VSED stands for voluntarily stopping eating and drinking. It is a decision by a person with a serious or terminal illness to hasten death by refusing all food and fluids. The process typically leads to death within two weeks, and it is legal in the United States. Several major medical organizations, including the American Academy of Hospice and Palliative Medicine and the American Nurses Association, recognize VSED as a legitimate option for terminally ill patients.
How VSED Works
A person who chooses VSED stops consuming all food and liquids, including water. The body begins breaking down stored fat for energy through a process called ketosis, which is why most people do not experience severe hunger after the first day or two. Thirst, particularly dryness of the mouth and throat, is the most common discomfort and tends to be strongest in the early days.
As dehydration progresses, kidney function declines and electrolyte levels shift. The person becomes increasingly sleepy and weak. Eventually, the imbalance of sodium and potassium disrupts heart cell function, leading to cardiac arrest. Death from VSED is generally described as peaceful by clinicians who have observed it.
The Three Stages
VSED is typically described in three phases. In the early stage, which covers roughly the first few days, the person is still alert and able to talk with family and caregivers. Thirst and difficulty urinating are the main symptoms. Mouth swabs, mist sprays, lip balm, and room humidifiers can ease dryness without introducing enough fluid to slow the process. Even small sips of water adding up to 50 milliliters a day or more can delay dehydration significantly.
The middle stage brings progressive weakness as the kidneys begin to fail. The person needs help with toileting, hygiene, and eventually turning in bed. Confusion, anxiety, and delirium can occur during this phase. Lightheadedness and loss of balance make it unsafe to stand or walk without assistance.
The final stage typically lasts one to two days. The person is largely unresponsive, and caregivers watch for nonverbal signs of pain, restlessness, or agitation. Comfort-focused care continues at the bedside until death, which usually occurs within about two weeks of starting VSED, though the exact timeline depends on the person’s overall health and how strictly fluids are restricted.
Managing Discomfort
The most challenging symptom for many people is thirst, especially in the first several days. Clinical guidance focuses on keeping the mouth and lips moist without reintroducing meaningful amounts of fluid. Oral swabs, moisturizing sprays, and lotion for dry skin are standard comfort measures. Keeping the room humid also helps.
Thirst can trigger anxiety, and as dehydration deepens, some people develop delirium. Palliative care teams can provide medications to manage anxiety, agitation, or severe confusion when needed. One specific risk during delirium is that the person may forget their original decision and ask for water or food. This is one reason advance planning is so important.
Advance Planning and Documentation
Because confusion is a predictable part of the process, people considering VSED are strongly encouraged to document their intentions before they begin. This typically includes updating an advance directive to state the desire to continue VSED even if they later ask for food or drink while confused. Recording a short video explaining the decision in your own words adds another layer of evidence that the choice was deliberate and well-considered.
Naming a healthcare proxy who fully supports the decision is critical. This is the person who will speak on your behalf if you become unable to communicate. If your current proxy is uncomfortable supporting VSED, changing proxies beforehand is recommended. Family members or friends who oppose the decision can be explicitly excluded from healthcare decision-making in the advance directive to prevent conflict during the process.
For people living in assisted-living facilities, adding a rider to the residential agreement can help ensure the facility will respect end-of-life wishes rather than intervening with food or fluids. An advance directive alone may not be sufficient as the sole legal basis for honoring VSED wishes, but having detailed documentation helps caregivers feel confident following the person’s stated goals.
Legal and Ethical Standing
VSED is legal in the United States. