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Addressing and Managing Requests to Hasten Death

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Neuropalliative Care

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Abstract

In this chapter we discuss how to respond to and address requests by a patient for a hastened death. The initial response should always be exploration and maximization of palliative care. For persistent requests to hasten death that are rational and not the result of inadequate palliative care, discussion and education about the following options are appropriate: withdrawal/withholding of life-sustaining treatment, palliative sedation, voluntarily stopping eating and drinking (VSED), physician-assisted death (PAD), and voluntary active euthanasia (VAE). This discussion will be colored by the legal status for the latter two options in the jurisdiction in which the conversation is being held. We recommend referral to a palliative medicine specialist if there is any uncertainty about the appropriateness of the intervention, and in all cases where palliative sedation to unconsciousness, VSED, PAD, or VAE are being considered. Neurologic patients may present particular challenges in these circumstances. We use amyotrophic lateral sclerosis (ALS), Parkinson disease, Alzheimer’s disease, Huntington’s disease, stroke, and glioblastoma as model diseases to explore the special circumstances in neurology and how various options for a hastened death may be more or less appropriate depending on the underlying illness.

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Author information

Authors and Affiliations

  1. Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA

    Neal Weisbrod

  2. Palliative Care Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA

    Timothy E. Quill

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  1. Neal Weisbrod
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  2. Timothy E. Quill
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Corresponding author

Correspondence to Timothy E. Quill .

Editor information

Editors and Affiliations

  1. Assistant Professor, Department of Neurology, University of Washington Harborview Medical Center, Seattle, WA, USA

    Claire J. Creutzfeldt

  2. Professor of Neurology, Chief Neurology Supportive and Palliative Care Section, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Benzi M. Kluger

  3. Professor and Edward A. and Alma Vollertsen Rykenboer Chair, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA

    Robert G. Holloway

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Weisbrod, N., Quill, T.E. (2019). Addressing and Managing Requests to Hasten Death. In: Creutzfeldt, C., Kluger, B., Holloway, R. (eds) Neuropalliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-93215-6_14

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  • DOI: https://doi.org/10.1007/978-3-319-93215-6_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-93214-9

  • Online ISBN: 978-3-319-93215-6

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