Voluntarily Stopping Eating and Drinking (VSED)
VSED stands for “voluntarily stopping eating and drinking,” a legal right for any individual who wishes to shorten their dying process by refusing nourishment orally or through a tube. In order to hasten death, a person can voluntarily stop eating and drinking (VSED). By refusing any food or liquid, the body dehydrates, causing it to cease functioning.
For those who are considering using VSED to end their life, it is important to do so under the care and support of a medical professional. VSED is a process that requires commitment. One should not begin this process without a plan for symptom management and caregiving. Family and friends can be a great source of support for people who have decided to begin VSED.
For those who are considering using VSED to end their life, it is important to do so under the care and support of a medical professional or a hospice agency.
Why a person might choose this option
- This option does not require a diagnosis of six months or less of life expectancy.
- It does not require an MD, although it usually does require medical help for control of discomfort
- It allows a person to take control and to have time to say goodbyes
- It allows a person to die at home as most people desire
Who might choose this option?
- A person who is suffering physical or mental pain, but is not within 6 months of death, for instance ALS, Parkinson’s, Alzheimer’s, auto-immune diseases
- A person who fears loss of independence and quality of life
- A person who is determined and able to maintain the fast until death
- A person who has the support necessary to carry through with VSED
What are some of the challenges of this option?
- It may be very difficult for loved ones to refrain from encouraging food or liquids and even more difficult to withhold them.
- It may be difficult in the initial phases. Usually very ill people have already nearly stopped eating, but thirst can be hard, although mouth care such a lip moisturizer, mouth rinses, dry mouth products can help.
- Some medical providers or helpers feel that it is not morally right and may not participate.
- Some hospices or care facilities may not support or allow VSED. It is very important to determine this before entering a facility or engaging a hospice.
- It requires a great deal of support including 24 hour care after a few days. The patient often becomes too weak to walk and sometimes experiences delirium and so must be monitored to minimize any injury.
What are the expectations about using this option?
- The time to death is between 5 days and 14 days with 10 days being the average. This depends on underlying issues, condition, weight. Coma mostly happens about day five.
- After the first day or two, it is usually not painful though it does take discipline and support to provide comfort care
- Hospice may support from the beginning, or it may require a person to be in the dying process before providing services.
- VSED is NOT considered suicide and death certificates will specify underlying conditions.
Preparation for VSED
- Get all documents in order: Advance Directives, DNR, NM MOST, POA for both health care and financial, and your will
- Write or video specific intent to do VSED voluntarily to end life of suffering, dependence, pain to assure that there are no repercussions
- Enlist help of healthcare professional and a hospice that will support VSED
- Review current medications with your healthcare provider and discontinue all but comfort measures
- Obtain any comfort items desired: movies, books, music, picture albums
- Gradually decrease food intake
- Empty system as if for a colonoscopy to reduce discomfort
Care considerations for person choosing VSED
- 24-hour care will be necessary after the first few days to prevent falls and to provide support
- Thirst can be the most difficult issue, but can be ameliorated with lip moisturizer, oral sprays, dry mouth products, cool air humidifiers. Do NOT give ice chips or sips of water. This only prolongs the process. This can be very hard for caregivers
- Gentle touch or massage with moisturizing lotion
- Distractions such as movies, books (on tape if necessary) music, company
- Most discomfort can be controlled with medications from your healthcare provider and/or hospice