A Guide to Managing VSED
Part Two: Moving ahead with VSED
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.
Moving ahead with VSED
- Document the client’s decision. Once the client has chosen to move ahead with the VSED process, encourage the family to make a pair of videos of the client talking about their decision. These videos serve several functions:
- As a legal record documenting the client’s decision.
- As a reminder aid for the client during the VSED process.
- As reassurance to a grieving family that this type of death was, indeed, what their loved one intended.
- Explain the purpose of recording two videos:
- The first video should be longer (3-5 minutes) and should feature the client describing their reasons for doing VSED, such as family history with current diagnosis and/or skilled nursing facilities; markers met during the course of the disease, such as no longer being able to read, garden, visit with family, or travel; and any other personal reasons for choosing to hasten their death.
- The second video should be shorter (around one minute) and should feature the client speaking to her/himself with VSED coaching tips. For example: “Hi, this is yourself. I’m reminding you that you chose to stop eating and drinking and die a natural death because you already have a terminal disease, and if you continued on you would…” Fill in with personal reasons, such as: forget your loved ones and yourself; end up in a memory care ward; be placed in a skilled nursing facility; or whatever else the client thinks would be personally motivating at difficult times of the process.
- Caregiver selection: Guide the family in the selection of experienced caregivers, knowing that private caregivers may be the only option because some agencies have policies governing staff assistance with VSED or Medical Aid in Dying cases. Caregivers should be:
- Experienced with end-of-life caregiving and accompanying the dying
- Available during the anticipated time of beginning VSED and for the following 3 weeks
- Aware that the job will end when the client dies or stops the VSED process
- Knowledgeable about VSED and preferably experienced with helping someone through the VSED process
- Willing to meet with the family in person, knowing that a compatible match is important
- Agreeable to NOT giving the client food or water and to immediately find a family member if the client asks for either
- Respectful of client’s spiritual views
- Welcoming of family members and their interactions
- Open to attending a gathering in celebration at the beginning of the VSED process for client, family, and caregiving team
- Flexible with shifts and days, knowing that family member participation may vary from day to day and person to person, and that caregiver availability can also change
- Able to maintain good self-care in order to be fully present and open-hearted with client and family
- Willing to check in regularly with death doula (in person or by phone, text, or email) about their own well-being, with feedback about family interactions and any challenges.
- Meet with client’s PCP ahead of time (together with client, family member, and at least one primary caregiver) so that everyone is clear about start date, expectations, medications, and how to contact physician with questions, etc. This is essential to:
- Foster good communication with physician about expectations and follow-up
- Have physician write prescriptions for liquid morphine, anti-delirium medicine, and liquid lorazepam to have all medications in the home prior to VSED start date
- Request that the physician plan to make at least one home visit if possible. Families are very reassured and appreciative when the physician is personally supportive.
- Notify hospice nurse manager (specifically) as early as possible about client’s plans to VSED at home and request a hospice intake be completed as soon as is permitted. In the past, our local hospice’s policy has precluded the admission of a VSED client until they are “sleeping most of the time” or until they’ve lost consciousness.
- Evaluate family involvement: Help family members evaluate the amount of caregiving they want to do. Their role as family members is so important to the client, and it can become too heavy a burden for them to provide care AND deal with their own grief.
- Legal and financial documents: Encourage the client to consult with an attorney to make sure all legal and financial documents are in order. Some families choose to have an attorney draw up a “Release and Assumption of Risk” document, especially if there is not total agreement among family members regarding the VSED decision. As detailed above, it can also be valuable for the client to make a video stating their desire and reasons to use VSED.
- After-death care: Discuss and make plans for professional assistance after the death, i.e. funeral home or cremation services. Talk with family about options that they can arrange themselves.