Background Voluntarily stopping eating and drinking (VSED) with intent to hasten death, even in the context of concurrent disease, can be argued to constitute a form of suicide, albeit by omission rather than act. In the UK, therefore, where assisted suicide is not legally permissible, providing inpatient nursing and medical care to a patient competently withholding food and fluid intake with the aim of ending their life potentially raises legal and ethical challenges.
Argument We argue, however, that healthcare professionals are ethically bound to uphold patient autonomy, and an informed, capacitous decision to voluntarily stop eating and drinking represents autonomous patient choice. Furthermore, to force enteral or parenteral fluids or nutrition on a capacitous patient would constitute battery. Assuming patient capacity is maintained, and the provision of basic care including the offer of food and fluids continues, providing care to patients voluntarily stopping oral intake is legally unproblematic. Ethically it is not necessary for healthcare professionals to share the patient’s intention of hastening their death to provide clinical care, hence they should not be considered complicit or instrumental to a patient’s deterioration through VSED.
Inpatient care may be necessary for patients voluntarily stopping eating and drinking to ensure optimal physical and psychological symptom management towards end of life, with hospices being ideally placed to meet these needs. Declining to admit such patients to a hospice on the basis that this may constitute assisting suicide risks leaving them vulnerable to suboptimal symptom control and merely displaces ethical discomfort onto an alternative group of healthcare professionals.
Conclusion Hospices should be open to providing inpatient care to patients voluntarily stopping eating and drinking, confident in the ethical clarity that they are supporting patient autonomy, but acknowledging the moral burden for involved healthcare professionals who may not share a sentiment to hasten death.
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