VSED: Voluntary Stopping of Eating and Drinking as A Way to Speed Up the Dying Process

Today in our Memento Mori Conversations about Death and Dying we discussed VSED.  I want to thank everyone who participated for such thoughtful and vulnerable sharing. I am honored that such beautiful and courageous humans are a part of this group.

As promised to those in attendance, and for those who were not but are curious, here are the note cards - the bare minimum of info - as well as a few starter resources for further exploration.

As always, please feel welcome to reach out for support - either from myself or for a reference to other providers. I will do my best to connect you with someone wonderful fitted to your needs!

Much Love to You All,
Rev. Maya

 
VSED
Voluntary Stopping of Eating and Drinking

 

1.
VSED is a mentally capable person’s conscious decision to refuse foods and fluids of any kind, including artificial nutrition and/or hydration, in order to advance the time of their death.
 
VSED is legal in all 50 states of the USA
In Canada, you have the right to refuse medical attention, even if it is life-saving.  (No one can legally force you to eat or drink.)
 
VSED is legal nationwide. The U.S. Supreme Court (in Cruzan v. Director), Missouri Department of Health stated that “a competent person would have a constitutionally protected right to refuse lifesaving hydration and nutrition." 
Therefore, VSED is legal for a person nearing the end of life who has the capacity to make their own medical decisions.

2.
If you choose VSED:
To cover all legal bases (both for yourself and your caregivers) in planning to do VSED it can be helpful to:

• Write down your wishes to not receive nutrition and hydration and attach them to your advance directive. 
• Video tape yourself making it clear that you do not want nutrition and hydration  
• Receive a psychiatric evaluation for decisional capacity and to rule out depression or other conditions that may affect decision-making capacity (if the person is not terminally ill).

It is completely FINE to change your decision at any time and to resume eating or drinking after starting VSED; caregivers chosen should agree honor that choice.

3.
 
What else is VSED?

• A patient’s legal right
• One option to consciously and voluntarily limit suffering at end of life
• Reassurance that there is an end to suffering or deterioration
• Supported by most hospices, and many end-of-life health care providers
• A patient-centered approach to care at end-of-life
• Consistent with the body’s natural dying process
  

4.
WHO might choose VSED?
 

• Someone with a terminal illness
• Someone with an illness that is likely to cause severe suffering as illness progresses
• Someone with a severe blockage of the gastro-intestinal system that makes eating and drinking extremely difficult, painful or impossible.
• Someone in early/cognizant stages of dementia
• Someone with a good support system to assist with the process
• Someone who is determined, well informed, and mentally capable, who decides to control their own dying
  

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More on Caregiving:
Caregivers may be on the lookout for spoken or unspoken desires to make amends, to forgive and to be forgiven.
Be open and accepting when/if dying person sees, hears or speaks with deceased loved ones or others in the “unseen” realms.

9.
How long does it take?
A person with a terminal illness may expect anywhere from a few days to a few weeks to pass from beginning the process of VSED to death.  Some people may experience unconsciousness within a few days, some may not become unconscious until the moment of death. A number of things contribute to the length of time it will take to die:

• Stage of illness
• Body weight – a larger body may take longer to die as it holds more moisture. A body that has a lot of fat takes longer to die.
• Hydration at time of start – a body that is well hydrated at the beginning of VSED may take longer to expire than one that is not well hydrated.
• Organs – strength of heart and kidneys plays a part in length of time it takes for organ shut-down.
• Willingness to go “cold turkey” – even the ingestion of ice chips to manage thirst will prolong life. 
• Ambiguity – if a person is uncertain they are ready to die, and/or if there is unresolved emotional turmoil, this may affect the length of time it takes for the body to die.

 

10.
How does it feel (for the dying person)?
Symptoms vary for individuals, and of course we on the outside cannot know everything.  From what we do know, the main symptoms that may accompany VSED are:

• Occasional hunger (especially in first few days)
• Thirst or dry mouth (may be relieved by good oral care)
• Muscle spasm or organ pain (may be relieved by medical assistance via pain medication, or by massage, warm compresses)
• Confusion and delirium as organs shut down and body chemistry shifts
  

11.
What to do while “waiting”?
Often, the process of VSED allows the dying person to think and share authentically in new ways.  Desire to communicate these my increase.  Some possible topics are:

• Expressing love to those one is close to via letter, video or in person.
• Attending to unfinished interpersonal issues
• Creating poetry or journaling
• Making some sort of art/craft/”legacy project” to leave behind for loved ones
• Receiving or participating in singing/chanting/prayer
• Inviting friends and family to say goodbye
• Sharing wisdom, wishes for those who will remain after the dying person is gone

Accepting gentle care such as massage, body lotion or oil to sooth dryness, hands-on healing or other forms of compassionate touch may be welcomed during the dying process, even if they might not have been in life.
Listening to music, being read to, even watching favorite movies may all be welcome.

