Saturday, March 26, 2005

Patients who refuse food and fluids to hasten death

Patients who refuse food and fluids to hasten death.
Letter by Schaler, reply by Ganzini et al. This letter appeared in the October 30, 2003 issue of NEJM (349:18, pp. 1777-1779). Note the reply by authors. The study was cited in the opinion piece by Timothy Quill that appeared in the March 24, 2005 issue of NEJM.


At 3:31 PM, Blogger Mira de Vries said...

Hastening death by withholding nourishment and liquids is common practice in the Netherlands. There is nothing voluntary about it. The family will sometimes be warned not to offer food or drink to the patient, because she has supposedly lost her swallowing reflex. Or they will be told that offering food and drink will prolong the suffering.

These last weeks the news have prominently reported on widespread starvation and dehydration in nursing homes, not because the patients or family requested or, nor because the staff have decided to speed up death, but because they are too busy to help patients, many of whom cannot manage eating and drinking on their own.

The effects are distressing. How aware the patients themselves are about what is happening to them, and to what extent they suffer, is generally not knowable, but the family are gravely distressed by watching their elders slowly starve or thirst to death.

I cannot imagine anyone choosing to die this way, except perhaps in an advanced stage of dementia, when the administration of IV drips and feeding tubes requires restraining the patient.


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