![]() In this systematic review we analyzed seven qualitative studies carried out in Australia, Canada, China, and United States. Our reflection is based on the systematic review and synthesis of qualitative studies (meta-ethnography) on the meaning of the WTHD in patients with advanced disease carried out by our group ( Monforte-Royo et al., 2012). The statements made in this article led us to reflect on whether VSED can properly be considered a particular case of the WTHD and, if it is the case, what the implication would be for clinical practice. Importantly, these people are physically able to take in food and fluids orally, but they are consciously unwilling to do so. The data from this study ( Bolt et al., 2015) suggest that VSED is a decision taken by adult or older patients with severe disease, short life expectancy, and dependency on others for everyday care. (2015) in the Netherlands, the role and involvement of family physicians when confronted with patients who accelerate their death by VSED was analyzed. In a recent study carried out by Bolt et al. VSED defined as “an action of a competent, capacitated person, who voluntarily and deliberately chooses to stop eating and drinking with the primary intention to hasten death because unacceptable suffering persists” ( Ivanović et al., 2014) leads to crucial questions about clinical ethics and clinical practice: what is the quality of life of the patients who prefer to die than to carry on living? What is the good care to provide to these patients and what is the good for them? What factors contribute to some patients wanting to die? Should this be understood as an unequivocal case of the wish to hasten death (WTHD), as a request to end their life? Voluntarily stopping eating and drinking (VSED) is a topic that raises challenging clinical and ethical questions. ![]() Failure to do so will mean that we run the risk of abandoning a fellow human being to his or her suffering. Prior to interpreting this act as a deliberate expression of personal autonomy, it is important to explore all possible areas of suffering, including physical symptoms, psychological distress, existential suffering, and social aspects. ![]() Thus, VSED is consistent with the wish to hasten death. In our view, VSED can be understood as a response to physical/psychological/spiritual suffering, as an expression of a loss of self, a desire to live but not in this way, a way of ending suffering, and as a kind of control over one’s life. We analyze the data reported in some studies in relation to primary care patients who died as a result of VSED and examine their results in light of the qualitative findings of patients that expressed a wish to die. The question is to what extent voluntarily stopping eating and drinking (VSED) may be considered an expression of a wish to hasten death, in the sense that the latter has been defined recently. Some persons with advanced disease but no significant cognitive impairments consciously decide to stop taking food and fluids orally, even though they remain physically able to do so.
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