Sterbefasten – voluntary death by renunciation of food + drinking

Fasting to die – the wish to die in a self-determined way and to be allowed to put an end to one’s agony. A guest contribution by Christiane zur Nieden.

The fact that a person becomes dependent on care completely upsets his own life and that of his relatives. The need for care can drag on for years or even decades, putting a strain on everyone involved. However, there are also relatives who devote themselves to this task with love and for whom no burden seems to be too much.

But also relatives are concerned, with whom the daily demand takes its toll, since they become in the course of the care time ever more needy themselves.

With all these possible constellations, it is not surprising that a person in need of care may become tired of suffering, even tired of life, tired of care, and express the wish to die. One possible form: the Dying fast.

Here we distinguish between two forms in which the wish to die is expressed: implicitly or explicitly.

Death fasting – The implicit form

Implicitly means that the dying person simply turns his head to the side when taking food or drinks, shakes his head or simply pinches his mouth shut. Whether he gives these signs to the caregiver consciously – with the conviction and intention of wanting to end his life, or whether he does it more unconsciously, since his life forces are leaving his body and they don’t need any more energy input, we don’t always know.

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However, it remains to be established that this person in need of care wants to say something with his reaction, namely: I don’t want any more. Maybe he just does not want today, because he is not well or it z.B. is too hot to eat. As relatives, we should keep offering food and drink for the next few days, but accept his refusal if he continues to "communicate" it, and not force him to eat.

Coercion against the will of the person fulfills the criminal offense of bodily harm.

Man does not die because he no longer eats or drinks,
but he eats and drinks no more because he dies.

Many relatives understandably find this very difficult to accept. At this point, every caring relative should ask himself whether he could imagine to lie in the place of the sick person for months or even years and be cared for. Often the change of perspective helps with the acceptance of the dying wish.

My book recommendation: Dealing with dying fasting

Voluntary abstention from food and fluids (FVNF) is a natural, self-determined form of dying. This book is intended to help relatives to understand the dying and to accompany them lovingly and with understanding on their last journey.

The author Christiane zur Nieden did not only accompany her mother during her fasting for death. She also presents other examples in this book to show family members that they are not alone in dealing with this issue.

Sterbefasten – The explicit form

The explicit Form to express his wish to die is direct communication, as it was z.B. my mother did at the age of 88 in 2010.

My mother was multimorbid and a spatial change of her living situation was imminent. She was able to live alone in her small apartment with a lot of help, but in a few weeks she would have had to move in with us or into a nursing home, but no one in the family wanted that.

Since both alternatives were out of the question for her, she asked my husband, who is a doctor, for a lethal injection, which he had to refuse, since this is strictly forbidden in Germany. When she asked me then for a solution, how she could die, I introduced to her the "Sterbefasten". So the renunciation of food and liquid, with the intention to die. We then explicitly discussed everything and also her motives, the possible problems and advantages of this form of dying, as far as I already knew at that time through my years of assisting dying.

Most of the people who express this wish to die are already very old, which means that they eat and drink possibly. not much for a long time.

My mother, who was visibly getting weaker and weaker, but who also refused any diagnoses and therapies at her advanced age, had already spent the last few weeks eating and drinking like a sparrow. Thus the renunciation of food and later also of liquid was not so difficult for her.

Gerald Neitzke, a medical ethicist from Hanover, said at a lecture: Everyone stops eating and drinking at some point. The only question is when it should be called "fasting to die".

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What happens in the body during death fasting?

If the decision to the Sterbefasten comes from the patient, it happens completely voluntarily and self-determined, it comes by the food renouncement as with the welfare fasting to a body-own Endorphinausschuttung, which is mood-lightening, mood-stabilizing and pain-relieving. This fact helps to endure this dying process, which is not easy. According to ca. 48 hours the hunger is gone and against the thirst must be made good and continuous mouth care.

If these basic conditions are given: Self-responsibility of the person wishing to die (d.h. (no severe mental illness), voluntariness and the fact of having considered all pros and cons and other perspectives, the dying person and the caregiver can use the remaining time together meaningfully. Knowing that it is now really coming to an end, that this time of life is limited, is what makes it so valuable and offers the opportunity

  • to assure themselves of love once again,
  • to pick up old "chickens,
  • confessing family secrets and
  • express their gratitude.

If these basic conditions are fulfilled, then it is also no "miserable starving and dying of thirst", then the Endorphinausschuttung helps to master this dying process even in a good mood, presupposed it good mouth care is accomplished. Then this dying process, even if it was started with suicidal intent, resembles a natural dying process.

A doctor should be brought on board so that the discontinuation of the previous tablets can be discussed and also possibly. A medicine can be prescribed against occurring lying pain or restlessness.

