VSED in Alzheimer’s Patients

Healthcare today has centered its focus on individuals having increased autonomy, especially with medical judgments. Autonomy is a fundamental principle giving individuals the liberty to determine their own actions based on the plan individuals choose for themselves. What happens, however, when one loses their ability to think or speak for themselves because their disease state has progressed so far? What happens when an Alzheimer's patient considers voluntary stopping eating and drinking, or VSED, or if their family is making the decision for them as a surrogate? It becomes a moral conflict to provide a way, like VSED, to increase quality of life by ending it prematurely, to end their suffering. These decisions are made daily and, like death, are inevitable.

We make decisions for ourselves on a daily basis. Many healthcare professionals, especially those who work in long-term care facilities, face the ethical dilemma to feed or not to feed those who are suffering from Alzheimer's and dementia. Many questions revolve around what would the loved one want? Will you continue to feed because it will enhance their quality of life? What if stopping feeding will increase their quality of life? Most people, including the patient, the patient's family and interdisciplinary team, want to preserve the patient's autonomy and control. Facilitating VSED honors the request of autonomy if that is what the patient has chosen.

Another benefit of VSED include increasing the family's comfort knowing that it was not their decision to end their loved one's life in this way. Family members experience great amounts of stress when decisions need to be made at the end of life, especially when the decisions are placed in their hands. It also gives family time to cope and have anticipatory grieving. They often wonder if they are doing the right thing and if that is what their loved one would have wanted.

Nonmaleficence and beneficence: to do good and to do no harm. Beneficence involves healthcare providers treating patients utilizing ways to provide them with the maximum benefit possible while doing no harm (whether intentionally or unintentionally), or nonmaleficence. In a situation like VSED in Alzheimer's patients, healthcare professionals must keep their beliefs and values masked about the situation and continue to provide care, as well as follow the patients' wishes.

The other side of the argument are the cons of VSED. Some view VSED as a form of suicide due to the definition of suicide”the act of taking one's life voluntarily and intentionally (citation). Many consider VSED as an act of suicide by omission. Some consider VSED a form of physician-assisted suicide (citation). Stated by Jack Kevorkian, As a medical doctor, it is my duty to evaluate the situation with as much data as I can gather and as much expertise as I have and as much experience as I have to determine whether or not the wish of the patient is medically justified.

Dehydration and starvation are thought of as forms of neglect, but neglect can also mean not listening to what the patient or their family wants (citation). In many cases, the Durable Power of Attorney can modify the patient's decision to stop eating or drinking if they feel like the patient would experience an increase in suffering, pain, and anxiety nearing their death. Others feel as if VSED is neglecting the human body, and that it is not allowing the body to succumb to death upon its own.

Is it ethically justifiable for a surrogate to make the decision to refuse food and drinks on a patient's behalf? If an individual with Alzheimer's loses their capacity, they must rely on their legal surrogate decision maker to either continue or discontinue life-sustaining treatment, like VSED, when the opportunity arises. The patient's wishes must be communicated to everyone involved in the decision-making process and care provided to the patient. This decision, however, can affect negatively on the family and the final decision can be a very controversial topic to family members. Keeping the patient alive for sake of family can be looked upon as a pro and a con. If the family chooses not to follow the patient's wishes of VSED, family members may continue to grieve or prolong their grieving process.

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