Voluntarily Stopping Eating and Drinking (VSED): A Viable, Lesser Known Palliative Option of Last Resort
Voluntarily Stopping Eating and Drinking (VSED) has recently gotten attention as a viable 'last resort' palliative option for patients who want to escape their current medical situation through a self-initiated death, but might not qualify for a physician assisted death or might not want it even if they did qualify.
VSED is primarily under the patients own control, and it requires a tremendous amount of discipline and persistence to successfully complete. Physicians are not directly needed to carry out VSED, but they should be a central part of the evaluation process to ensure decision making capacity, and then part of the support process to help palliate symptoms and respond to challenges.
We will explore the clinical, ethical, legal, moral and cultural challenges and opportunities of this practice both in theoretical terms, and then through three real clinical cases:
- A patient with early to moderate Alzheimer’s who wanted no part of the later stages;
- A patient with advanced cancer and paralysis who wanted PAD but lived in NY where it is illegal, and
- A patient with advanced terminal disease and complex cultural issues around eating and intentionally hastening death.
Opportunity for interaction and exploration of the clinical, ethical and cultural elements of process itself, as well as how it unfolded in each of the cases will be provided.
Upon completion of this activity the learner should be better able to:
- Identify two clinical circumstances where VSED might be a viable option and two clinical contraindications to the practice
- Name two ethical principles that would support this practice as well as two ethical principles that might prohibit the practice, as well as the current status of the law around this practice in the US
- Recognize how VSED might be consistent with some cultural practices toward the end of life, and how it might be morally prohibited in others.
- Explore how the clinical, ethical and cultural aspects of VSED play out within a diverse group of real cases
AAHPM endorses the Accreditation Council for Continuing Medical Education (ACCME) Standards for disclosure and commercial support and endeavors to ensure balance, independence, objectivity, and scientific rigor for all accredited products or programs. All who are in a position to control or influence the content of an educational activity must disclose any relevant financial relationships with ineligible companies.*Disclosure documents were reviewed for potential conflicts of interest and, if identified, they were resolved prior to confirmation of participation. Only those who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this activity.
All editors, faculty and staff have disclosed no relevant financial relationships.
*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. (Exclusions at the time of this writing included 501-C not-for-profit organizations, government organizations, liability and health insurance providers, non-healthcare-related companies, group medical practices, for-profit healthcare providers, blood banks and diagnostic laboratories.)
Robert Horowitz, MD FAAHPM
Timothy Quill, MD MACP FAAHPM
Vyjeyanthi Periyakoil, MD
Continuing Medical Education (CME)
The American Academy of Hospice and Palliative Medicine (AAHPM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Academy of Hospice and Palliative Medicine (AAHPM) designates this Enduring material for a maximum of .50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME credits expire October 13, 2024.
Maintenance of Certification (MOC)
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
ABIM MOC points expire on October 13, 2024.
Physicians certified with the American Board of Internal Medicine who wish to earn MOC points within the current calendar year must submit their MOC data no later than December 31 of the calendar year.
- 0.50 ABIM MOC
- 0.50 CME (physician only)
- 0.50 Participation