The advantage of this conscious renunciation of food and drink is that this process can be easily reversed during the first period and the person in need of care can return to life. It takes a strong will and a lot of stamina to go through this dying process. But it is basically the last self-determined act that a person who is otherwise only dependent on help can perform. For a person with a wish to die, this step can be difficult and at the same time a liberation.

Accompaniment during fasting for the dying by relatives

If the dying wish is explicitly expressed, a good, detailed communication without reproaches should first find space again and again before the dying fast begins. Only through good communication can concerns and fears be eliminated and all parties involved can pull in the same direction.

It took me two days before I was able to accept my mother’s dying wish. I have discussed everything with her and she has described her motives to me in detail, so that I could understand her decision well. I know that it may be difficult, as a caregiver for years, to accept the dying wish of your loved one:

  • What will be when he is no longer there, when I no longer have to care for him?
  • What will become of me then??
  • What do I do then, when my daily care work is omitted?
  • Do I then fall into a deep hole?

But doesn’t love for a person also include accepting their will and being able to let go?.

My mother’s self-determination was very important to her, after having had an authoritarian husband all her life and having fought and worked for her self-determination after the death of her partner. It was her last and perhaps also her greatest wish for me as her daughter to accept her dying wish and to accompany her lovingly on this last path. And I fulfilled her wish, even if I would have liked to have her by my side for a few more years.

Sterbefasten, d.h. the wish to die in a self-determined way is a big topic with many facets that I can’t even list all here.

In the PDF document Nursing Aspects for the Dying / Fasting for the Dying you will find further information on the subject of mouth care, nose and lip care.

Eating and drinking in the last phase of life

Even if I repeat myself, I would like to remind you of this sentence: "The seriously ill person does not die because he does not eat,
but not eat anything because he is dying!"

In the last phase of life, appetite and hunger decrease more and more. The organs gradually stop functioning. Food can no longer be utilized and is more of a burden to the organism than a benefit to it.

Some cancers lead to severe emaciation, which cannot be stopped even by high-calorie supplementary food. The tumor prevents the other cells of the body from properly processing the ingested food.

ONLY the wishes of the seriously ill should be fulfilled! This also means that certain diets, such as those for diabetes or liver disease, no longer have to be followed. What tastes good is allowed.

Artificial feeding in the last days of life can put a lot of stress on the body. Fluid is stored, which can lead to shortness of breath, nausea and additional pain.

The most important thing in short:

  • Offer favorite foods.
  • Arrange small portions in an appetizing way.
  • Offer mushy or viscous foods.
  • Ice in all forms: Ice cream, ice cubes, also juices, cola, tea or beer.
  • Administer liquids drop by drop with a small syringe or spoon; a soaked rag for sucking is also possible.
  • Extensive and thorough mouth care – in addition to water or tea, aromatic oils or coconut oil are also suitable for this purpose.
  • Artificial supply of fluids does not eliminate the feeling of thirst.

Death fasting – a supplement to the living will

So that doctors, nursing staff and also relatives can follow your wishes, you should make an additional addition to the living will. A corresponding sample text is available here:

Living will for people who have decided to fast for death

(please fill in your full name, date of birth and address)

Disposition

Regarding my premature death by voluntary abstention from food and fluids (FVNF)

declare after careful consideration on the basis of my whole attitude to life and on the basis of my present health situation

The following:
I have decided to end my life prematurely in the very near future by voluntarily abstaining from food and fluids (FVNF).

I hereby decree: If I become unresponsive during or as a result of FVNF, no attempt whatsoever may be made to save my life; rather, even then my will to die must be consistently observed.

In particular, I prohibit resuscitation, artificial caloric intake in any form whatsoever, and artificial hydration (except when it is essential for palliative care as the only means of administering palliative medications).

Neither a physician nor relatives or other persons may prevent the occurrence of death in any way, whether by their own measures or those of a consulted emergency physician. Should there be a life-threatening or life-shortening complication (such as z.B. pneumonia) or an infirmity, or an existing condition worsens:

( ) so the reduction of a suffering possibly connected with it should be the aim of medical actions, without these measures leading to a retraction or a withdrawal of the patient. blockage of my self-chosen way out of life lead to.

( ) this is how to proceed in the sense of my living will from…….

I wish, if necessary, to receive care and palliative care as is customary in end-of-life care (with special attention to oral care, respectively. Keeping the mucous membranes moist). My dying process is to be allowed on the one hand, on the other hand facilitated if necessary (z.B. Relief of anxiety, significant discomfort, pain, thirst, vomiting, shortness of breath, etc.; I expressly agree to palliative and pain-relieving measures.

Since this current FVNF Patient Decree is completely unambiguous in its binding nature with regard to the therapeutic goal to be rejected, no guardian or proxy is required for its implementation. I reserve the right to change my mind during the first days of my voluntary renunciation of food and liquids. However, I reject any form of urging to do so as coercion, and I do not wish for food or fluids to be offered to me unless I would ask for them while still in a state of understanding. If a living will has been previously written by me, it will remain in effect. The FVNF order made today is if necessary. to be considered as their update, which, with its clear situational reference, has priority in case of doubt.

