{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:28:43Z","timestamp":1791473323990,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,3,12]],"date-time":"2018-03-12T00:00:00Z","timestamp":1520812800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Fraser-Parker Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,3]]},"abstract":"\n Voluntary stopping of eating and drinking (\n VSED<\/jats:styled-content>\n ) is a deliberate, self\u2010initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider\n VSED<\/jats:styled-content>\n tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden.\n VSED<\/jats:styled-content>\n can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician\u2010assisted dying or other palliative measures of last resort, However,\n VSED<\/jats:styled-content>\n is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well\u2010informed clinician who can provide appropriate pre\u2010intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support. Before initiation of\n VSED<\/jats:styled-content>\n , clinicians should carefully screen for inadequately treated psychiatric conditions, unaddressed symptoms, existential suffering, and evidence of coercion\u2014consultation from palliative medicine, psychiatry, or ethics is often indicated. The most common symptoms encountered after starting\n VSED<\/jats:styled-content>\n are extreme thirst, hunger, dysuria, progressive disability, delirium, and somnolence. Although physiologically similar to cessation of artificial nutrition and hydration, the onset and management of symptoms is often different. We propose an organized system for evaluating individual appropriateness for\n VSED<\/jats:styled-content>\n , anticipatory guidance, and management of symptoms associated with\n VSED<\/jats:styled-content>\n . A brief review of ethical and legal considerations follows.\n <\/jats:p>","DOI":"10.1111\/jgs.15200","type":"journal-article","created":{"date-parts":[[2018,3,13]],"date-time":"2018-03-13T00:55:14Z","timestamp":1520902514000},"page":"441-445","source":"Crossref","is-referenced-by-count":58,"title":["Voluntary Stopping Eating and Drinking"],"prefix":"10.1111","volume":"66","author":[{"given":"John W.","family":"Wax","sequence":"first","affiliation":[{"name":"Palliative Care Division Department of Medicine University of Rochester Medical Center Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy W.","family":"An","sequence":"additional","affiliation":[{"name":"Palliative Care Division Department of Medicine University of Rochester Medical Center Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kosier","sequence":"additional","affiliation":[{"name":"Palliative Care Division Department of Medicine University of Rochester Medical Center Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy E.","family":"Quill","sequence":"additional","affiliation":[{"name":"Palliative Care Division Department of Medicine University of Rochester Medical Center Rochester New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,3,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1814"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1850"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1353\/nib.2016.0028"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.09.001"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa035086"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1177\/104990919501200205","article-title":"Patient refusal of nutrition and hydration: Walking the ever\u2010finer line","volume":"12","author":"Byock I","year":"1995","journal-title":"Am J Hosp Palliat Care"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2015.0092"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216306071814"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-132-5-200003070-00012"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550230075041"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13454"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2007.0027"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-13-1"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005200000205"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0885-3924(94)00123-3"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3339-z"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1993.00410240021003"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1849"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1076\/jmep.29.1.61.30413"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-136-11-200206040-00014"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlp.2013.06.009"},{"key":"e_1_2_9_23_1","unstructured":"Bouvia v Superior Court 225 Cal. 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E 2d 651(1989)."},{"key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1086\/JCE201425110","article-title":"Legal briefing: Voluntarily stopping eating and drinking","volume":"25","author":"Pope TM","year":"2014","journal-title":"J Clin Ethics"},{"key":"e_1_2_9_26_1","first-page":"213","article-title":"Clinicians may not administer life\u2010sustaining treatment without consent: Civil, criminal, and disciplinary sanctions","volume":"9","author":"Pope TM","year":"2013","journal-title":"J Health Biomed Law"},{"key":"e_1_2_9_27_1","unstructured":"Vacco v Quill 521 793(SCt 1997)."}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fjgs.15200","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.15200","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:37:45Z","timestamp":1762195065000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.15200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1111\/jgs.15200"],"URL":"https:\/\/doi.org\/10.1111\/jgs.15200","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}