Voluntarily Stopping Eating and Drinking (VSED)
Voluntarily stopping eating and drinking (VSED) is the conscious act of a person to intentionally stop eating and drinking with the goal of ending their life. The decision to use VSED relies solely on a competent person’s preference and determination to control his or her own dying. VSED is a natural process by which people have chosen to die in many cultures, as their loss of appetite is a natural process at the end of life. Hospice nurses in Oregon rated VSED a “good death,” giving it an 8 out of 9 as a peaceful way to go.
For Patients
If you have read the information on accessing the End of Life Option Act and all of this seems overwhelming, know that you are not alone. Many people find accessing the law difficult. That’s why we are here. Learn More.
For Attending Physicians
For Consulting Physicians
A consulting physician is a physician who is independent from the attending physician and who is qualified by specialty or experience to make a professional diagnosis. Learn More.
- Must be 18 years or older.
- Must be of sound mind and exhibit appropriate decision-making capabilities to the attending physician.
- Must be able to self-ingest the medication either orally or by pushing through an NG tube.
- Must be diagnosed with a terminal disease, with a life expectancy of six months or less, by two physicians.
Frequently Asked Questions
Why Would I Choose to Stop Eating and Drinking?
People with a terminal diagnosis, people with uncontrolled pain, shortness of breath and discomfort, where the degree of suffering outweighs the quality of life, may find VSED a viable option. VSED has also been used by people faced with an untenable prognosis such as ALS (Lou Gehrig’s disease) or Alzheimer’s disease, choosing VSED so as not to prolong their suffering or experience physical and mental deterioration.
VSED is not for everyone. For some individuals, choosing the date to initiate a fast that will result in death requires more self-control and determination than they possess. For others without family, caregivers, or other social support, this option also may not be feasible.
Is VSED Legal?
The Self-Determination Act of 1990 that came out of the U.S. Supreme Court decision, Cruzan v. Director (Cruzan case), paved the way for all Americans to be able to refuse unwanted treatment, which includes refusing nutrition and hydration. The decision affirmed the right of a competent, mentally capable individual to refuse medical therapies, including food and fluids. People considering this option need not seek permission from anyone since it is legal in all states. Personal autonomy and self-determination are the legal basis for end-of-life decision making.
What are the Roles of the Caregivers?
Around-the-clock care (24/7) is recommended in order to provide a safe physical environment as falls and disorientation are a real possibility. Caregivers should maintain an environment that is pleasant, soothing, and comfortable. Caregivers should know what the person wants, making sure they have a realistic understanding of what will happen once VSED begins.
Who Else Should be Involved?
Hospice should be involved as they can provide appropriate palliative care including medication for pain control, agitation, confusion, discomfort, breathing trouble, and possibly sedation. People who are on the journey to use VSED to end their lives and have been told by a physician they are expected to die within six months would be hospice eligible.
Family and friends are always welcome on this journey. If a person has not been determined to die within six months and still wishes to pursue VSED, generally after three days of no intake of food or fluid, hospice can be called in under a secondary diagnosis of failure to thrive or similar.
It would be important to speak with your physician about this prior to beginning VSED. Our volunteers also can offer information and support through this process.
How Do People Die from VSED?
How Long will it Take?
Is VSED Painful?
Based on studies in palliative medicine, VSED is not painful. The discomfort caused by dehydration is a dry mouth, tongue, and cracked lips which can be relieved by swabs of glycerin or coconut or similar oil, or a sponge soaked with a favorite beverage such as fruit juice or ginger ale to moisten the lips and mucosa of the mouth.
Death from VSED occurs from dehydration; people who only stop eating and continue to take in fluids will prolog the process.
What are Some of the Problems Associated with VSED?
People exercising VSED might ask for water as they become a little woozy, forgetting the decision they made. Usually, reminding them of the process they have chosen to engage in is enough for them to no longer ask. However, if the person continues to request fluids, their request must be honored. This will prolong the dying process and is likely to cause additional discomfort.
People with Alzheimer’s are not typically good candidates for VSED because they forget about their commitment, and might also become easily agitated.
Should the person change his or her mind and decide to stop VSED, that is the person’s right and of course will be supported out of the process by caretakers and/or hospice by slowly reintroducing food and fluids. Again, this is why VSED should be undertaken with a supportive hospice who can provide medical support through staff and medication management and supportive therapies.
Are There Any Potential Challenges with Facilities?
Assisted living and skilled nursing facilities (SNFs) often have their own policies about VSED and while many are supportive, some are not.
Family members or friends may be needed to monitor the process and observe the offering or denial of food and hydration. In some cases, the person might have to leave the facility if the policy or rules do not allow VSED and the individual is determined to follow this path. EOLCCA can refer you to more supportive facilities.