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![]() Although the dying process is generally reported to be peaceful, symptoms such as thirst, pain, insomnia, anxiety, and delirium may require medical support. Studies show that the prevalence of VSED is underestimated and may in fact be higher than that of assisted suicide. Therefore, patients may resort to another option to hasten their death – voluntary stopping of eating and drinking (VSED) – wherein patients deliberately and voluntarily cease eating and/or drinking to bring about their own death earlier than it would have occurred naturally. Yet, euthanasia and assisted suicide (together called ‘assisted dying’) are legally prohibited in most countries, despite a recent liberalization in some North American jurisdictions. ![]() Severely ill patients with a short life expectancy may have the desire to hasten death. Physicians, lawmakers, and societies should discuss specific ways of regulating medical support for VSED in order to provide clear guidance for both patients and healthcare professionals. Thus, for many jurisdictions worldwide, medically supported VSED may fall within the legal prohibitions on suicide assistance. This is especially the case if a patient’s choice of VSED depends on the physician’s assurance to provide medical support. Second, we demonstrate, on the basis of paradigmatic clinical cases, that medically supported VSED is, at least in some instances, tantamount to assisted suicide. First, we argue that VSED falls within the concept of suicide, albeit with certain unique features (non-invasiveness, initial reversibility, resemblance to the natural dying process). In this context, dying by voluntary stopping of eating and drinking (VSED) is often proposed, and practiced, as an alternative method of self-determined dying, with medical support for VSED being regarded as ethically and legally justified. Physician-assisted dying has been the subject of extensive discussion and legislative activity both in Europe and North America. ![]()
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