Voluntary Stopping of Eating and Drinking: An Ethical Alternative to Physician-Assisted Suicide.

T he polarized debate over physician-assisted suicide (PAS) (now sometimes referred to as assisted dying) has included little discussion on an alternative method for voluntary death – terminal dehydration (Miller, Fins, & Snyder, 2000; Miller & Meier, 1998). With terminal dehydration, competent patients with a terminal or incurable illness seek death by forgoing artificial nutrition and hydration or by ceasing to eat or drink. With accompanying standard palliative care measures, individuals can escape conditions they consider to be worse than death. Clinical, ethical, and policy issues will be analyzed primarily by comparing voluntary stopping of eating and drinking (VSED) to PAS. Recommendations for nursing practice, education, and organizational policy will be provided. Clinicians with palliative care expertise generally agree how to respond to requests for aid in dying (Schwarz, 2014). They begin to explore the reasons behind the request, intensify efforts to relieve pain and suffering, consult specialists for relief of psychological or spiritual suffering, commit to nonabandonment, and seek mutually acceptable solutions for the patient’s suffering (Schwarz, 2014). If unacceptable suffering persists despite all efforts, then decisionally capable patients should be informed about all legal options that permit a hastened death (Hospice and Palliative Nurses Association [HPNA], 2011). These options include withholding or VSED, withdrawing life-sustaining interventions, and sedation to unconscious for relief of intractable suffering (HPNA, 2011; Schwarz, 2007). The American Nurses Association (ANA, 2013), HPNA (2011), and Oncology Nursing Society (2010) do not support assisted dying. However, all recognize nurses practicing in a state where PAS is legal will have to decide if their own moral value systems do or do not allow them to be involved in providing care for a patient who has chosen to end his or her life through PAS. Ethical Differences in PAS and VSED