Final Exodus

Your Life. Your Terms. Your Plan.

Final Exodus

Your Life. Your Terms. Your Plan.

VOLUNTARILY STOPPING EATING AND DRINKING (VSED)

“At the end of life, choice can take many forms. For some, choosing to stop eating and drinking is a deeply personal decision—a recognition that living longer is no longer the goal, and a choice to allow life to come naturally to its close.”

— Final Exodus

UNDERSTANDING VSED

Voluntarily Stopping Eating and Drinking (VSED) is a deliberate decision by a person with decision-making capacity to stop eating and drinking with the intention of allowing life to end. VSED is legal in all 50 states. While the concept may sound straightforward, the physical, emotional, and practical realities can be complex.

VSED is initiated by the individual rather than performed as a medical procedure. As fluid intake decreases, dehydration develops and the body gradually begins to shut down.

Understanding what to expect and arranging appropriate medical, caregiving, and comfort-focused support are important considerations for anyone exploring VSED.

WHAT TO EXPECT

Every experience of VSED is different. A person’s underlying illness, overall health, physical condition, and other individual circumstances can influence how the process unfolds.
During the earlier stages, some people may remain awake, alert, and able to spend meaningful time with family and friends. As the process continues, increasing weakness and fatigue are common, and the person may sleep more and require greater assistance with daily care. Eventually, the person may be become increasingly drowsy and less responsive as death approaches. The underlying illness a person has or dehydration is what is listed on the death certificate. VSED typically does not affect life insurance payouts or invalidate policies.
There is no precise timetable for VSED.
The course varies considerably from person to person which is one reason careful planning, and appropriate support or important.

COMFORT AND SUPPORT

Comfort care is an important part of VSED. Symptoms can occur and should not be assumed to be absent simply because a person has chosen this option. Dry mouth, weakness, fatigue, confusion, agitation, and other symptoms may develop, particularly as the process progresses.

Knowledgeable health care professionals can help anticipate and manage symptoms and support comfort throughout the process. A physician, palliative care clinician, hospice team, or other experienced professional can help assess the person’s needs and develop an appropriate plan for care and support.

Hospice may be an important resource when a person is eligible and the hospice is prepared to support the individual’s VSED decision. Hospice care can often be arranged in advance of beginning the VSED process. End-of-life doulas, caregivers, family members, and others may also provide valuable practical and emotional support.

DECISION-MAKING CAPACITY

VSED ordinarily refers to a decision made and initiated by a person who has decision-making capacity. Questions can become considerably more complicated if the person later loses capacity, particularly when previously expressed wishes conflict with the person’s subsequent behavior or requests.

These circumstances can raise important medical, ethical, and legal questions. For this reason, a person considering VSED—particularly someone living with a condition that may affect future decision-making capacity—may wish to consider these issues in advance, discuss them with appropriate health care professionals, and clearly document their wishes. Applicable laws may vary by state.

VSED Directive

A VSED Directive documents your end-of-life wishes in the event that dementia or another progressive illness causes you to lose the ability to make your own health care decisions. Although VSED is an option throughout the United States, whether a written VSED Directive is legally recognized or enforceable varies significantly by state.
If you choose to complete a VSED Directive, keep it with your advance directive and share copies with your health care agent, physician, and health care organization so it can be included in your electronic medical record.

Advance Directive for Voluntary Stopping of Eating and Drinking VSED-10

LEARNING MORE

VSED has received increasing attention in medicine, palliative care, ethics, and end-of-life planning. Individuals considering VSED—and the people who may support them—may benefit from learning more and discussing the decision with health care professionals experienced in end-of-life care.

Additional information is available in our Resources section.

PREVENTING ALZHEIMER’S DISEASE

Extensive recent medical research clearly indicates that with a good lifestyle you can prevent developing Alzheimer’s disease. What life style changes? (As many as you can do; the more, the better.)

  1. Eat healthy
  2. Exercise regularly
  3. Avoid negative thinking
  4. Do what you enjoy
  5. Have a good sense of humor
  6. Meditate, live mindfully
  7. Socialize
  8. Get outside into nature
  9. Actively relax – listen to music, garden, etc.
  10. Get a massage – even the 15 minute ones
  11. Change your environment – take a trip
  12. Stop multitasking
  13. Turn off electronic devices
  14. Take supplements, especially B complex, C, zinc, magnesium

This list is taken from a class on prevention given at the San Diego Community Colleges in the fall of 2022. You can get similar information from this YouTube video: Ten tips to prevent Alzheimer's, Melissa Batchelor. There are others.