Local and national media stories, often promoted by Compassion and Choices, are easily retrievable on the internet ( Gross 2012). Pitre (2009) documented legislative efforts in California to require physicians and other healthcare providers to inform patients of their “legal options including VSED” as end-of-life treatment ( Pitre 2009, 390–407). A recent review article estimated that 2.1 percent of deaths in the Netherlands (approximately 2,800/year) occur as a result of VSED ( Ivanovic, Busche, and Fringer 2014, 13). Additionally, the estimated number of deaths actually attributable to VSED alone is difficult to quantify though it is thought to be increasing. These issues are made even more difficult because clinicians, aid in dying advocates and lawyers all seem to have slightly different conceptualizations of the practice of VSED to hasten death. Responding to patient requests for symptom palliation related to VSED will require clear communication, expert assessment, establishment of a mutual understanding with regard to what services can be provided, and the formation of a relationship in which the patient does not feel abandoned. This obligation precludes participation in suicide or euthanasia ( United States Conference of Catholic Bishops 2009, Part V, Introduction). The Catholic tradition views life as a precious gift from God and recognizes that human beings do not have absolute power over when life begins and ends but do have an obligation to preserve the dignity of human life.
Hospice programs, in particular Catholic hospice programs, must remain steadfast in the philosophy that they do not hasten death by any method including VSED. Careful exploration of these issues is essential to the ongoing development of hospice programs and the future articulation of their mission. Conversely, accepting this patient would seem to contradict the very nature of hospice care and the mission of hospice organizations.
Since the hospice knows the patient's intention, denying the patient's enrollment in hospice could potentially leave a dying person without the palliation, spiritual, and bereavement support they might badly need. It was unclear whether the patient's medical conditions really required the symptom management of hospice nor was it clear that her prognosis had progressed from chronic to terminal except for her voluntary decision to stop eating and drinking.Ī key issue for the hospice in this situation is whether accepting a patient who is choosing VSED constitutes cooperation with suicide. At this point, the social worker phoned her manager stating her discomfort with the patient's request for hospice services. At the hospice intake interview, the patient and her husband tell the hospice social worker that the patient intends to hasten her death by refusing all food and fluids. Their coach instructed them on the protocol for “voluntarily stopping eating and drinking” in order to hasten death (VSED) and encouraged them to contact hospice for the palliation of symptoms which sometimes accompany VSED if they chose to do that. They both decided long ago that they did not wish to die by a lingering, debilitating death, and if that became a reality, they would choose to die “by their own hand.” Feeling more debilitated and fatigued by her chronic diseases and recent hospitalizations, the patient and her husband sought a “coach” from Compassion and Choices (an aid in dying organization). The patient is married and she and her husband have no children. Her primary care physician believes that depression is a major contributor to her fatigue and prescribed an antidepressant for her. V's breathing requires home oxygen therapy for most of the day and her other medical issues include some mild hypertension and chronic pain from osteoarthritis of her hip. V has decided that she does not want to be intubated in the future and she asked her doctor to sign a do not resuscitate order for her. After three hospitalizations in the last eight months, each requiring several days on a ventilator, Ms. V is a 76-year-old retired bank teller who has end-stage chronic obstructive pulmonary disease. The social worker tells you that there is a concern about a new client on the program whose case history is as follows: Imagine yourself as the director of a Catholic hospice program receiving a telephone call from your intake social worker.
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