Patient refusal of hydration and nutrition. An alternative to physician-assisted suicide or voluntary active euthanasia

PUBLIC AND scholarly debates on legalizing physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) have increased dramatically in recent years.1-5These debates have highlighted a significant moral controversy between those who regard PAS and VAE as morally permissible and those who do not. Unfortunately, the adversarial nature of this controversy has led both sides to ignore an alternative that avoids moral controversy altogether and has fewer associated practical problems in its implementation. In this article, we suggest that educating chronically and terminally ill patients about the feasibility of patient refusal of hydration and nutrition (PRHN) can empower them to control their own destiny without requiring physicians to reject the taboos on PAS and VAE that have existed for millennia. To be feasible, this alternative requires confirmation of the preliminary scientific evidence that death by starvation and dehydration need not be accompanied by suffering. DEFINITIONS Before proceeding, we will