A Guide to Managing VSED

Part Four: Managing the VSED Process


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.

Managing the VSED Process

  1. Hold a “Gathering of Intent” before starting the VSED process. This can include the client, family members, and caregivers and helps set the energy and intention of the group for the days ahead. The gathering also allows the group to honor the life of the client and celebrate their courageous choice.
  2. Encourage family members and caregivers to practice good self-care. Frequent walks, adequate sleep, and regular meals will help family and caregivers be supportive and remain as healthy as possible during a difficult time. 
  3. Anticipate what family members will see happen to their loved one and prepare them, interpreting the physical and emotional changes that happen.
    • Share Barbara Karnes’s booklets Gone From My Sight and The Eleventh Hour.
    • Prepare family members for the “death rattle” and for the physical sight of their loved one in a coma, as the sound of labored breathing and the sight of a loved one’s mouth remaining open can be disturbing for those experiencing this for the first time.
  4. Compile a notebook for professional caregivers with the expectation that all caregivers keep thorough notes about meds given, care given, family interactions, client reaction, and communication with physician or hospice.
    • Let family know that they are welcome to read the notebook and add comments.
    • If possible, leave the notebook in an accessible, consistent spot.
  5. Keep hospice nurse manager informed of client’s progress so that an intake can be done as soon as the client meets hospice requirements.
    • Involve hospice as soon as possible because hospice can more easily expedite getting professional medical support and medications. Their presence is always comforting to the family and reassuring to caregivers.
    • Remind the family that the hospice nurse can pronounce death as well as call the mortuary, and that the death of a hospice patient is not investigated by authorities. This can be comforting for those who worry about VSED legality.
  6. Determine ahead of time who would like to be present, if at all possible, at time of death.
  7. Ask family members prior to the death if they want to spend time alone with the body or if they wish to be accompanied by a family member or caregiver.
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