title: VSED Narratives: Exploring Complexity.
abstract: In this article three palliative care physicians review narratives about the complicated experience of voluntarily stopping eating and drinking (VSED). Despite consensus about its legality, the decision to end life by VSED is emotionally and ethically challenging for patients, family members and clinicians. Each VSED story is unique, and the individual perspectives within a single story may diverge, conflict, and evolve over time. The narratives differ substantially in the range of suffering described, from acute, graphic, physical symptoms to primarily anticipatory and psychological distress. The narrators' conclusions about the meaning of VSED also vary, some perceiving it to be an irrational act of suicide, others describing it as an affirmation of personal autonomy, and most with a mixture of sometimes conflicting reactions in between these edges. The authors conclude with observations drawn from the narratives about the potential in VSED for benefit, harm and conflict for all involved.
authors.forename: Robert
authors.initials: R
authors.lastname: Horowitz
authors.forename: Bernard
authors.initials: B
authors.lastname: Sussman
authors.forename: Timothy
authors.initials: T
authors.lastname: Quill
mesh_terms: D033101:Euthanasia, Active, Voluntary / Q000523:psychology; D026684:Personal Autonomy