Hospice patients refuse fluids to speed death

Bioethicist questions results of an Oregon study that says this practice is more common than thought.

By Andis Robeznieks, AMNews staff. Aug. 18, 2003.

Elderly terminally ill patients, particularly those with neurological diseases, may be "hastening their deaths" by refusing food and fluids in numbers greater than most people realize, according to a report in the July 24 New England Journal of Medicine.

Of 307 Oregon hospice nurses who responded to a survey, 102 (33%) reported that they had at least one patient in the previous four years who voluntarily refused food and fluids. The report also stated that 85% of these patients died within 15 days of refusing food and fluids, and most experienced a "good death" in terms of peacefulness and a lack of suffering or pain.

The study "brings this behavior out from underneath a rock so we can develop standards and be prepared for when patients and families bring this up," said the report's lead author, Linda Ganzini, MD, director of the Palliative Care Fellowship at the Portland Veterans Affairs Medical Center.

Dr. Ganzini said significant findings were the number of patients who refused food and fluids and the reasons given for the behavior, similar to those for choosing physician-assisted suicide, including being ready to die, having a poor quality of life and seeing continued existence as "pointless."

Mark G. Kuczewski, PhD, director of the Neiswanger Institute for Bioethics & Health Policy at Loyola University Chicago, criticized Dr. Ganzini's methodology and disagreed with her conclusion that this behavior occurs more than people realize.