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17 Widener L. Rev. 351 (2011)
Death by Voluntary Dehydration: Suicide or the Right to Refuse a Life-Prolonging Measure

handle is hein.journals/wlsj17 and id is 363 raw text is: DEATH BY VOLUNTARY DEHYDRATION: SUICIDE OR THE RIGHT TO REFUSE A LIFE-PROLONGING MEASURE? JUDITHI K. SCInX Y RZ* ABSTR i' The decision concerning voluntarily stopping eating and drinking (VSED) is increasingly discussed by health care professionals as an appropriate palliative option for decisionally capable, suffering patients who wish to hasten their deaths. Most palliative care clinicians consider VSED an ethical and legally supported choice, and some argue that there is therapeutic value in discussing this option with patients when suffering is intolerable and the desire to control the circumstances of dying is clear and enduring. Others resist informing patients about this option. This article presents a case of a decisionally capable, terminally ill patient who requests hospice support for her decision to hasten her death by VSED. I. INTRODUCTlION Most terminally ill patients occasionally think about death, and many hope that it will come quickly. Similarly, the desire for a hastened death regularly occurs, but such thoughts are frequently kept secret unless clinicians specifically inquire. Palliative care clinicians observe that it is not uncommon for patients with advanced cancers to ask their caregivers for an assisted or hastened death.' There is agreement among such clinicians that a request for an assisted death represents, at a minimum, a plea for help. Understanding the meaning of the request and the nature of the patient's distress requires assessing unmet psychosocial, spiritual, and/or physical concerns, and requires a thoughtful and respectful exploration of the patient's fears, hopes, and needs. When palliative or hospice clinicians respond with intensified symptom management and psychosocial support, the desire for an assisted death often abates. On other occasions, the patient's determination to control the circumstances and timing of death persists and these cases present challenges for clinicians, as being asked by a patient for an assisted death often causes intense and conflicted feelings in clinicians.2 The following case study reveals some of the difficulties of perception regarding VSED, but provides a * Judith K. Schwarz, Phi), is the Regional Clinical Coordinator for the Northeast for Compassion & Choices. Dr. Schwarz can be reached at Judithschwarzea earthlink.net. 1. Janet L. Abrahm, Patient and Falnit' Requests for Hastened Death, in IIE\LM I)(-GY 2008: 1 DUCATION IPROGRAv BooK 475, 475 (Am. Soc'y Hematology ed. 2008). See Judith K. Schwarz, Responding to Persistent Requests for Assistance in Dj)ig: A Phenomeno/ogical Inquii,, 10 INT'L J. PALLIXII\E NURSIN( 225 (2004). 2. Susan 1). Block & J. Andrew Billings, Patient Requests to Hasten Death: Eva/uation and Management in Te ina/ Care, 154 ARCI IIVES INTERNAL MED. 2039, 2043 (1994).

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