Voluntary stopping of eating and drinking. On tackling its ethical ambivalence

Abstract

Definition of the problem: An ethical evaluation of voluntary stopping of eating and drinking (VSED) continues to be challenging not only for patients and proxies, but also for accompanying physicians and nurses. This article intends to clarify the existing ambiguity and ethical ambivalence often encountered when discussing VSED. Arguments: Informed by qualitative research with proxies of VSED persons, the distinction of individuals with and without terminal disease is introduced as a game-changing factor when tackling VSED in the ethical field. Setting the precondition of an autonomous patient with full decision-making capacity and basing on Thomas Aquinas’ fonts of morality, to look at intention and situation helps to ethically evaluate VSED and its medical support. Conclusion: Focusing on the primary intentions of terminally ill patients—moderating, not intentionally causing death—VSED appears ethically acceptable. Consequently, support by health care professionals should be provided, valuable both for the person concerned as well as her proxies. In cases of non-terminally ill persons, accompanying VSED needs to be answered in a broader context: specifically, of how to address the wish to end life by a person possessing full decision-making capacity.