"VSED" as an Advance Directive in Case of Future Dementia


In a recent post, we discussed an emerging debate about advance directives: Should people be able to request—and count on—VSED (voluntarily stopping eating and drinking) in the event of future dementia?

If this is something that interests you, it is important to relalize that there are several possible ways to draft such a directive.

Natural Dying Living Will

California psychiatrist Dr. Stanley Terman specializes in end-of-life decision-making. He has developed a "Natural Dying Living Will" that he describes as "an ironclad strategy" for dealing with advanced Alzheimer's dementia and unbearable end-of-life pain.

Dr. Terman explains his approach in this video:

If you go to YouTube and search for "Dr. Terman" and "living will," you will find other videos with additional details. You can visit Dr. Terman's "Caring Advocates" website to order the living will planning documents and videos.

The End-Of-life Healthcare Directive I Plan To Use

I will probably end up using a simpler, easier process. Recently, I was talking with a friend about VSED and advanced end-of-life decisions for dementia patients. For several years, he has been undergoing treatments for cancer.

He shared the end-of-life healthcare directive he has in place, and I really like it.

His plan includes using VSED in the event he becomes incapacitated by dementia. It also addresses other major end-of-life healthcare treatment issues. Personally, I agree completely with his plan of action for handling these issues.

Therefor, with a few minor adaptations, I will authorize these provisions:


I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the following:

(A) I direct that no life-sustaining procedures be started, and, if started, that they be withdrawn if

  • I have an incurable and irreversible condition that will result in my death within a relatively short time,
  • I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness,
  • I undergo a marked lessening of my cognitive powers due to dementia, Alzheimer’s disease, stroke or a sudden and permanent brain injury, or
  • my Agent believes the likely risks and burdens of treatment will outweigh the benefits.

(B) My body has been seriously weakened by a progressive disease. If life-sustaining treatment of any kind is not expected to return me to the physical, emotional, and mental competence needed for me to live independently, then I direct that such treatment not be given or be withdrawn. I do not wish to be resuscitated.

(C) I direct my Agent to withdraw all life-sustaining treatment and, further, to ensure that I do not receive any fluid or food, whether by IV, tube feeding, or otherwise if

  • pain medications fail to relieve all pain,
  • major weight loss occurs;,
  • lack of appetite appears to herald cachexia or anorexia;,
  • break-through abdominal pain or delirium occur, or
  • I fail to recognize medical staff or friends.

I wish to die by voluntarily stopping eating and drinking (VSED).

(D) If any of the conditions described in (A) or (B) or (C) above is present, I direct that I not be given

  • CPR,
  • blood or platelet transfusion(s),
  • artificial nutrition, whether enteral or parenteral,
  • dialysis,
  • surgery,
  • intrusive diagnostic tests, including those requiring drawing my blood,
  • resuscitation or any other life-giving or life-sustaining treatment, and
  • that I not be placed on a ventilator or given.

My wish is that I be allowed to die quietly by voluntarily stopping eating and drinking (VSED).

(E) Treatment for alleviation of pain or discomfort is to be provided at all times, even if it hastens my death or makes me lose consciousness.

(F) I wish to be kept fresh, clean and warm at all times. I direct that my Agent consult with a palliative care physician and that all recommended palliative procedures to ease my physical and emotional suffering be instituted. These include

  • frequent position changes and
  • meticulous oral, nasal, and conjunctival hygiene.

In this respect, insertion of a urinary catheter should be considered by my physician. I do not wish to be provided oxygen except as a palliative measure.

(G) If I am in a hospital, I direct my Agent to transfer me to a private room in a palliative care wing. If I am not in a hospital, or if transfer to the palliative care wing is not possible, I direct my Agent to transfer me to a private room in a skilled nursing facility that agrees to follow these instructions.

I plan to contact a local hospice that gets good reviews to learn if they have any problems with this directive, or their ability to honor it. If they see no problems, I will change the final paragraph—(G)—to name that facility as the place to which I would want to be transferred for palliative care.

This is a highly debated subject and is certainly personal in nature. It is an important document for end-of-life care that everyone should consider. We should also foster honest discussions with our loved ones about our decisions and the deocuments we have in place.

Washington, DC, resident John Schappi blogs about aging, exercise, diet, pills, supplements, and his life with Parkinson’s disease and prostate cancer. Once upon a time, he was addicted to nicotine, alcohol and sex. These days, his passions include gardening, playing bridge, meditating, going to the theater and traveling.

Aging, Parkinson’s, and Me

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We have had 4 very elderly family members voluntarily end their lives: 2 by discontinuing eating, and 2 by refusing to have stomach hemorrhages repaired. The 2 who stopped eating were in nursing homes. The 2 who bled to death were in hospitals. No medical staff sought any kind of intervention. This fact makes me wonder if the Advance Directive is actually needed in order to voluntarily stop eating. On the other hand, when my 84 yr. old mother goes to ER to prevent a stroke, the staff acts disappointed that she has no DNR and that she is actually directing them to resusitate. Their attitude greatly concerns me. I have seen quite a bit of evidence in medical facilities, with several different loved ones, that lead me to believe there is an unspoken committment to hasten elders' deaths. With this attitude present, I question the wisdom of having a DNR in place that could result in poor care.
Thank you for this great VSED addition to a natural directive. I am adding it to my directive today. I am wondering if something has been left off of the next to the last line of D - "and that I not be placed on a ventilator or given." Is something else supposed to follow the word "given?"
My mom was killed by medical staff in the hospital. She had everything in place a D.N.R.,advance directive that said no drastic measures. I don't believe that it said kill me if you want and if it would be easier for the staff to not have me around. Or drug me so severely so I will suffer complications and need more medical care and then you can call me severly demented cause I am so drugged up into a coma..As strong as she was they were still not able to get her to the point of needing drastic measures and cpr. It was not from a lack of medical staff trying.They tried real hard to get her to need drastic measures or C.P.R. so they could say she died naturally.They were able to kill her at the end since they were so bound and determined. How can you stop this from happening.This is not rare either. Because this happens I would suggest wanting no dnr and drastic measures to keep the person alive since you can not trust the staff to have good morals. besides having that on your advance directive what else could be put on there to protect the elder from the medical staff even if the elder is not suffering from any kind of dementia.