More Patients Choose Starvation Than Assisted Suicide

A study suggests a surprising number of terminally ill hospice patients who choose to speed their deaths refuse food and drink.

Oregon is the only U.S. state that has legalized physician-assisted suicide. Researchers from Portland Veterans Affairs Medical Center surveyed 429 nurses in Oregon, who said patients pick self-starvation twice as often as physician-assisted suicide. Refusing food and water is legal everywhere in the United States.

One-third of the nurses said at least one patient deliberately hastened death by stopping food and fluids during the previous four years. Only a few patients abandoned their plan because of thirst or family pressure, according to the study, which is published in Thursday's issue of the New England Journal of Medicine.

"Voluntary refusal of food and fluids occurs often enough that it must become part of our dialogue on end-of-life issues facing care providers, terminally ill patients and their families," said Dr. Linda Ganzini, director of the Palliative Care Fellowship at the Portland Veterans Affairs Medical Center and professor of psychiatry in the Oregon Health & Science University School of Medicine.

The nurses reported that patients in hospice care who stopped eating and drinking were elderly, no longer found meaning in living, and 85 percent died a "good" death within 15 days after stopping food and fluids.

"We were surprised that patients who chose this means to hasten death were, according to their nurses, more peaceful and suffered less in the last two weeks before death than patients who choose assisted suicide," Ganzini said.

The researchers also interviewed doctors about their experiences with patients who request assisted suicide under Oregon's Death With Dignity Act.

"The idea to stop eating and drinking was not coming from the physicians," Ganzini said. "In fact, physicians worried about the choice and were surprised when patients had a very peaceful death and didn't suffer from hunger and thirst."

Ganzini said that although the number of people refusing food and water was surprisingly high, it accounted for only a tiny fraction of the more than 10,000 people who die under hospice care each year in Oregon.

New England Journal of Medicine: Study Abstract