12.
Is it possible to receive medications without fluids?

• Before starting VSED, review all medications with your doctor. 
• Liquid medicines will prolong life. 
• You and your health care team may choose to end use of all medications that cause dry mouth.
• Most likely, especially if on hospice, you will not be taking life-saving medications.  You can chose to stop medication for heart disease, for example, or for diabetes. This will speed up the dying process but are not likely to cause added discomfort.
• Continue medication for anxiety and/or pain as long as they do not require drinking or fluid intake such as IV.
• Be patient as your health care providers figure out the best medications for you while going through your VSED experience.
  

13.
Can I just stop eating but keep drinking?
Dehydration is an important part of the process. You can go for many months without eating and not die, yet experience prolonged discomfort.  In fact, dehydration can make the process less uncomfortable by

• Leading to fewer episodes of coughing choking or shortness of breath
• Reducing fluid overload (and drainage/release) from the body
• Lessening associated respiratory distress with heart failure and pulmonary edema
  

14.
How to Prepare for VSED?

• Learn as much as you can about the process
• Discuss deeply all aspects with loved ones, spiritual advisors, your own heart
• You cannot do this alone – you will need 24 hour care during the process. Hospice, or a medical team, family and friends may all be a part of your team. Give good thought to this.
• Understand your condition, the natural course it may take if you do not go forward with VSED
• Understand how your specific condition may evolve through the VSED experience
• If your condition is not likely to cause death within 6 months, medical professionals may require that you have a psychological evaluation to rule out depression or other decision-making capacity issues.  (If you are an elder, request a psychological evaluation specifically for seniors.)
• You may wish to create an Out of Hospital Do Not Resuscitate (DNR) order
• Make sure your paperwork is in order – will, password info, contact info, funeral/memorial plans, last words to loved ones, debts taken care of etc.

 

15.
What if I forget what I am doing?
Sometimes with delirium the dying person forgets their mission to die, and asks for fluids. Caregivers must give you fluids if you ask, so discuss (before you begin VSED) how you would like them to handle this if it occurs for you.

• You can suggest that they remind you in a gentle way bye saying something like “yes, I would be happy to get you some water, but I want to remind you that you wanted to stop eating and drinking to control your dying. Would you still like some water?”

NOTE: You can go back to eating and drinking in early stages of VSED, but doing so in late stages may be painful and difficult as organ damage may be irreversible – that is, organ dysfunction and associated pain and suffering may be expected.

17.
What obstacles might a person choosing VSED face?
While legal, not everyone is “OK” with VSED. Getting the support you need may be difficult based on

• Your geographic location
• Your religion or cultural biases
• The stage of your disease
• Your age (it is more difficult to find support if you are younger)
• Your living situation (it may be easier to get support in a care facility than a remote cabin)
• Your provider’s beliefs
  

18.
WHAT ABOUT ETHICS, IS IT OK TO CHOOSE TO DIE?
Is VSED Suicide?
How is VSED different from PAD/DWD (Pysician Assisted Death/Death With Dignity)?
Does my religion sanction it?
Caregivers, what are your beliefs vs. your loyalties to someone you love
choosing VSED?

These are crucial topics to explore if you or a loved one are considering VSED. I, Maya, neither suggest nor deter anyone from exploring VSED or other controversial subjects around death and dying.  I do, however, strongly urge anyone considering - or loved one of someone considering - a pathway towards death to consult a professional in the arena of death and dying for guidance.

A good guide is someone who has experience with death and dying, someone who is at least somewhat versed in religious or cultural view and biases that you may encounter, someone with training in psychological issues faced around dying or supporting the dying, and other topics that may be relevant to you specifically.

Here are A  Few Starter Resources

There are MANY - start looking and reading and listening and you will find other helpful sources online with ease! 
Note: The first few are sources of support, the last two - for those who may lean this way - are focused on ethical concerns around the practice of VSED.

VSED Resources Northwest
https://vsedresources.com/education-outreach/vsed-reading-list
 
World Federation Right To Die Societies
https://wfrtds.org/novels-on-assisted-dying/voluntarily-stopping-eating-and-drinking/
 
Dying with Dignity Canada
https://www.dyingwithdignity.ca/blog/vsed_vsc/
 
journal of Pain and Symptom Management on VSED
https://www.jpsmjournal.com/article/S0885-3924(23)00565-1/fulltext

 
Ethical Dilemma – VSED and PAD (Physician Assisted Death)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569446/
 
Concerns about VSED in Canada:
http://eol.law.dal.ca/?page_id=2475

PPS: Thank you for making it through this long post on a potentially difficult subject. If you find yourself stressed, curious, or in any way desirous of support, please feel welcome to reach out to book a session or request a referral.  I will do my best to get back to you as quickly as I am able.

Blessings to You Upon Your Journey, at whatever stage that may be.
May you find Grace, Presence, and plenty of Healthy Support along the way!

With Love Always,
Rev. Maya

PS: Thanks in advance for forgiving my typos!
PPS: You may request the PDF of this info via email.