Voluntary stopping of eating and drinking
By Dr. Roland Martin Hanke
The article refers to Bodewijn Chabot’s book Ausweg am Lebensende, which describes FVNF as a conscious way to end life at the end of life, explaining its tradition, physiological background, legal basis and practical procedure.
Although some supporters see FVNF as a method of suicide without primary physical symptoms or as an alternative to active euthanasia, the article focuses mainly on people with a high symptom burden at the end of life and no realistic therapeutic option. Hospice and palliative care professionals cannot evade questions about active life-ending wishes; discussing FVNF can be a sensitive way to explore the many dimensions of such wishes.
Hanke distinguishes reasons for wanting life to end. Suicidal actions may express protest, loneliness, depression or life weariness, and these must be carefully explored and addressed with psychosocial help and, where appropriate, medication. The article, however, concentrates on shortening a process of suffering and dying rather than ending non-limited life.
The legal discussion emphasizes the primacy of the patient’s will. Treatment against the patient’s will would amount to bodily injury and a violation of dignity. Accompaniment may include allowing dying, changing the therapy goal, stopping or limiting treatment, pain treatment, relief of dyspnea and palliative sedation.
The article also discusses physician-assisted suicide and the then-new German criminal provision on commercial promotion of suicide. Hanke argues that counseling about FVNF is not only permitted but required when it can slow down and humanize suicidal intent.
Ethically, FVNF demands careful case discussion and reflection with the person’s social context, especially in cases involving cognitive impairment, dementia or brain-organic damage. Preparation includes informed consent among those involved, symptom medication, bowel emptying, psychosocial support and spiritual reflection.
In practice, food and fluids may be stopped gradually or completely. Mouth care is central because it relieves thirst and gives relatives a deeply intimate, loving task. Food and drink remain within reach. Symptoms such as pain or restlessness can be treated, and during the first seven days FVNF is usually reversible without organic consequences. Death generally occurs after about twelve to fourteen days as part of kidney failure and cardiac arrhythmia and is often perceived by observers as peaceful.
Hanke concludes that voluntary stopping of eating and drinking is a self-determined action at the end of life. Its ethical dimension can be understood and accompanied. It creates time for preparation, farewell, reflection and reconciliation for everyone involved.
