Starvation Can Be A "Good" Death, Hospice Study Finds

August 4, 2003
Patients in hospice care who have voluntarily chosen to hasten death by refusing food and fluids are elderly, no longer find meaning in life, and tend to die a "good" death within two weeks, according to a report in the July 24 issue of the New England Journal of Medicine.

Physicians had varied responses. Some may feel uncomfortable and "complicit" at hastening death, while others feel that continued involvement in their patient's care is preferable to turning away. Setting the standard for physicians to "give permission" for this practice creates an ethical conundrum for some.

Some caregivers expressed the belief that voluntary refusal of food and fluids was preferable to committing suicide by overdose or other means. Although most of the deaths in the study were rated by the nurses as being "good," follow-up interviews with a subgroup of nurses revealed poor quality of death in some patients, such as prolonged survival and body odor after fasting in an obese patient.

One of the study's authors suggested that refusing sustenance may not be a good option for patients who do not have a malignant process or organ failure, because death may take too long and involve increased suffering.

The study's lead author, Linda Ganzini, MD, MPH, expressed concern that publication of the data could lead to "thousands of elderly, depressed people going on hunger strikes" and to some physicians offering this option to their patients before enough is known about it.

Of 429 hospice nurses in Oregon contacted to participate in the survey, 307 (72%) returned the questionnaire, and 102 of these (33%) reported that in the previous four years they had cared for a patient who deliberately hastened death by voluntarily refusing food and fluids. Reasons for this decision included feeling ready to die, viewing continued existence as pointless, and considering their quality of life to be poor.

Most patients (85%) died within 15 days of refusing sustenance. On a scale rated by the nurses from 0 for a very bad death to 9 for a very good death, the median score was 8. Compared with 55 patients who died by physician-assisted suicide, patients who died after refusing to eat or drink were older, less likely to want to control the circumstances of their death and less likely to be evaluated by a mental health professional.

For more information: www.medscape.com/viewarticle/459099 (free registration required).