Should Terminal Sedation Be Expanded to Individuals Who Choose to Die Via the Voluntary Stopping of Eating and Drinking?

The voluntary stopping of eating and drinking (VSED) is a phenomenon whereby an individual with decision-making capacity chooses to cease eating and drinking with the intention of ending their own life. This is widely acknowledged as a lawful, albeit uncommon, end-of-life decision. It is now generally accepted that patients undertaking VSED should have access to appropriate palliative care, as per any other form of dying. However, it remains unclear whether terminal sedation (TS), the use of sedative drugs to treat intolerable symptoms at the end of life, should form part of this palliative care. In this paper, we explore and defend the use of TS in the management of VSED. We argue that TS is medically appropriate in the management of patients undertaking VSED who develop refractory delirium and have previously consented to TS. We further argue that, given the life expectancy window in cases of VSED, the appropriate use of sedation during this time does not hasten death and fits within the 2-week limit applied to traditional TS. We conclude that TS is medically and ethically appropriate in the management of VSED.