Tim Quill on voluntary stopping eating and drinking

For this week's GeriPal podcast we are honored to be joined by Tim Quill, palliative care physician and bioethicist from the University of Rochester, New York. Dr. Quill has pushed our nation to seriously grapple with the issue of physician aid in dying with a remarkably thoughtful and measured approach. We talk with Dr. Quill on this podcast about voluntary stopping eating and drinking, and a paper on this topic he recently published in JAMA Internal Medicine. As noted in the podcast, I am deeply ambivalent about physician aid in dying. I find voluntary stopping eating and drinking (VSED) to be far more acceptable. Some of this has to do with the acceptability of positive and negative acts (positive act - giving a patient a prescription for lethal medication; negative act - not inserting a feeding tube in a patient who refuses to eat and drink). Some of this just has to do with the time course: patients who stop eating and drinking must have the resolve and dedication over time. And they can change their minds. We address many aspects of this issue on the podcast, including: Who is VSED appropriate for? What can patients expect? How does VSED compare to other "options of last resort?" What is the role of palliative care? Should hospice's deem a patient eligible if they would not have a less than six month prognosis if they continued to eat and drink? When should a psychiatrist be involved? What if the suffering is not physician, but social or psychological? Is VSED legal? Should clinicians routinely offer VSED to all patients with serious illness as an option? How do you feel about this topic? Feel free to respond in the comments, or on Twitter!