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Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey
  1. Takuya Shinjo1,
  2. Tatsuya Morita2,
  3. Daisuke Kiuchi3,
  4. Masayuki Ikenaga4,
  5. Hirofumi Abo5,
  6. Sayaka Maeda6,
  7. Satoru Tsuneto7 and
  8. Yoshiyuki Kizawa8
  1. 1 Department of Palliative Medicine, Shinjo Clinic, Kobe, Hyogo, Japan
  2. 2 Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka, Japan
  3. 3 Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Tokyo, Japan
  4. 4 Department of Palliative Medicine, Hospice Children’s Hospice Hospital, Yodogawa Christian Hospital, Osaka, Osaka, Japan
  5. 5 Department of Palliative Medicine, Rokko Hospital, Kobe, Hyogo, Japan
  6. 6 Department of palliative medicine, Kyoto university hospital, Kyoto, Kyoto, Japan
  7. 7 Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
  8. 8 Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
  1. Correspondence to Dr Takuya Shinjo, Shinjo Clinic, 1-5-1-307 Kitagoyou, Kita-ku, Kobe, Hyogo, 651-1131, Japan; shinjo{at}


Objectives Voluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.

Methods 219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.

Results A total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).

Conclusions In Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

  • terminally ill patient
  • continuous deep sedation
  • voluntarily stopping eating and drinking

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  • Contributors TS, TM and DK: designed the study and wrote the initial draft of the manuscript. TM, DK, MI, HA, SM, ST and YK: contributed to analysis and interpretation of data, and assisted in the preparation of the manuscript. All other authors: contributed to data collection and interpretation, and critically reviewed the manuscript. All authors: approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was granted by the Japanese Society of Palliative Medicine, the Japan Hospice Palliative Care Foundation and the Home Health Care Support Yuumi Memorial Foundation (2015).

  • Competing interests None declared.

  • Ethics approval The Seirei Mikatahara General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.