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What is VSED?

We’re excited to feature our hospice colleague and friend Katie Ortlip, LCSW as this week’s guest blogger. Katie is the co-author of Living With Dying: A Complete Guide for Caregivers. In this article Katie gives information about VSED (Voluntarily Stopping Eating and Drinking). You can find more information about Katie and her co-author Jahnna Beecham at livingwithdying.com. Be sure to check out their book “Living with Dying: A Complete Guide for Caregivers” – an awesome guidebook for anyone caring for a loved one.

Photo by Helen Bauer, The Heart of Hospice

At this moment, 8 states have “Death With Dignity” laws that allow patients who are terminally ill to take medication prescribed by a physician to end their lives. As a 26-year hospice social worker, I have had the privilege to attend a number of those deaths. But even in my state of Oregon, that option is not always available or some people don’t feel comfortable with it, and so some patients make the decision to hasten their deaths by not eating or drinking. Usually people do this when they feel that their body is starting to fail, their quality of life is not acceptable to them anymore, and they are just done.

Voluntarily stopping eating and drinking, referred to as VSED, hastens the dying process by shutting down the kidneys. Stopping eating usually isn’t that difficult because most people at this stage in their illnesses don’t feel that hungry. It’s the thirst that can be the most uncomfortable. People can suck on ice chips and moisten their mouths with sips of water but they have to realize that if they want to go quickly, they should drink as little water as possible. And, of course, medication for pain, anxiety and other symptoms can be given and can help make the process easier.

The process generally takes from 10 days to 2 weeks for a person to die once they stop eating and drinking depending on how hydrated the person is. The first few days are the most difficult, again because of the thirst and maybe some hunger pangs. The closer one is to a natural death, the easier VSED is, as the patient most likely already stopped eating and is partially dehydrated. After the first 3 days or so, the person gets sleepier and the process should get easier, as the kidneys start to shut down, and a gentle euphoria can occur.

I had a patient last year who was at the end stage of his esophageal cancer and there was a chance that the cancer would cause extreme bleeding and pain in his throat as it progressed. He was beginning to dread getting up in the morning and had nothing to look forward to but worsening symptoms. Rather than wait for the tumor to get bigger and make things awful for him, he said, “I am ready to go and I want to know how to make it happen sooner.” After a discussion with him and his family, who gave him their blessings, he decided to proceed with VSED.

He stopped eating and drinking, took regular doses of pain and anxiety medication to be more comfortable and to help him sleep. We provided them with swabs and mouth moisturizers, and instructed them on good mouth care. I had told him and his wife that sometimes, as the kidneys start to shut down, people feel a mild euphoria. On my last visit his wife reported, “He’s doing pretty well, but he’s waiting for the euphoria.” She gave him his medication and we chatted a while. When I said good-bye, I bent to give him a kiss and he smiled. I asked, “Are you feeling euphoric?”  He nodded dreamily and answered, “Yes.” He died peacefully a few days later.

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