VSED: Discussing intentions & obtaining symptom management
By Judith Schwarz, PhD
Despite the growing awareness of voluntarily stopping eating and drinking (VSED) as a legal end of life option for hastening death, there continues to be a considerable amount of misinformation and misunderstanding regarding what is involved in this option. What follows is my response to two frequently asked questions about VSED.
Why do I have to discuss my intention to VSED with anyone? Isn’t it my body and my choice?
Many people believe they can achieve a hastened death by VSED without anyone’s assistance or support. While it is true that people have died this way for generations without medical support, they probably endured a good deal of suffering. Palliative (or hospice) medical support for the symptoms associated with dying by dehydration can facilitate a peaceful, relatively pain-free death. Family members or close friends who understand the decision to hasten death by VSED provide important social and psychological support throughout the process. This becomes particularly important as cognitive abilities wane as death nears, and the person who has chosen VSED may “forget” their intention to forgo oral intake and their desire to hasten their death. In addition, caregiving help becomes necessary as the person loses physical strength and becomes unable to safely provide for their own physical care.
These issues ought to be anticipated and planned for while the person is still capable of making decisions and can effectively instruct their appointed health care agent, hired caregivers, and loved ones of their decision to forgo all future oral intake. They should also discuss how to respond if the person forgets their desire to hasten death and requests fluids.
It is recommended that a written advance directive be completed to inform future caregivers of this decision. Accompanying the written directive with a video recording of the person’s values and reasons for their end of life wishes is also recommended for the benefit of future caregivers who may not have known the person before capacity was lost. The person’s primary health care clinician ought to be aware of the decision to VSED, along with the reasons for that decision. The goal is to have medical (palliative) relief available for any unacceptable symptoms associated with the process.
Isn’t dying of starvation a painful death that takes a very long time to achieve?
When a person choses to hasten death by VSED, the cause of death is dehydration, not starvation. If that person is also suffering from a terminal illness, the “usual” length of the fast is one to two weeks. Absent an underlying terminal illness, the length of time before death may be longer, perhaps three weeks. What is critical to achieve death within that time span is the ability and determination to forgo all fluids. This requires great personal resolve in addition to comprehensive and accurate information about the process, good symptom management, and caregiving and psycho-social support.
VSED is generally not a painful process; hunger pangs tend to disappear after several days but feelings of a dry mouth or thirst can be more challenging to remedy. Providing excellent oral care usually relieves most of those symptoms when accompanied by small doses of oral pain medication and anti-anxiety medications. Good oral care includes the following: frequent opportunities to rinse and spit cool water can relieve dry mucus membranes, plus fine mist sprayed a back of throat, cold/frozen washcloth to suck, use of mouth wash & brushing teeth, artificial saliva — all help relieve distress.
Judith Schwarz is a PhD prepared nurse, and has provided End of Life Counseling for 20 years for adults with living incurable/progressive or terminal illnesses. As the Clinical Director of End of Life Choices New York (EOLCNY), she answers New Yorkers’ questions about a range of end of life issues.
To learn more about EOLCNY’s counseling program, click here. To connect with Judy, please email judith@eolcny.org.
