Voluntarily Stopping Eating and Drinking (VSED)
Frequently Asked Questions
What is VSED?
VSED (voluntarily stopping eating and drinking) 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 historically chosen to die in many cultures, as they’ve lost their appetite as a natural process at the end of their lives. Hospice nurses in Oregon rated VSED a “good death” giving it an 8 out of 9 as a peaceful way to go.
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 an absolute requirement 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 and breathing trouble and possibly sedation. A person who is on the journey to use VSED to end their life and has 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 on VSED?
A person engaging in VSED will not die of starvation; they will die of dehydration.
Stopping drinking all fluids, including liquid medication, leads to the kidneys shutting down and a rise in blood sodium and creatinine levels. Further biochemical changes lead to heart failure and death. Hospice can provide medication support in other ways than liquid form.
How Long Will it Take?
Once all oral intake stops, there is an interval of at least several days – usually three to eight – before the person loses consciousness. Once the person goes into a coma, death usually happens within another five to eight days. This time frame varies significantly depending on the person and their disease process. We’ve seen some people die peacefully in 3 days, others in two to three weeks. With adequate medical support, caregivers and preferably hospice care, this can be achieved peacefully.
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.
However, people who choose to just stop eating and continue taking in fluids often have a very uncomfortable experience. We do not recommend this. It is important that intake of all food and fluids is stopped completely.
What are Some of the Problems Associated with VSED?
The person 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.
Should the person change their mind and decide to stop VSED, that is their 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.
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. SNFs are required to offer food and hydration but sometimes, at the direction of the resident, negotiation can be made to get around this requirement.
Family members or friends may be needed to monitor the process and observe the offering 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 they are determined to follow this path.