VSED and Hospice Care:
A Case Study
By Patrick T. Smith; Elizabeth Collins; Tim Cox;
Deborah Jacques; Bonnie Meyer; and Kate Pepin
If a patient decides to forgo eating and drinking in
order to hasten his or her own death, how should a
hospice respond?
From a legal standpoint, “voluntarily stopping eating
and drinking” (VSED) is an option for individuals in
all 50 states and distinct from the natural reduction in
nutritional intake that accompanies the dying process.
It is a voluntary decision by patients with decision-making
capacity, with the explicit intention of hastening death.1
While legal, the peer-reviewed literature does not reflect strong
ethical consensus about whether, how, and for what reasons
hospices should or should not participate in patients’ care
decisions about VSED.
The NHPCO Ethics Advisory Council offers the following
case study and questions in the spirit of fostering robust
discussion on this difficult ethical issue. The Council also
encourages each hospice to explore these questions
in their organizational ethics committees, with the
ultimate goal of establishing a policy or guidelines
to address VSED so staff is prepared when such
situations arise. Some resources that
may help inform these internal
discussions are provided at
the end of this article.
10
NHPCO NewsLine
Table of Contents for the Digital Edition of NewsLine - September 2013