Voluntarily Stopping Eating and Drinking (VSED) With Hospice Support in America: A Case Series

BACKGROUND: Despite increasing public awareness of voluntary stopping of eating and drinking (VSED), there are no descriptions of the clinical course of U.S. patients who pursue VSED, with or without hospice support. MEASURES: We report on the socio-demographics and clinical experiences of U.S. patients pursuing VSED with hospice support. INTERVENTION: We employed retrospective chart review methodology to review a consecutive case series of 20 patients who requested and received hospice support for VSED. OUTCOMES: Average age was 80 years (standard deviation [SD] 14, range 50-95), 55% female, 85% White, 60% divorced or widowed, 100% spoke English as their primary language, 75% were living in a private residence, and 55% had a daughter as their informal caregiver. All patients (100%) who started VSED with hospice support died, and did so in an average of 9.6 days (SD 4.1, median 9.0, range 4-23). Eleven (55%) had documentation of thirst, 3 (15%) had documentation of hunger, 19 (95%) had documentation of taking pain medication at least once and 17 (85%) had documentation of anxiety, agitation, and/or delirium at least once, for which they received lorazepam (88%), haloperidol (47%) and/or quetiapine (29%). No patients required hospitalization or sedation. CONCLUSIONS/LESSONS LEARNED: While this study has significant limitations, VSED was completed by all who initiated the process, and death generally occurred within 10 days. Therefore, those initiating VSED should be considered eligible for hospice care, with care initiated quickly. Symptoms during VSED were typical of hospice patients and can be managed using common hospice techniques and medications.