Saturday, October 22, 2016

The VSED Exit

A Way to Speed Up Dying, Without Asking Permission

[ed. This is something I've harped on for years. I can't understand how our society (families, legal institutions, religions, businesses, politicians, medical professionals, etc.) continues to do everything it can to prolong life (for a variety of reasons, many of them self-serving), despite the wishes of those most acutely affected. From the moment we're born we're encouraged to control our impulses, our bodies, our environment, our destinies, but as lives wind down or take unexpected turns that control is wrested away and we're forced to endure all manner of medical interventions, indignities, isolation, and pain. How does that seem right? Or compassionate? And, for what purpose? We treat our pets better. I have the extreme view that any adult should be able to obtain a life-ending cocktail of pills that can be taken at any time. Any time, not just when facing some terminal illness. You want to go? Go. It's the most profound decision an individual can make, and should be honored as such. Instead, we force people to use guns, and ropes, poisons, automobiles, high dives and any number of other horrific solutions, including starving themselves. It's barbaric. Thankfully, I don't think the life-at-all-costs attitude will last much longer (especially as Boomers confront the inevitable), and it's possible that a more personally empowered ending (to the extent possible) might actually have the benefit of making life up to that point much less anxious. Someday we'll have a more humane alternative, and I hope it's something like this: Sol's Euthanasia. See also: I am not afraid of death. I worry about living.]

Del Greenfield had endured repeated bouts of cancer over four decades, yet kept working as a peace activist in Portland, Ore., into her 80s. “She was a powerful force,” said her daughter, Bonnie Reagan.

But in 2007, Ms. Greenfield was struggling. She had been her husband’s caregiver until he died that year at 97, never telling her family she was feeling miserable herself. She’d lost much of her hearing. She required supplemental oxygen.

When she fell and broke an arm, “that was the final straw,” her daughter said. “She was a real doer, and she couldn’t function the way she wanted to. Life wasn’t joyful anymore.”

At 91, Ms. Greenfield told her family she was ready to die. She wanted a prescription for lethal drugs, and because she had active cancer, she might have obtained one under Oregon’s Death with Dignity statute for people with terminal illnesses.

Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent.

“I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.”

In end-of-life circles, this option is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy.

Unlike aid with dying, now legal in five states, it doesn’t require governmental action or physicians’ authorization. Patients don’t need a terminal diagnosis, and they don’t have to prove mental capacity. They do need resolve. (...)

Can VSED be comfortable and provide a peaceful death?

“The start of it is generally quite comfortable,” Dr. Quill said he had found, having cared for such patients. The not-eating part comes fairly easily, health professionals say; the seriously ill often lose their appetites anyway.

Coping with thirst can be much more difficult. Yet even sips of water prolong the dying process.

“You want a medical partner to manage your symptoms,” Dr. Quill said. “It’s harder than you think.”

Keeping patients’ mouths moistened and having aggressive pain medication available make a big difference, health professionals say.

At the conference, the Dutch researcher Dr. Eva Bolt presented results from a survey of family physicians in the Netherlands, describing 99 cases of VSED. Their patients (median age: 83) had serious diseases and depended on others for everyday care; three-quarters had life expectancies of less than a year.

In their final three days, their doctors reported, 14 percent suffered pain, and smaller percentages experienced fatigue, impaired cognition, thirst or delirium.

Still, 80 percent of the physicians said the process had unfolded as the patients wanted; only 2 percent said it hadn’t. The median time from the start of their fasts until death was seven days.

Those results mirror a 2003 study of hospice nurses in Oregon who had cared for VSED patients. Rating their deaths on a scale from 0 to 9 (a very good death), the nurses assigned a median score of 8. Nearly all of the patients died within 15 days.

The slower pace of death from fasting, compared with ingesting barbiturates, gives people time to say goodbye and, for the first few days, to change their minds. Several conference speakers described patients who had fasted and stopped a few times before continuing until death.

That’s hard on families and caregivers, though. And slowness won’t benefit people who are dying with severe shortness of breath or pain. “Two weeks is a lifetime in that situation,” Dr. Quill said.

by Paula Span, NY Times |  Read more:
Image: Ezra Marcos