Aging in Place: Another choice in choosing how to die

A friend of a friend chose to die via VSED (voluntarily stopping eating and drinking) recently. I guess there is an acronym for everything these days. But I had never before heard of this one. There are, apparently, many books, videos, and podcasts describing this method of choosing to die. As a hospice person for decades, of course I have known of people choosing to die this way. It does happen from time to time. I did not realize that this very personal choice had both a formal name and a movement to support it.
We live in a state with a death-with-dignity option. However, the processes and the hoops a dying person must jump through in order to fulfill that wish are so very complicated that, in my experience, most folks die before all the red tape has been completed. That law allows a person to self-administer a lethal drug. However, to obtain the required drug, a person must be seen to be mentally qualified and within the last six months of life. That effectively excludes a person with progressing dementia. By the time you have only six months to live your mental capacity will likely be severely compromised.
VSED, on the other hand, is entirely within the control of the individual if they decide on that route. A caveat: they must have a caretaker willing to assist them and that person is agreeing to a very challenging role.
Is VSED the same as suicide? Those who champion it say it is elective death (at a time of their own choice) since most of these people know already that they are dying of some illness that over time will rob them of any dignity. If you have witnessed a parent declining into dementia and you, too, have been diagnosed with the same disease, VSED might look like a possible option. Degenerative diseases like multiple sclerosis or ALS conceivably might make VSED look attractive.
What is the process like? It appears that there are lots of moving parts to consider before the person actually ceases to eat and drink. First and foremost, good medical supervision is imperative. If your local hospice and/or palliative care physician will assume that role, that would be ideal. Those professionals are specially trained to provide medical aid and support to the dying and they know their stuff when it comes to keeping someone comfortable. The partner/caretaker is probably the cook, nurse, driver, case manager, liaison with doctors, and full-time support person for the patient who is dying. They, too, must get their own needs met and be taken care of. So, likely, paid caregivers who understand the process must be interviewed and hired.
There is no one way that all this occurs. In general, the person who wishes to die makes the decision to stop eating, and most critically, drinking, and sets a date to start. We can go quite a while without food. But liquid is a whole other story. There are people who regularly do intermittent fasting as a way to diet. There is a real “high” that humans experience after fasting for a length of time, which is the result of our bodies going into ketosis.
After a few days, hunger is not such a big issue, but the need for liquid is. The caregivers have a humidifier running in the patient’s room, swab their mouth with damp swab sticks, put drops in their eyes, and later squirt a fine mist into the mouth. The doctor prescribes low dose morphine and/or a fentanyl patch to keep the person calm and comfortable. As the days go by someone needs to turn the patient regularly to avoid bed sores. Bed baths and peri-wash, changing of clothes and bed linens are a daily regimen. Eventually, the patient slips into a coma. Consciousness is gone but the body ticks on longer until it can no more.
The caretaker has to watch all this, and it cannot be easy. You would have to love someone an awful lot to endure it.