22 January 2015

VSED as an end-of-life strategy

Excerpts from Complexities of Choosing an End Game for Dementia:
Mr. Medalie’s directive also specifies something more unusual: If he develops Alzheimer’s disease or another form of dementia, he refuses “ordinary means of nutrition and hydration.” 

A retired lawyer with a proclivity for precision, he has listed 10 triggering conditions, including “I cannot recognize my loved ones” and “I cannot articulate coherent thoughts and sentences.”

If any three such disabilities persist for several weeks, he wants his health care proxy — his wife, Beth Lowd — to ensure that nobody tries to keep him alive by spoon-feeding or offering him liquids. VSED, short for “voluntarily stopping eating and drinking,” is not unheard-of as an end-of-life strategy, typically used by older adults who hope to hasten their decline from terminal conditions. But now ethicists, lawyers and older adults themselves have begun a quiet debate about whether people who develop dementia can use VSED to end their lives by including such instructions in an advance directive...

Even in the few states where physicians can legally prescribe lethal medication for the terminally ill, laws require that patients be mentally competent and able to ingest those drugs themselves. Mr. Medalie would prefer that option if he were to become demented, preferably with the barbiturates dissolved in “a little vodka.”

But demented patients don’t qualify for so-called death with dignity. VSED is a lawful way to hasten death for competent adults who find life with a progressive, irreversible disease unendurable...

“Neglecting basic human comfort care is a big source of elder abuse complaints and criminal prosecutions.” And if a patient demands that his basic care be withheld in the event of dementia? “Nobody from a legal perspective has really meaningfully grappled with that,” he said.

In several states, including New York, Wisconsin, Minnesota and New Hampshire, legislatures have banned the withdrawal of oral nutrition or hydration at all, no matter what a directive or a proxy says.
More at the link.  Worth a read for those dealing with a family member with dementia.


  1. But demented patients don’t qualify for so-called death with dignity.

    Score one for the 'right-to-live' nuts.

    America really needs to get a end-of-life discussion. How is it possible that in the land of the free, and after all the complaining we've had about the government interfering between doctors and patients, people can not choose how they die?

    My grandmothers had dementia. Pretty soon after the disease was diagnosed, their doctors asked them how they wanted to die. There were pretty much four options ranging from do-nothing to keep-me-alive-at-all-cost. They picked, and when it was time, their choice was executed. My parents were just informed by their doctor about their decision, and were told how the procedure usually unfolds. No input from them was needed, asked or accepted.

    I was very happy to see this (I was across an ocean and had little input). This way, there was no stress on anybody during the last week of my grand-mothers' lives. They had peace with their decision, and all attention could be focused on peaceful and meaningful farewells. One of the few times I've seen my dad cry is when he remembers the loving care from my grandmothers nursing staff during her last days.

    Contrast that with the death of my grandfather-in-law, who died in the US, where you can not make such choices ahead of time, and where the last days of his live were filled with agonizing impossible choices. Impossible choices because his clearly stated wishes were simply illegal. That put immense emotional stress on his daughter who had the power of attorney. What a fucking mess.

    Land of the free. But not when you want to die in dignity.

  2. I don't want to live one minute after my mind goes. All that will be left is a shell, and it should be allowed to die quickly and mercifully.

  3. Having seen my father pass away from alzheimers late last year, I have told my family that once I don't know what I'm being fed, let it be chocolate. It's not like I'll NEED healthy food at that point.


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