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Special Communication
Health Care Policy and Law
January 2018

Voluntarily Stopping Eating and Drinking Among Patients With Serious Advanced Illness—Clinical, Ethical, and Legal Aspects

Author Affiliations
  • 1Palliative Care Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York
  • 2Health Services Research & Development Center of Innovation, VA Portland Health Care System, Departments of Psychiatry and Medicine, Oregon Health & Science University, Portland
  • 3Center for Bioethics, Harvard Medical School, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 4Health Law Institute, Mitchell Hamline School of Law, St Paul, Minnesota
JAMA Intern Med. 2018;178(1):123-127. doi:10.1001/jamainternmed.2017.6307

Patients with advanced illnesses sometimes request that physicians help hasten their death. Increasingly in North America and Europe, legal options allow physicians to perform this role. Among death-hastening options, the spotlight has been on physician-assisted death. However, voluntarily stopping eating and drinking (VSED) is also a course that patients may choose. Although VSED theoretically does not require physician involvement, clinician participation is critical in terms of initial assessment and ongoing management. In this review, we examine both clinical issues in assessing patients who are considering VSED and the clinical challenges that may emerge during VSED. We also explore some of the underlying ethical and legal considerations for physicians who either care for or decline to care for these patients. Physicians who care for seriously ill patients should be prepared to respond to patients’ requests to participate in VSED.

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