Voluntarily Stopping Eating and Drinking (VSED) is a patient-driven end-of-life choice made under the supervision of a hospice team. This process involves a competent adult deliberately stopping all food and fluid intake with the goal of hastening death through natural physiological means. VSED is fundamentally a legally recognized right to refuse medical intervention, even when that refusal leads to death. This deliberate decision distinguishes VSED from the natural decline in appetite that occurs as the body shuts down. Hospice management focuses entirely on providing comfort and dignity to the patient.
Defining Voluntarily Stopping Eating and Drinking (VSED)
Voluntarily Stopping Eating and Drinking is defined by the patient’s clear intention to bring about their own death by forgoing all nutrition and hydration. The “voluntary” aspect is paramount, requiring the patient to possess full decisional capacity and to sustain that determination throughout the process. This means the patient must be mentally capable of understanding the consequences of their decision, ensuring the choice is informed and not coerced.
The process is distinct from the natural loss of appetite or diminished intake seen in the final stages of illness, which is a passive bodily function. VSED is an active commitment that requires significant willpower from a patient. Unlike the gradual decline in a terminal illness, VSED is an intentional fast initiated by the patient.
VSED is fundamentally different from Physician-Assisted Dying (PAD) or Medical Aid in Dying (MAID), which involves a physician prescribing a lethal medication. In VSED, no lethal substances are administered; the cause of death results from the body’s natural response to dehydration. The patient relies on their personal decision to refuse nourishment, which is legally viewed as refusing treatment. VSED provides a prolonged and reversible dying phase, allowing the patient to change their mind at any point by simply resuming intake.
The Medical Process and Comfort Care
The physiological process of VSED leads to death primarily through dehydration, not starvation. While a person can survive without food for an extended period, the complete cessation of fluids causes the body’s systems to shut down more quickly. The typical timeline for death following VSED is generally one to three weeks, though the duration is highly variable depending on the patient’s underlying health. A person who is already frail may die in a few days, while a more robust individual may take longer.
The hospice team’s role during VSED is aggressive comfort care to manage symptoms and ensure dignity. Hunger is typically not a persistent symptom, often subsiding after the first few days due to ketosis. However, thirst and dry mouth are common and require careful management.
Hospice care involves frequent, specialized oral care, such as using mouth swabs, lip balm, and cool water mists to keep the mucous membranes moist. Pain, anxiety, and agitation are managed with palliative medications, which can include sedatives if suffering becomes intractable. This symptom management is crucial to a peaceful death. The goal is to relieve all suffering while strictly avoiding the provision of any nutrition or hydration, as even small sips of water can prolong the process.
Legal and Ethical Framework
VSED is widely recognized as a legal end-of-life option across the United States. Its legality is rooted in the constitutional right of a competent individual to refuse medical treatment. Refusing food and water is legally seen as an exercise of this fundamental right, which applies even when the refusal is known to hasten death.
The ethical justification for VSED centers on patient autonomy and self-determination. The choice reflects the patient’s right to control their own body and decide what constitutes an acceptable quality of life. While some medical professionals and faith communities may hold ethical reservations, clinicians must respect the competent patient’s choice and provide supportive palliative care.
Ethical discussions distinguish VSED from active euthanasia or assisted death. Because the patient initiates and sustains the action, and death results from a natural physiological process, it is viewed as allowing a natural death rather than actively causing one. The obligation of the hospice team is non-abandonment, ensuring comfort and symptom relief, which is ethically permissible even if the team disagrees with the patient’s choice to hasten death.
Supporting the Patient and Family Through VSED
Support from the hospice team is necessary for a successful VSED process, extending beyond medical care to emotional and psychological well-being. The patient requires ongoing counseling to reaffirm their decision and ensure they maintain decisional capacity throughout the fast. This support also addresses any existential suffering, fear, or isolation the patient may experience.
Family members and caregivers also receive support, as the process can be emotionally challenging to witness. Hospice provides grief counseling and assistance with family communication, helping loved ones understand the patient’s choice and their role in providing a supportive presence. Practical support is organized, often including 24-hour caregiving and managing the environment to ensure privacy and a calm atmosphere.
It is important to ensure all caregivers fully support the patient’s decision to avoid inadvertently prolonging the process. This holistic care helps the patient and family navigate the emotional and practical complexities of choosing VSED.