Occasionally patients do make a deliberate choice to stop taking in food and fluids and they may actually say they are doing this to speed up the dying process. These are people in the last stages of a terminal disease. They do not suffer from a mental illness or other condition that has affected their reasoning. They are not suicidal in the usual sense of the word. They have concluded that the burden of living has gotten so great that they would rather die sooner.
This choice is usually disturbing to family members and the medical personnel. When a patient does make such a choice the family and caregivers do need to be sure that the patient is not suffering from depression or inadequate pain control. Perhaps these conditions could be adequately managed and once under control the patient may no longer want to hasten death. It is very important to consider the conditions that the patient feels are too great a burden and see if they can be relieved. These burdens may be emotional issues such as discord in the family or spiritual issues.
After the emotional, spiritual and symptom management issues have been adequately addressed, the patient may still choose to refuse to eat. If this happens, it usually is in the very last days of the course of the disease. Just as a patient can refuse surgery or chemotherapy that might prolong life, a patient also can refuse to eat. However, finally, the patientís decision binds everyone else.
A Case Study
The patient was 42 years old and had been suffering from slowly disabling neurological disease for ten years. He had concluded the burden of living had become so great that he was ready to die. He had a faithful and loving wife, a caring larger family and even continued to work as a consultant out of his home. He was confined to his wheelchair or to bed. He was totally dependent on others for all his care. He took massive doses of medications just to be able to get out of bed in the morning and keep his vital systems going. He experienced regular infections and occasional hospitalizations. He was a man of deep faith and regularly worshipped at his congregation. He knew his disease was terminal and that his condition would only get worse.
He rejected the idea of suicide for moral reasons as well as the burden it would place on his family. He chose to stop all his medications and let the disease run its natural course as quickly as possible. Over the months following this treatment plan, he became weaker and more frail. He kept a low grade bladder infection, enough to make him uncomfortable. His heart and other vital systems were failing. Six days before his death he stopped eating and drank only sips of water. He was fully conscious during his last days. He had pushed his body to his physical limits and knew that to refuse to eat and drink would allow his death to come more quickly. He died peacefully in the night, his wife sleeping at his side.
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