Conclusion

I wish you all a lot of strength for your usually not easy, very self-sacrificing work and also strength for the moment when your relative to be cared for gives you to understand implicitly or explicitly that he does not want to live any longer. My mother would certainly have liked to live a little longer, but not at the price and with the possibilities that life still offered her, despite all the help and aids available to her. Some of the dying fasting patients we have accompanied have also found thirst agonizing, despite good oral care, but – as one of those affected expressed it – continuing to live is much more agonizing.

Christiane zur Nieden - honorary death and grief counsellor

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Comments to the topic "Sterbefasten: Voluntary death by renunciation of food + drink"

We do not know your motives and cannot advise you also from technical regard unfortunately at all. It may well be that you had perhaps a wrong contact person in the psychiatry and another therapist/doctor would have been better for you.
Please contact your attending general practitioner/specialist so that he can help you comprehensively.
Self-help groups can also help you.
Another very good contact point is the telephone counselling service. You can reach them nationwide at 0800 / 1110111. You can reach the pastoral care also via chat or mail. Read more on the website of the telephone counselling service.
I’m sorry that we were the wrong person to talk to about this. Nevertheless, we are convinced that you will be helped at the listed places and you will find new courage to live again.

I want to die. I am mentally ill. Was probates in psychiatry and nothing has helped. How can I get help to die.

On the question whether you need a further order, I recommend you to visit a lawyer, who can examine that properly and also judge, what you must do exactly.
I can advise you with your second question also only to speak with your physician about it whether it is possible to donate the body after the Sterbefasten.

Dear Mr. Beier,
I have decided some years ago for dying fasting. In my living will I have given my consent for passive euthanasia and expressly stated that I do not wish to receive fluids or artificial nutrition.
Furthermore, I have stipulated a modification of the guarantor obligation, for my voluntary and premature death by food-u. Fluid renunciation. It should give me the possibility to end an unbearable condition, if I wish it.
Do I then still need o. g. Disposition for premature death?
Furthermore, I have a contract for body donation.
Will there be problems with body donation if I want to voluntarily end my life by this method?
I guess I can’t be 100% sure that my body will be taken then, or? Unfortunately I have not found anything concrete.
Perhaps you can say something regarding my concerns.

Lis,
this fictitious example is somewhat contrived. If it were "real If it were "real", then (inferring from the whole description) the mother-in-law would have gotten involved in an argument (s. Dispute previous day).
Based on book research, I have spoken with many terminally ill people, relatives, hospice staff, doctors, etc. Conversations held. Therefore I can consider it only as a very extreme case and rather improbable case. Something is always and everywhere possible.

An example of certainly many other possible ones for how it could also go, if that dying wish could have been based on a misunderstanding that unfortunately cannot be cleared up any more. Therefore, in my opinion, the point is missing in your explanations that it is in any case important to inform yourself about the motive in detail. Because it could not only have led to a misdiagnosis, a patient mix-up or just something like this invented example shows here:

A mother of almost 90 years lives with her daughter-in-law. One day she sees on the open screen a book with the title "Voluntary Death Fasting"
The elderly lady reads a little in it and concludes immediately, above all, because there was still this violent quarrel with the daughter-in-law the day before, for itself secretly: "Oh, so that is the desire here in the house, so it looks like that. She falls into a mild depression because she feels that she is only tolerated. But soon she thinks: Your wish is my command, they can have that with pleasure. The old lady is sure, even if she is in the middle of a mistake, which she can’t recognize, that the young people in the house wish that the mother should leave voluntarily", because the strain was quite high. She even brought some understanding to it.
From that moment on, based on this false premise, on a simple misunderstanding, she starts dying fasting and asks in each case to accept her wish, she would not want to explain herself about it either. And dies. She dies, although this was not her own wish, but she was sure that it was the wish of the daughter-in-law or also of the son to be finally freed from the burden of the care of the mother.
But if the daughter-in-law or the son had asked the mother in detail why she was doing this, they would have found out that she found this article in the PC and "knew" afterwards what to do.
But then the mother-in-law would have found out what a big misunderstanding there was, because this article had been searched out for a colleague at work by the son of the daughter-in-law and was forgotten to shut down the PC by a colleague who had asked her to search out something from the Internet because of her mother.
It can be so stupid. Therefore it is – I mean even meanwhile regulation to inquire in a detailed conversation about the reasons for the voluntary dying-want, in order to find out such and similarly stored misunderstandings and to be able to eliminate them from the world. LG Lis

Thank you for your praise. That really pleased me. Above all, that I could help you further.

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