[Refusal of food and fluids of a psychiatric patient in order to hasten death: obstacles for patient, family and care-team].
In this case-report we present a patient with a psychiatric history of a chronic depressive disorder. After a period of several years of ambivalence, he decided to refuse nutrition and hydration because he--in the words of the Royal Dutch Medical Association--was "suffering from life". There was no request for euthanasia or physician assisted suicide. His first attempt, that lasted six weeks, did not result in his death. A second attempt, four months later, ended successfully. We describe the pitfalls that the patient, his family and the professional caregivers faced in both trajectories. The premorbid psychiatric disorder with polypharmacy and several psychotropic drugs as a result, the enormous complaints of thirst, the role of his wife and the dilemmas faced by the professionals made this case very complex. These issues make such cases very challenging for professional teams that have to provide good palliative care.
Stichting de Waalboog, Nijmegen. R.Koopmans@waalboog.nl
R T C M
RT
Koopmans
W J M
WJ
Dekkers
D000368:Aged; D001293:Attitude to Death; D003681:Dehydration; D003865:Major Depressive Disorder / Q000523:psychology*; D004992:Ethics, Medical; D005190:Family / Q000523:psychology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000941:ethics*; D011570:Psychiatry / Q000941:ethics / Q000592:standards; D013217:Starvation; D016312:Treatment Refusal