More interest in self-chosen end of life by stopping eating and drinking

NieuwsuurStop eating and drinking in a hospice

Judith Pennarts

reporter Nieuwsuur

Judith Pennarts

reporter Nieuwsuur

There is a growing number of people who consider their lives complete and want to die by consciously stopping eating and drinking. Hospices receive more requests from people who choose this self-chosen end of life, which requires medical supervision. They die within one to two weeks in hospice. This is evident from a survey by Nieuwsuur.

If euthanasia is not possible, or someone does not want it, there are not many options. There is no Drion pill, drug X is illegal and leads to a potentially gruesome death. But there is another method: consciously refrain from eating and drinking.

Nieuwsuur approached forty hospices in total. Of these, 31 completed the survey. A large majority of them offer care and guidance for this process. General practitioners are also increasingly discussing consciously stopping eating and drinking.

Stien (not her real name), who is over 90, thinks it was nice. She was not eligible for euthanasia by her GP. “I honestly don’t like it anymore. I have a lot of pain in my legs and I am very incontinent. I think it’s enough. I had to come up with something else,” she says on the first day of her admission. She was now eating her last lunch.

She discussed her wish with family, friends and acquaintances and has now said goodbye. “There were several people who had never heard of it. Some were surprised and some thought I was brave.” She thinks it is important that the method becomes more widely known. “That there is help as soon as you are in such a situation.”

Jules Vermaat (96) consciously stopped eating and drinking and died two years ago, after nine days in a hospice in Alkmaar. Her niece filmed her journey from day one:

‘I’m ready for heaven’

General practitioners are more likely to receive questions about the method or bring it up themselves. For example, if people – in the eyes of the GP – do not meet the conditions for euthanasia. “These are people who want to prevent suffering and deterioration,” says hospice doctor Annemarie den Dulk in Roosendaal. “People who don’t want to get sick or are afraid they will end up in a nursing home.”

In principle, hospices only accept critically ill people with a life expectancy of a maximum of three months. “Clients with a death wish are not terminal in advance, but they become terminal through the process they enter,” says Yvonne van Ingen, palliative care consultant at a hospice in Alkmaar. “That is why we think it is important to guide them well and we therefore include them.”

Solutions

They now have a lot of experience at the hospice in Alkmaar and Roosendaal. The number of people admitted who want to stop eating and drinking has grown in recent years to about ten per year. In the other hospices that responded to our survey, it varies between five admissions per year to a single admission. The Central Bureau of Statistics, which does not specifically investigate this group, estimated in 2020 that more than seven hundred people die per year due to consciously stopping eating and drinking.

Van Ingen emphasizes that she does not go along too quickly with a client’s wishes and also speaks to family members. “We first look carefully: what is bothering you, are there any solutions?” For example, she recently had a lady who could no longer walk her dog. “While she could still do that with a mobility scooter. She wanted to try that at the time.”

Stopping eating and drinking requires quite a bit of perseverance from the client. People get thirsty, have a dry mouth, become tired, weak and experience dehydration symptoms including drowsiness. “But it is a misconception that it is an ordeal,” says Den Dulk. “If you do it under good medical supervision, with nurses who have experience and prepare people well, then it can be a nice process.”

They get a bit lost due to the lack of moisture and nutrition, says Van Ingen. “No matter how strange it may sound, if they ask for water, you don’t give it. Because you respect the death wish.” That is why the agreements with the patient and family members about the course of events during the various situations are recorded on paper. This should prevent misunderstandings.

Question answer

The impact of consciously stopping eating and drinking is enormous: for the family, but also for healthcare providers. Is it a painful death? Is there an age limit? And what does the guidance consist of? Read the answers to important questions here.

Not everyone with a death wish who goes to a hospice continues the process. More than half of hospices have had a client who could not cope or changed their mind. For example, Den Dulk had a client who drank anyway. “He occasionally walked to the tap and that is possible, people can smuggle. That in itself is not a problem. But we do ask whether the desire is still there. There may be reasons to stop stopping.”

Sterfbed

The Public Prosecution Service has announced that it is not a criminal offense in the Netherlands to kill yourself. Helping someone commit suicide or providing resources is a criminal offence. “But this does not concern actions that doctors and other healthcare providers perform around a patient’s deathbed,” the Public Prosecution Service says.

The Dutch Association for a Voluntary End of Life (NVVE) emphasizes that the choice to stop eating and drinking should not be born out of necessity. “Because the GP is not prepared to provide euthanasia or the waiting time at the Euthanasia Expertise Center is too long. It still happens too often that someone who meets the requirements and requests euthanasia does not receive euthanasia. Think of people with a stack of old age complaints, dementia and psychological disorders.”

Are you thinking about suicide or worried about someone? Talking about suicide helps and can be done anonymously via chat at www.113.nl or by telephone on 113 or 0800-0113.

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