Understanding VSED: Voluntarily Stopping Eating and Drinking

In the complex landscape of end-of-life decisions, Voluntarily Stopping Eating and Drinking (VSED) is a significant, yet often misunderstood option. This blog will explore what VSED is, the reasons individuals choose it, the ethical considerations, and the practical steps involved. Additionally, we will provide references and resources for those looking for further information or support.

What is VSED?

Voluntarily Stopping Eating and Drinking (VSED) is a deliberate decision by an individual to stop consuming food and fluids, intending to hasten death naturally. Unlike Medical Aid in Dying (MAID), which involves prescribed medications, VSED is a personal choice where the individual ceases nourishment to allow the body to gradually shut down. This process typically results in death within one to two weeks, depending on the person’s overall health condition and hydration levels before beginning the process.

VSED is legal in many countries, including the United States, as it falls under the right to refuse medical treatment, a right guaranteed to individuals under various legal frameworks, including the U.S. Constitution (Quill, 2005).

Why Do People Choose VSED?

People may choose VSED for a variety of reasons, often deeply tied to their sense of dignity and autonomy:

1. Maintaining Control Over End-of-Life: VSED provides individuals the ability to determine the timing and circumstances of their death, particularly when faced with the potential loss of autonomy and independence due to chronic or terminal conditions (Menzel & Chandler-Cramer, 2014).

2. Avoiding Prolonged Suffering: People with terminal illnesses or conditions that drastically reduce quality of life may view VSED as a way to avoid prolonged suffering that often accompanies these conditions (Ganzini, 2016).

3. A “Natural” Death: For some, VSED may represent a more "natural" way of dying. Since it involves allowing the body to expire without invasive interventions, it may align with personal, philosophical, or religious beliefs about what constitutes a dignified end (Quill, 2005).

4. An Alternative to Medical Aid in Dying (MAID): In areas where medical aid in dying is not legally available, VSED can be an option for those seeking to hasten death in a controlled and planned manner (Chabot & Goedhart, 2009).

The Process of VSED

The process of VSED requires careful planning and support:

1. Decision-Making: The decision to pursue VSED must be made by the individual voluntarily, with full mental capacity. It is often essential for individuals to discuss their decision with healthcare professionals, spiritual advisors, and family members to ensure they understand the physical and emotional implications (Menzel & Chandler-Cramer, 2014).

2. Support and Care: A strong support network is crucial. Family, friends, and healthcare providers can assist in making the person comfortable throughout the process. Hospice and palliative care professionals can provide medical and emotional support to ensure pain is managed and dignity is maintained.

3. Symptom Management: Symptoms such as dry mouth and fatigue are common during VSED. Caregivers can help alleviate discomfort using ice chips, oral swabs, or mouth moisturizers. Pain and anxiety medications may also be administered to ensure the person remains as comfortable as possible (Ganzini, 2016).

4. Time to Death: Death from VSED typically occurs within 10 to 14 days, but this may vary depending on the individual’s health. Throughout this time, the person often spends more time sleeping or in a semi-conscious state, gradually becoming weaker (Chabot & Goedhart, 2009).

Ethical Considerations

Ethical concerns about VSED revolve around autonomy, the role of caregivers, and healthcare professionals’ responsibilities:

• Respect for Autonomy: VSED is grounded in the ethical principle of respecting an individual’s right to self-determination. It allows individuals to make choices about their own body and end-of-life process (Menzel & Chandler-Cramer, 2014).

• Non-Maleficence: Healthcare providers are obligated to "do no harm." Supporting a patient’s decision to pursue VSED requires careful consideration of how to balance this principle with respecting the individual’s autonomy. Providing palliative care to mitigate pain and suffering is often the solution to this ethical dilemma (Quill, 2005).

• Emotional Impact on Caregivers: The involvement of family members and caregivers in VSED can be emotionally challenging. Witnessing a loved one’s physical decline can be distressing, which is why psychological support and counseling for caregivers are often essential (Ganzini, 2016).

Legal Considerations

In the United States and many other countries, VSED is legal, as it involves an individual’s right to refuse medical treatment. This right was affirmed in the landmark case "Cruzan v. Director, Missouri Department of Health" (1990), which upheld the principle that competent individuals have the right to decline life-sustaining treatment (Quill, 2005).

However, the legal status of VSED and the extent of available support vary by jurisdiction. Consulting legal professionals and understanding local regulations is essential for those considering VSED.

Practical and Emotional Challenges

• Emotional Preparation: Choosing to hasten death through VSED is an emotionally intense decision. It requires both the individual and their loved ones to be prepared for the physical sensations involved and the emotional impact of witnessing this process (Chabot & Goedhart, 2009).

• Family Involvement: Family members may experience a range of emotions, from guilt to confusion. Honest and open communication, supported by counseling or spiritual guidance, can help alleviate these concerns and bring peace to all involved (Ganzini, 2016).

• Caregiver Support: Caregivers may face emotional and physical exhaustion during the process. Hospice and palliative care professionals can provide respite and counseling to ensure caregivers are adequately supported.

Resources and References

For those considering VSED or supporting someone through it, numerous resources are available:

1. Compassion & Choices: This nonprofit organization offers resources and support for end-of-life decisions, including information on VSED. Their website provides guides and contact information for local support (https://compassionandchoices.org/).

2. Hospice and Palliative Care Services: Local hospice organizations are an invaluable resource for those considering VSED, offering medical, emotional, and spiritual support for both patients and caregivers.

3. Medical and Ethical Literature:

   • Quill, T. E. (2005). The Ambiguity of VSED as an End-of-Life Option. The New England Journal of Medicine.

   • Menzel, P. T., & Chandler-Cramer, M. C. (2014). Advance Directives, Dementia, and VSED by Advance Directive. Journal of Clinical Ethics.

   • Ganzini, L. (2016). Dying with Voluntary Stopping of Eating and Drinking: Clinical and Ethical Considerations. Journal of Pain and Symptom Management.

   • Chabot, B. E., & Goedhart, A. (2009). A Survey of Self-Directed Dying Attended by Informal Caregivers in the Dutch Population. Omega - Journal of Death and Dying.

Conclusion

Voluntarily Stopping Eating and Drinking (VSED) is a deeply personal end-of-life decision that offers individuals a way to exert control over their dying process. Although it presents complex ethical, emotional, and practical challenges, VSED can be an empowering choice for those seeking to end their suffering on their terms.

Anyone considering VSED should consult with healthcare professionals, legal experts, and trusted loved ones to make an informed decision that respects their values and wishes. For some, VSED represents an opportunity for a dignified and autonomous conclusion to their life—a choice that aligns with their beliefs about quality, autonomy, and dignity.