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April 3, 2015 by: John Schappi

How To Draft a VSED Advance Directive for Hastening Death in the Event of Dementia

In yesterday's 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?

Today, let's consider 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'll 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'll probably end up using a simpler, easier process. Recently, I was talking with a friend about VSED and advanced directives for dementia. For several years, he's been undergoing treatments for cancer.

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

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

So, with a few minor adaptations, I'll authorize these provisions:

END-OF-LIFE DECISIONS: 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(A) I direct that no life-sustaining procedures be started, and if started, that they be withdrawn if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, (3) I undergo a marked lessening of my cognitive powers due to dementia, Alzheimer’s disease, stroke or a sudden and permanent brain injury, or (4) 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) 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, for example, 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. 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, resuscitation or any other life-giving or life-sustaining treatment and that I not be placed on a ventilator or given intrusive diagnostic tests, including those requiring drawing my blood. 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'll change the final paragraph -- (G) -- to name that facility as the place to which I'd want to be transferred for palliative care.

More information:
http://parkinsonsand5htp.blogspot.com/2015/04/how-to-draft-vsed-advance-directive-for.html