Voluntarily Stopping Eating and Drinking (VSED) is a deliberate end-of-life choice made by an individual with full mental capacity. It involves the intentional refusal of all food and fluids with the specific goal of hastening death. This option is typically considered by those facing a terminal illness or an irreversible condition that leads to unacceptable suffering, allowing them to maintain control over the timing and manner of their death. The process requires careful consideration of the physical, emotional, and practical aspects for the person choosing VSED and their loved ones.
Defining Voluntarily Stopping Eating and Drinking
VSED is defined as a decision made by a mentally competent adult to forgo all oral intake of nourishment and liquids with the primary intention of accelerating the dying process. It is a personal and voluntary act, meaning the choice must be free of coercion and made with a clear understanding of the consequences. The person must retain the mental capacity to initiate and maintain the decision throughout the process.
The intent to hasten death distinguishes VSED from the natural decline in appetite and thirst that often occurs in the final stages of a terminal disease. In VSED, the person is capable of eating and drinking but chooses not to, making it an active choice of omission. The cause of death is typically dehydration, not starvation, which is a significant distinction in the medical and legal context.
Suitable candidates must have a steadfast desire to pursue this path, often driven by concerns over loss of dignity, autonomy, or suffering that palliative care cannot fully alleviate. While a terminal diagnosis is not strictly required, VSED is most commonly pursued by those with a serious, progressive, or incurable condition. The process requires determination and comprehensive support from caregivers and medical professionals to ensure the individual’s comfort and resolve.
VSED is considered a passive act, rooted in the legal right of any competent person to refuse medical treatment, including the refusal of food and hydration. This makes it legally permissible across the United States, unlike other options for hastening death that are restricted by state law. It is a form of self-determination, where the individual chooses to die from dehydration rather than from the underlying illness’s natural progression.
The Physical Process and Timeline
When VSED begins, the body is systematically deprived of the necessary resources to sustain life, leading to a predictable physiological cascade. The initial phase is marked by the feeling of thirst, which is managed through rigorous mouth care rather than fluid intake, as even small amounts of water can prolong the process. True hunger pangs generally subside after the first few days as the body enters ketosis.
Ketosis, the process of burning fat reserves for energy, can produce a mild euphoric or analgesic effect, contributing to a more comfortable experience for some individuals. As dehydration progresses, the body’s systems begin to shut down, leading to increasing weakness and fatigue. The person will spend progressively more time sleeping and may become largely unresponsive.
The timeline for death following VSED varies significantly based on the person’s baseline health, underlying illness, and the strictness of fluid abstinence. For someone already frail or near the end of life, death may occur within a few days. However, the average time for VSED to result in death is typically within 10 to 14 days, though it can extend up to three weeks for more robust individuals. As the process nears its end, the person may experience symptoms such as dry mouth, agitation, and delirium due to chemical imbalances from dehydration and kidney function decline. This late stage necessitates continuous, dedicated care to address these symptoms and maintain comfort. The ultimate cause of death is usually cardiac arrest resulting from severe electrolyte disturbances.
Medical Support and Comfort Care During VSED
A successful VSED process relies heavily on the cooperation and expertise of a dedicated medical and caregiving team, often provided through hospice or palliative care services. This support focuses exclusively on symptom management and comfort, not on actively hastening death. The team ensures the person’s experience remains peaceful and that their commitment to VSED is not compromised by avoidable suffering.
Aggressive oral care is a primary intervention used to alleviate the persistent symptom of thirst and dry mouth. This involves frequent swabbing of the mouth with moist, cooling agents, the use of lip balm, and sometimes misting with a fine spray of water, ensuring total fluid intake remains minimal. A cool-mist humidifier in the room also helps to soothe the dry mucous membranes.
Pain management is another central component, involving medications to control discomfort arising from the underlying illness or the physical effects of VSED. Anti-anxiety medications and sedatives are often prescribed to manage agitation, restlessness, or delirium as the person becomes progressively weaker. These medications ensure the person remains in a comfortable, often sleep-like state. The medical team ensures that any medications not necessary for comfort are discontinued, as some drugs can worsen dry mouth or slow the process. Caregivers must also provide 24-hour personal care, including assistance with repositioning, hygiene, and incontinence, as the person becomes increasingly weak and bed-bound.
VSED Versus Other End-of-Life Decisions
VSED is distinct from other end-of-life options due to its passive nature and the role of individual autonomy. It is fundamentally different from Medical Aid in Dying (MAID), which is an active medical intervention where a physician prescribes lethal medication that the patient self-administers. MAID is subject to strict legal regulations and is only available in limited jurisdictions, typically requiring a terminal prognosis of six months or less.
In contrast, VSED is a refusal of sustenance, considered a basic right to refuse care, and does not require a physician’s prescription or a specific terminal diagnosis, making it legally available in all states. The legal distinction hinges on VSED being an omission—the patient stopping an action—whereas MAID is an act—the patient taking a lethal substance. This difference has significant implications for how medical institutions and care providers engage with the process.
VSED is also separate from the withdrawal of life-sustaining treatment, such as removing a ventilator or stopping artificial nutrition and hydration. While both are refusals of care, the withdrawal of a life-sustaining intervention focuses on stopping a medical treatment. VSED is a refusal of oral intake and a decision to forgo fundamental human sustenance, though the right to refuse it is equally protected.
The individual maintains control over the process in VSED, as they can change their mind and resume eating and drinking at any point, though doing so late may be physically challenging. This retained personal control is a primary reason many people choose VSED, particularly those whose suffering involves existential concerns about future decline. The choice empowers the person to determine their own end without requiring a physician’s active participation to cause death.