Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities

Area of Science:

• Gerontology
• Bioethics
• Palliative Care

Background:

• Residents in long-term care (LTC) facilities with terminal illnesses may request to hasten death through voluntarily stopping eating and drinking (VSED).
• LTC clinicians face ethical dilemmas balancing resident autonomy and safety with moral objections to hastened death.
• VSED requests necessitate careful assessment to uncover underlying suffering and ensure resident rights are upheld.

Purpose of the Study:

• To provide guidance for LTC facilities and staff on managing requests for VSED.
• To outline a framework for addressing resident autonomy while ensuring safety and ethical care.
• To offer practical strategies for supporting residents who choose VSED.

Main Methods:

• Review of ethical considerations and clinical best practices for VSED.
• Emphasis on interdisciplinary assessment, care planning, and staff training.
• Recommendation for independent second opinions, particularly from palliative care specialists.

Main Results:

• Initial VSED requests should be viewed as opportunities to explore underlying concerns and suffering.
• Rigorous assessment, interdisciplinary planning, staff training, and documentation are crucial.
• Facilitating VSED can honor resident-centered care when it is the only option to relieve suffering in terminally ill residents.

Conclusions:

• LTC facilities must develop protocols to manage VSED requests ethically and effectively.
• Balancing patient autonomy with safety and ethical considerations is paramount.
• Supporting residents through VSED, when appropriate, aligns with resident-centered care principles.