Voluntarily Stopping Eating and Drinking Among Patients With Serious Advanced Illness—A Label in Search of a Problem?

To the Editor In a Special Communication published in a recent issue of JAMA Internal Medicine, Quill et al¹ offer a thoughtful analysis of circumstances when dying patients voluntarily stop eating and drinking (VSED). We suggest several amendments to their analysis.

Although a clever acronym, VSED is not novel and ought not to be equated with other forms of actively hastening death; VSED rests on a spectrum of normal end-of-life patient behaviors that few would equate with suicide. Underlying disease processes can impair appetite and thirst and prompt patient desires for a quick death. Before the VSED label, no one was forcing dying patients to eat or drink.