The VSED Exit: A Way to Speed Up Dying, Without Asking Permission – The New York Times – By Paula Span 10/21/2016
Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself.
When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”
At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.
Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.
“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”
In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking.
It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.
Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve.
“It’s for strong-willed, independent people with very supportive families,” said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center.
He was speaking at a conference on VSED, billed as the nation’s first, at Seattle University School of Law this month. It drew about 220 participants — physicians and nurses, lawyers, bioethicists, academics of various stripes, theologians, hospice staff
What the gathering made clear was that much about VSED remains unclear.
Is it legal?
research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.
Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.
The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids.
Can VSED be comfortable and provide a peaceful death?
“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.
Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.
“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”
”Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.
In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.
Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t.
The median time from the start of their fasts until death was seven days.
The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.
slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.
Other obstacles could restrict VSED. A quiet choice in a private home, it could be derailed in nursing homes and assisted living facilities where administrators fear lawsuits or regulatory sanctions.
Physicians might decline to participate; home care aides might quit.
Del Greenfield fared better. “She didn’t use any medicines, just some oxygen,” her daughter said. Ms. Greenfield’s children, grandchildren and great-grandchildren came to see her, and “she was completely peaceful, chatting and joking and telling people she loved them.”
On the fifth day of fasting, “she just fell asleep,” and died about 36 hours later.