Abstract
Voluntarily stopping eating and drinking at the end of life can potentially hasten death as an expression of a person's self-determination. With voluntary assisted dying now legally available in Aotearoa New Zealand, and all but one jurisdiction in Australia, some people who do not meet the eligibility criteria for voluntary assisted dying may consider voluntarily stopping eating and drinking. This viewpoint paper aims to examine two questions: How should voluntarily stopping eating and drinking be understood in relation to suicide or other practices which hasten death? How is voluntarily stopping eating and drinking addressed within existing legal frameworks in Australia and New Zealand? Given that voluntarily stopping eating and drinking is a complex, multifaceted phenomenon shaped by individual ethical and moral interpretations and practices, debates about whether it constitutes suicide, a hastened death or a natural death are likely to persist. A reductionist approach to categorising voluntarily stopping eating and drinking is unlikely to adequately capture this complexity. We contend that voluntarily stopping eating and drinking should be considered as a distinct clinical issue that requires its own clinical interventions and support when initiated by patients. The legal positions in Australia and New Zealand are similar, with case law supporting the proposition that a competent adult may legally choose to refuse to eat and drink, even if it results in their death. Voluntarily stopping eating and drinking may be considered as a legally acceptable end-of-life care option, prompting consideration of providing palliation to individuals who have initiated it. There is an urgent need for research to better understand the motivations, experiences and support needs of those involved, along with informing the development of culturally appropriate guidelines with patients, families, clinicians and communities.