title: [Conscious refusal of food and fluids by Dutch nursing home patients in order to hasten death: a matter regarding patient and physician?].
abstract: Refusal of food and/or fluids frequently occurs in nursing home patients. If the patient's decision to stop eating and drinking has been taken consciously and with due consideration of the consequences, it is referred to in Dutch as 'versterven'. A mentally competent, 73-year-old male nursing home patient suffering from progressive supranuclear palsy wished, in order to prevent further suffering, to end his life by taking sleeping tablets that he had saved up and by refusing artificial food and liquids. This wish met with a lot of legal and moral objections from the board of directors of the nursing home as well from experts consulted by the nursing home physician. Closer examination afterwards, however, showed that the patient would have been spared a lot of uncertainty if all parties concerned had been better informed as to the legal and moral framework. There are no legal objections as long as the doctors assess the refusal of food and drink with regard to voluntariness, deliberateness and permanence. If we as a society accept that mentally competent patients who are fully aware of the consequences and of possible alternative methods of treatment may take this road, then there would seem to be no moral obstacles either.
authors.affiliation: Afd. Verpleeghuisgeneeskunde, Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen. r.koopmans@vphg.umcn.nl
authors.forename: R T
authors.initials: RT
authors.lastname: Koopmans
authors.forename: I P
authors.initials: IP
authors.lastname: Sindram
authors.forename: W J
authors.initials: WJ
authors.lastname: Dekkers
mesh_terms: D000368:Aged; D003657:Decision Making; D033101:Euthanasia, Active, Voluntary / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D010819:Physician's Role; D016414:Resuscitation Orders; D019452:Terminally Ill / Q000523:psychology*; D016312:Treatment Refusal; D028761:Withholding Treatment