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Review
. 2025 May 27;13(11):1264.
doi: 10.3390/healthcare13111264.

Carers' Perspective on Voluntary Stopping of Eating and Drinking: A Systematic Mixed-Methods Review of Motives and Attitudes

Christina Mensger  1 , Julien Poehner  2 , Maximiliane Jansky  3 , Yang Jiao  1 , Friedemann Nauck  3 , Henrikje Stanze  2
Affiliations
Review

Carers' Perspective on Voluntary Stopping of Eating and Drinking: A Systematic Mixed-Methods Review of Motives and Attitudes

Christina Mensger et al. Healthcare (Basel). .

Abstract

Background/Objectives: Voluntary stopping of eating and drinking (VSED) is a way to hasten death or end life prematurely. VSED is controversial, and research is essential to inform this debate. The aim was to systematically synthesize empirical data on the attitudes, motives, and experiences related to VSED from the perspective of caregivers. Methods: This systematic mixed-methods review (PROSPERO CRD42022283743) included qualitative and quantitative research. The MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT databases were searched for English and German articles published between 1 January 2013 and 12 November 2021. Studies examining experiences, attitudes, and knowledge regarding VSED were eligible. We analyzed the data inductively after quantitative data transformation. Quality and confidence were assessed using the Mixed Methods Appraisal Tool (MMAT) and GRADE-CERQual approach, respectively. Results: We identified 22 articles, including 16 studies. The participants were healthcare professionals and relatives, but not those who chose VSED. The motives for VSED are based on high symptom burdens and are closely related to self-determination. Most perceive VSED as a natural death and accept the patient's decision. However, this acceptance also depends on other factors, such as patient characteristics. Most healthcare professionals would accompany patients during VSED, sometimes leading to advocacy. Relatives often play an active role in VSED and may experience distressing grief if they struggle with their support or the dying situation. The confidence in the review findings ranged from moderate to very low. Our findings on the challenging and positive experiences related to VSED and the resulting needs have been published elsewhere. Conclusions: VSED is a complex phenomenon affecting patients, nursing staff, physicians, and relatives. We provide an empirical basis for VSED to support research, debate, and practice.

Keywords: attitude; end-of-life; experience; family; hasten death; health personnel; refusal of food and liquid; systematic review; voluntary stopping of eating and drinking.

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Conflict of interest statement

The authors declare no financial conflicts of interest. Non-financial competing interests: C.M. was employed part-time by the German Association for Palliative Medicine e.V. (DGP) from 2019–2022. Her detailed reflexivity statement can be found in the Supplementary Materials of Mensger et al., 2024 [48]. F.N. was the second supervisor of Nina Luisa Hoekstra’s dissertation, which was included in this systematic review. F.N. was not involved in data analysis or quality and confidence assessment.

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