Addressing and Managing Requests to Hasten Death

  • Neal Weisbrod
  • Timothy E. QuillEmail author


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.


Hastened death Palliative sedation Voluntarily stopping eating and drinking (VSED), or patient refusal of hydration and nutrition (PRHN) Physician assisted death (PAD), or physician aid-in-dying, or physician assisted suicide Voluntary active euthanasia (VAE) Medical ethics Primary palliative care Amyotrophic lateral sclerosis (ALS) Parkinson disease Alzheimer’s disease Dementia Huntington’s disease Glioblastoma Stroke 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Rochester School of MedicineRochesterUSA
  2. 2.Palliative Care Division, Department of MedicineUniversity of Rochester School of MedicineRochesterUSA

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