Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA.
International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
J Palliat Med. 2021 Mar;24(3):376-381. doi: 10.1089/jpm.2020.0223. Epub 2020 Jul 9.
Voluntarily stopping eating and drinking (VSED) is an ongoing voluntary choice to forego food and hydration in an effort to hasten death. Ongoing caregiving is necessary as patients become weak and lose focus as a result of dehydration, but little is known about the process of supporting a patient through VSED. To explore the experiences of caregivers who supported a patient through VSED. Qualitative study with hematic analysis of transcripts of semistructured interviews with 24 U.S. caregivers for 20 individuals who had attempted VSED. Analysis produced four themes: (1) Caregivers believe that VSED is the best death available to the patient. (2) Caregivers act as advocates and worry that the patient's goals will be challenged by health care professionals, the community, or legal authorities; obtaining support from a hospice is an important way to legitimize VSED. (3) Through the VSED process itself, caregivers carry the responsibility for the patient's success as the patient becomes weaker and loses focus. (4) Because there is no social script to guide the VSED process, caregivers choose what roles to play during VSED, such as focusing on physical care or being emotionally present as the patient's spouse or child. Caregivers face unique challenges in helping patients undertake VSED. Many are uncertain about whether they will receive support from clinicians or the community. Support from health professionals may improve caregiver confidence and reduce worry.
自愿停止进食和饮水（VSED）是一种持续的自愿选择，即放弃进食和饮水以加速死亡。由于患者脱水会变得虚弱且注意力不集中，因此需要持续护理，但对于支持患者进行 VSED 的过程知之甚少。为了探讨支持 VSED 患者的护理人员的经历。这是一项定性研究，对 24 名美国护理人员对 20 名尝试过 VSED 的个体的半结构化访谈记录进行了血液分析。分析产生了四个主题：（1）护理人员认为 VSED 是患者可获得的最佳死亡方式。（2）护理人员充当倡导者，并担心患者的目标将受到医疗保健专业人员、社区或法律当局的挑战；获得临终关怀的支持是使 VSED 合法化的重要途径。（3）通过 VSED 过程本身，当患者变得更虚弱且注意力不集中时，护理人员承担着患者成功的责任。（4）由于没有社会脚本来指导 VSED 过程，护理人员在 VSED 期间选择扮演什么角色，例如专注于身体护理或作为患者的配偶或孩子在情感上陪伴。护理人员在帮助患者进行 VSED 方面面临独特的挑战。许多人不确定他们是否会得到临床医生或社区的支持。卫生专业人员的支持可能会提高护理人员的信心并减少担忧。
