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.
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