1065-1067. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-14-jac80003

In Reply.—We agree with Dr Letvak that VSED has the advantage of not requiring active physician participation and therefore is not a medical procedure. But VSED results in intended death, the result of voluntary action distinguished from "natural" cessation of eating and drinking that results from the gradual shutdown of bodily functions at the end of life. Voluntarily stopping eating and drinking ought to be subject to informed consent, a search for palliative care alternatives, and an assessment of mental capacity. Voluntarily stopping eating and drinking should be prevented if the patient is psychotic or is suffering from inadequate pain treatment. We respect Letvak's religious objection to TS, PAS, and VAE, but such religious beliefs should not determine public policy in a pluralistic society like our own.

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