A Guide to Managing VSED

Part Three: Pre-Start Planning


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 single PDF with all pages included.

To-Do List for the Week before Start Date

  1. Meet with family and client before VSED start date so all are familiar with the VSED process, caregiving schedule, any after-death process or ceremony that is desired, and plans for disposition of the body.
    • If possible, help family resolve any outstanding family issues.
  2. Initiate steps for the client to shorten the VSED process:
    • Reduce meal frequency and calories.
    • Do a colon cleanse or colonoscopy prep one or two days before start date because bloating and constipation are the major cause of pain during VSED.
    • Drink only water and clear liquids after the prep until VSED start time to prevent stool from forming.
  3. Help client create a list of all the ways they like to be comforted and distracted. Encourage client to post this list in their room as a reminder to family and caregivers. Urge them to be as specific as possible, referencing all their senses.
  4. Help client create a comfortable space:
    • Select and make a ‘nest’ of the room where they will be throughout the VSED process, so it is a comforting, sacred space for them and has adequate room for a caregiver, caregiving supplies, and visitors.
    • Start as early as possible with a hospital bed in the room so that client has time to become accustomed to it, thus lessening the possibility of confusion or discomfort of changing beds later.
    • Suggest a sheepskin under the bottom sheet to provide comfort and decrease the development of pressure points and sores.
  5. Food smells and cooking sounds can be distracting, if not torturous, to someone who is not eating or drinking. Plan with the family so these smells and sounds are avoided. Also, do not leave food out to tempt the client, especially while she/he is still mobile. Signage in the kitchen may be helpful in remembering this. Some families move all meals outside the home during the first few days of VSED.

Medication and Comfort Care Planning

  1. Discuss with client and family the range of options regarding medication— i.e., easing pain vs. palliative sedation. This also needs to be discussed with the physician who is prescribing the medications as well as with all caregivers.
  2. Consider alternative methods of pain relief such as acupuncture, Healing Touch, Reiki, massage, acupressure, aromatherapy, CBD, and marijuana.
  3. Explain (and demonstrate to client and family members) mouth care for the client, including use of spray mist, oral foam swabsticks, and lip balm.
  4. Make arrangements for use of a cool air humidifier to keep room air moist, thus adding comfort and easing breathing.
  5. Help family members pick a consistent “point-person” to come into the room should the client need to be reminded about why they are not eating or drinking. This should be someone who can give the same message each time, such as, “You chose to stop eating and drinking so you would not have to live with dementia and move to a memory care setting. I can give you something to drink, but would it help if I just moistened your mouth with a spritz of cool water and wiped your face with a cool cloth?”
  6. If the client made a short video to be replayed as a reminder, discuss with the family and caregivers ahead of time where the video is stored and how it can be played for the client. Practice ahead of time so that this is an easy process for everyone involved.
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