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The Legal Right to Choose
Hastening dying by refusing food and drink is legal. If the patient has ability to communicate this wish, he or she can do so. It is equally legal to refuse to assist.
The decision to voluntarily stop eating and drinking is different from the loss of appetite or disinterest in food or drink that is often part of the end stage terminal illnesses. The patient should be well-informed and have the emotional and physical support of family, friends, or others. In addition, professional caregivers who can provide palliative or hospice support should be available.
The Physical Process
The following are the general stages a patient goes through once the fast has begun :
All fluid intake, even ice chips, cease once once oral intake stops
- The patient usually remains awake for several days while weakening physically.
- Good oral care is extremely important during the initial stage. The patient is conscious and may be thirsty or have a dry mouth. Treatment may include oral swabs, lip salve, rinsing the mouth and having the patient spit out the fluids, and misting the mouth with mouthwash to keep the mucous membranes moist..
- The patient will become sleepier as dehydration progresses.
- Occasionally, delirium or agitation may occur as death nears. Caregivers should be prepared to contact a hospice nurse or palliative care clinician to provide palliative measures, including sedation, to ease the patients death.
- The patient will slip into a coma.
- Excellent physical care should continue until death occurs.
Death usually occurs within one to three weeks of the beginning a fast. During this interval the patient has time to reflect on and perhaps reconsider the decision. Loved ones have time to reminisce and prepare to say goodbye. If the patient chooses to resume eating or drinking, caregivers must provide food and fluids.
Nurses who care for hospice patients who voluntarily stop eating and drinking report that this choice doesn’t seem to cause unacceptable discomfort or distress. In most cases, it seems to help achieve a peaceful or “good” death.
Observations from Professionals
Patients and their loved ones have increasingly been speaking publicly about what it’s like to decide to stop eating and drinking.
Another physician in Oregon described an elderly patient who’d grown increasingly debilitated by severe arthritis pain. . After the patient refused oral intake , the doctor said he “watched, surprised, as his suffering patient became self-confident and seemingly happy. Her family gathered. . . . Then, without requesting any palliative care-even ice chips-her body rapidly failed, and she died.”
Michael Miller, a retired surgeon, knew that his death from cancer was inevitable. He chose to stop eating and drinking, but refused assisted suicide and euthanasia. He asked a filmaker to record his death. The filmmaker described Miller’s sense that he’d regained control over his death: “Michael felt he was avoiding a wretched ending. For him, being a surgeon and used to being in control, his view of a wretched ending was about not having influence over how he leaves. For him not eating and drinking was about making the dying process gentler and having some control.”
These and other descriptions share an absence of implusiveness, nervousness, guilt, depression, or any other emotional state traditionally associated with suicidal behavior. Family and friends are spared unresolved feelings of shock, guilt, and anger that suicide can leave.
Hastening Dying Can Be Declined
Many people believe that stopping eating and drinking is morally equivalent to suicide. Thus, they may feel morally unable to discuss this option with their patients.
Nurses can transfer care of such patients to colleagues who feel differently. Thoses who value patient self-determination and informed decision making based on all available legal options will provide information about voluntarily stopping eating and drinking.
Nurses, family members, friends and any others must decide individually how to respond to patients’ requests for information about legal end-of-life options that permit hastened dying. This is not a decision to be forced upon any person involved in decision-making or support.
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