‘VSED’ to Hasten Death for the Terminally Ill

What is VSED?

VSED means refusing all food and liquids, even those through a feeding tube, in order to hasten death. One advantage of deciding on VSED is that a person may have a change of heart and resume eating and drinking.

While VSED might seem like a straightforward way to end one’s life, it isn’t something to take on yourself. Instead, it will ideally be part of advance care planning and a collaboration among you, your healthcare providers, and your loved ones.

Preparing for VSED

A bit of planning can ensure that your wishes are respected and your end is as comfortable as possible.

• Before you start, let your doctor know of your plans. Discuss your medications and find out if something is available to help keep you comfortable.
• If you don’t already have one, create an advance directive, informing everyone in writing that VSED is your wish. Your physician will then sign orders to withhold life-sustaining medical care and resuscitation efforts.
• Talk to those who care for you, explaining why you chose VSED. Support from loved ones and friends is essential, but you should be prepared for some to be unsupportive of your decision.
• Take care of your business and financial affairs, make funeral arrangements, and say your goodbyes.

If you are receiving hospice care, your team can help you prepare. If not, ask your doctor for a referral to a hospice provider. Hospice typically provides supportive care after you start the VSED process.

What to expect once the process starts

Most people initially feel no different than they did before starting VSED. They might have hunger pangs and thirst on the first day, but these are usually tolerable and subside quickly. Caregivers can alleviate discomfort with mild sedatives and methods such as mouth swabs and cool water rinses.

While most people can survive for quite a while without eating, dehydration accelerates the dying process. Death from dehydration is usually not uncomfortable after the initial feelings of thirst lessen. In fact, many people require less pain medication during dehydration, urinate less frequently, do not vomit as often, and breathe more easily because of less congestion.

After they stop eating and drinking, people might die as soon as a few days, although ten days to two weeks is more likely. In some rare cases, the VSED process can take several weeks, depending on the patient’s age and the type of illness.

Many who start the process communicate a feeling of peace, knowing that their suffering is ending. Others describe a euphoria or pleasant lightheadedness. After a few days, energy levels will diminish rapidly, and patients become less mentally alert and sleepier. By the third day, most are going in and out of consciousness and will soon become unresponsive.

Because dehydration will probably cause death, it is important not to give anything to drink, because even small sips of water could delay the dying process. Except for pain medications, all others should be halted. For example, medicines for diabetes and heart issues are unnecessary at this point, and withholding them could speed up the process.

Most VSED patients will experience delirium, agitation, or hallucinations in the last hours before death. Tranquilizers and anti-anxiety medications can help to manage these symptoms and prevent suffering. A short time later, they will stop breathing and their heart will stop beating.

Death is inevitable. In many ways, it’s out of our control. When a patient knows that the end is near, giving them some authority over their final days can bring some measure of peace and comfort.