Voluntary Stopping Eating and Drinking (VSED) is becoming a more recognized end-of-life choice, and more patients are choosing to hasten their death by stopping eating and drinking. Typically, they make this choice when they feel that their body is so severely compromised that their quality of life is no longer acceptable.
Many patients, afraid of a provider’s possible judgment, are reluctant to discuss this choice with a provider, and those who do talk with their provider about this choice, often find that he or she knows little about VSED – either about best practices and procedures or appropriate referral paths.
In Whatcom County, this lack of provider training about VSED as a possible choice at end-of-life has an additional complication.
Our county has only one hospital–a Catholic hospital. And Catholic teachings guide the system’s policies about some end-of-life options. Therefore, PeaceHealth does not clinically support the practice of either VSED or Medical Aid in Dying (MAiD).
And yet, we are pleased to report that the Continuing Education Committee (comprised of five PeaceHealth physicians) just gave permission to the Palliative Care Institute and the Northwest Washington Medical Society to submit an application for continuing medical education credits (CME) for a webinar on VSED to be offered this spring.
Although this decision to provide continuing education for a webinar with VSED as the topic may seem counter-intuitive given PeaceHealth policies, the committee’s decision to support the training of all providers (including PeaceHealth employees) about VSED is in line with both the American Medical Association’s (AMA) Code of Ethics and the American Nurses Association (ANA) Nursing Code of Ethics.
The AMA Code, which guides the ethics of interactions between physicians and patients, describes the clinical encounter as
“…fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering…The physician’s ethical responsibility is to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare.”AMA Code of Ethics
Both AMA and ANA Codes acknowledge that for some providers (and systems), patients’ needs and choices may be in tension with their own personal belief systems or values. The Codes also affirm that providers and systems should have latitude to practice in accord with well-considered, deeply held beliefs central to their self-identities. PeaceHealth’s policy not to support either MAID or VSED aligns with this part of the Code.
Yet the AMA Code goes on to assert that when a deeply held, well-considered personal belief leads a physician (or a system) to decline to provide treatment, the provider must
“…uphold standards of informed consent and inform the patient about all relevant options for treatment, including options to which the physician morally objects.”AMA Code of Ethics
The Code goes on to state that if a physician declines to provide treatment, he or she should refer a patient to another physician or institution and offer impartial guidance to patients about how to inform themselves regarding access to all desired services.
The Principle of Autonomy in the ANA Code guides nursing care in similar situations, stating that
“…it is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized because the medical team might not agree in those wishes.”ANA Nursing Code of Ethics
The CME Committee’s decision demonstrates that they understand that all providers need to be better educated about VSED, even if this choice may be in conflict with their own personal moral code or their employer’s policy.
So while this webinar will present information about an end-of-life choice that is not supported clinically by PeaceHealth, medical ethics clearly require that when a patient makes this choice, providers should have the basic knowledge about what this end-of-life option entails and the appropriate referral paths. The PeaceHealth CME Committee decision clearly affirmed this responsibility.
More information about the Webinar
This 2-hour webinar will examine Voluntary Stopping of Eating and Drinking (VSED) as an end-of-life choice, exploring moral, ethical, medical and legal issues that arise for patients, their families and providers. Although this webinar is intended primarily for those in the medical field, we welcome community participation.
Voluntary Stopping Eating and Drinking Webinar
Supporting Your Patients Who Choose VSED
May 13, 2021, 5:30-7:30 pm
Advance Registration Required
Visit link above for more information and registration links