Voluntarily Stopping Eating and Drinking: A Compassionate, Widely Available Option for Hastening Death

Editors: Judith Schwarz, PhD, RN (EOLCNY Clinical Director); Timothy Quill, MD (EOLCNY Board Member); Paul T. Menzel, PhD; Thaddeus Mason Pope, JD, PhD

Oxford University Press, July 2021, ISBN 978-0-19-008073-0

Persons living with incurable and progressive or terminal illness often wonder what may lie ahead as their disease progresses. Some of these individuals and their families will seek information about options and choices that permit a hastened death if their suffering or deterioration becomes intolerable. Their ability to effectively consider such options depends upon receiving accurate and comprehensive information.

Voluntary stopping eating and drinking (VSED) is a widely available option that permits decisionally capable persons to hasten death. Currently, VSED remains a relatively unknown, poorly understood option often associated with misleading images of starvation and suffering. However, death by VSED is typically a peaceful and meaningful experience when accompanied by committed caregiver support and guided by knowledgeable clinicians.

Unlike medical aid in dying (MAID), which is authorized in only eleven U.S. jurisdictions, VSED is legally available in all states. And unlike MAID, VSED is not limited to those with a terminal illness. Most distinctively, VSED is not limited to avoiding current unbearable suffering. Some patients may be able to direct VSED in the future to avoid later suffering should they lose decision making abilities. They can complete a written directive stipulating limitations on hand feeding by others should their capacity be lost. These directives allow patients to avoid living with unacceptable deterioration including future loss of decision-making capacity from conditions like dementia.

This volume addresses the inadequacies of currently available VSED information. It provides clinically realistic descriptions of the practice and, in separate chapters, explores benefits and challenges along clinical, ethical, legal, and institutional dimensions. Eight illustrative, previously unpublished actual cases receive pragmatic analysis, and the book concludes with recommendations for best practices.

This volume is designed for members of the medical, nursing, and social work communities, as well as attorneys, educators, ethicists, and members of the lay public – including those living with serious disease and those wanting to explore a wide range of future end of life options.