A Guide to Managing VSED

Part One: Initial Client Conversation


A Guide TO Managing VSED as an End-of-Life Choice

by VSED Resources Northwest

This document offers a thorough description of the VSED process and explains in detail how to plan for each step, from making the decision to do VSED and setting the date to begin, through after-death care, honoring the body, and supporting the family. The intended audience for this document is a death doula or end-of-life guide, but it may also be useful for family members who are either seeking to hire a death doula to facilitate the VSED process or are considering managing the process themselves.

NOTE: Due to the length of this document, we are breaking it into multiple parts on this website: At the bottom of each web page, please click the NEXT PAGE button. The printable PDF button at the top of each page will open a PDF with all parts included in a single document.

Initial Client Conversation: Voluntarily Stopping Eating & Drinking (VSED)

  1. Talk with client and family in detail. You may need to dispel negative misinformation the client may have heard about VSED. Discuss the role of the death doula, VSED preparation, the VSED process itself (including range of time to complete), the importance of medical collaboration, the benefits of involving hospice, the process of selecting caregivers, the necessity of preparing a schedule, and possible approaches to medication and pain management. Also, talk about choosing a start date.
  2. Be upfront with family about the financial realities of the process. Initially, the cost of caregivers for a 24-hour period sounds prohibitive to family members; however, paying $30-40 per hour for maximum coverage for 10-14 days is still cheaper than even one month in a memory care setting or skilled nursing facility (SNF).
  3. Frankly address the challenges of VSED.
    • The number of details involved in preparation for the process.
    • The length of the process, sometimes expressed as an emotional “marathon” for the family members who watch their loved one slowly decline.
    • The need for 24/7 caregiving, which can tax a family’s finances if resources are limited.
    • The memory and endurance the client must sustain in order to follow through with the VSED process. By day four or five, when the client might still be conscious, they often become confused due to dehydration and need frequent reminders of what they are doing and why.
  4. Also address the benefits of VSED, which center around the ability to choose an end of life that reflects the values, needs, and agency of the person carrying out VSED. As long as Washington State’s Death with Dignity law does not cover neurological diseases or dementia, VSED will remain the alternative choice. The person who is facing their death after preparing for it in extensive detail is often freed to live each moment of their process with purpose and love.
  5. Address what happens if the client cannot follow through with the process. By careful and explicit preparation, the person choosing VSED knows that they can stop the process during the first few days while still conscious. If this happens, a doctor should be consulted as to how to begin slowly reintroducing fluids and food. Further assessment would also need to be made to determine the status of organ systems.
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