Dear Barbara, Would you talk about voluntarily stopping eating and drinking (VSED)?
Here is a definition of VSED from Comfort Care Choices website:
“What is VSED (Voluntary Stopping Eating & Drinking)? This refers to the decision by a patient to stop eating food and drinking liquids when they have a terminal or life-limiting disease, so that their death can be hastened (and therefore their dying will not be prolonged).”
From the Death With Dignity website I got this information:
“You can live for a long time without eating, but dehydration (lack of fluids) speeds up the dying process. Dying from dehydration is generally not uncomfortable once the initial feelings of thirst subside. If you stop eating and drinking, death can occur as early as a few days, though for most people, approximately ten days is the norm. In rare instances, the process can take as long as several weeks. It depends on your age, illness, and nutritional status. At first, you will feel the same as you did before starting VSED. After a few days your energy levels will decrease and you will become less mentally alert and more sleepy. Most people begin to go in and out of consciousness by the third day and later become unarousable. Hunger pangs and thirst may occur the first day, but these sensations are usually tolerable; discomfort can be alleviated with mild sedatives or other techniques such as mouth swabs, lip balm and cool water rinses.” www.deathwithdignity.org/options-to-hasten-death/
The Death With Dignity article seems to me to be accurate regarding the dying process.
What do I personally think? If we want to die, VSED is a way of having total control. It is not illegal. It doesn’t involve others (which is illegal). It is basically easy, not needing any equipment, and leaves no mess. That said, I don’t think it’s a decision that should be made impulsively, in a moment of action, or when depressed. It is something that requires thought and commitment. It is one thing to not eat or drink for a couple of days, it is another to continue to not eat or drink when discomfort sets in.
Some articles that I used as a reference elaborates on how painful the process becomes and seems to stress being a “purist” in the respect of not even moistening the lips. Why? The idea here is a person has chosen to end their life--for whatever reason. There is no right or wrong, no rigid protocol to follow. I believe supportive care would be to keep the person as comfortable as possible and if that means moistening lips so be it. Actually I would recommend sucking on occasional ice chips or frozen grapes and using glycerin swabs to address the mouth discomfort. There is not enough moisture or nourishment in either to significantly alter the intended purpose of death. As long as the person is alert enough to control their swallowing that little bit may bring some comfort. Also medication to induce sleep as a comfort measure is very appropriate although I believe increased sleep will come of its own accord. In this situation sleep is very much your friend and I think it will increase naturally as the body begins shutting down.
Dying a gradual death from disease or old age naturally involves reduced eating and drinking. It just naturally happens. The body is shutting down due to the advancing disease process.
In the natural dying process, from disease or old age, people also gradually increase sleep, and withdrawal from their surroundings. With dehydration from disease induced or dehydration by choice the calcium in the blood stream increases and when it gets high enough sleep occurs and in that sleep death comes. That is how death from dehydration occurs whether chosen or happening naturally. I can’t help but think the dying process of VSED is similar to the natural dying from disease or old age.
This is an involved topic as well as emotionally charged. We bring to this discussion our relationships, our spiritual beliefs, and our sense of right and wrong. My perspective is most of us look at hastening our death because we are more concerned and frightened about dying than of being dead. If I have an illness and am told I am going to die soon, then lets skip the long drawn out “dying part”. If I am just old with no disease process, just finished living, then I suggest we first look for depression, for why this person is finished with living. Have a dialog, explore the reasoning. Maybe changes can be made. All that done, I think it would take a very strong personality to choose to die by not eating and drinking.
Something more about Dying From VSED...
Those who choose VSED most often die at home. The caregivers will need a guide to help their person and have a meaningful experience. Using the guide in The Eleventh Hour will give those at the bedside comfort and things to do during the dying process. You may also want more support with the End of Life Caregiver Bundle.
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4 comments
Dear Barbara,
Finally! I have been working with End of Life Choices and it’s predecessors and End of Life Washington and their predecessors for 22 years. After all those years helping folks with lethal medication or natural dying and occasionally VSED clients, I decided I wanted to specialize in our clients who chose VSED. I concur with you, it is natural, it is how many have died since we became humanoids, it is how animals choose to die still.
Thank you for this book. Like all of your books, I wish I could have done the service you have done and write about them. It is my choice, IF I have a choice when it becomes my time to go.
I became a hospice nurse in the 90’s in Dallas Texas and saw one good death. Since working in the PNW, I have seen so many, I cannot even count!
I believe as we age, we forgot how powerful we have been in our lives making huge decisions often with ease. My belief is we must remind our clients, family, friends and those that are dying that they are still excellent decision makers as they age and choosing to die quickly is also a choice we can make in our 40’s, 50’s and 80’s and 90’s. We do know statistically that many folks choose to die when they no longer have a life they think is valuable to themselves or their families. People don’t choose to die when life is unbearable from pain always. In my experience, choosing death is a personal decision.
As a person who has experienced numerous suicide attempts in family members and more than three successes of violent suicides, I absolutely have to believe that there are gentle ways to let go without leaving many victims behind who are left feeling guilty and a plethora of other negative emotions instead of a respect for a person’s right to choose their manner of dying in a natural way.
Thank you from the bottom of my heart. In my opinion, we need to be taught how peaceful dying can be when our society accepts this as a personal human right.
We need to teach people the gruesome way people die when someone is holding them back from a deeply personal choice when our time comes to stop living.
I will fight to continue to help folks die the way they want as long as it is not a violent and abusive way. Give our loved one the right to choose a peaceful, intentional, gentle way to let go, naturally.
Most gratefully, Derianna
Hi Carol, Interesting and beautiful how your grandparents approached their end of living. Hope I do it as gracefully. Thank you for sharing their stories. Blessings! Barbara
what about if the person das not want to died
My grandfather was 100 years old and rapidly started falling, couldn’t get up, and my grandmother would call for help getting him back to bed. He had gone from a walker for a month or so, to a wheelchair, then wasn’t able to transfer to the toilet or back to bed. I catheterized him but he had bladder spasms. He told me he wanted to go to a nursing home to stop eating and drinking so he’d die. He had NO medical problems, took no medication. He did not want my grandmother to have to help him. I’m a hospice nurse, it should have been me caring for him at the end, but he didn’t want that. I wanted to hire a person to let him die at home, but he said no. He did it all, I went to see him at the nursing home. He was in a dark room, weak, and spoke quietly. The nurses told me to talk him into a feeding tube. I told them no,he was there to go peacefully. He told me “I love you”, he had never said those words before even though I knew he did love all of us. He died the next morning. It took 3 days. Six years later my grandmother who was 100 did the same thing, only she had CHF. I cannot go in that nursing home,but they did what they were supposed to do. My grandparents slept most of the 3 days before each died. My father, their son who did everything for them, died a year later in a plane crash. Thank God they died first. If the circumstances warrant it, I’ll do the same thing. As I write this my ex-husband is dying of metastatic colon cancer and our 3 kids are dealing with it. My daughter just asked if she should call around for the best price for his casket. He appears to be dying imminently, in hours to days. I was married to him for 25 years, I’m a little surprised about the feelings I have myself. We’re friends and my children and grandchildren are hurting.
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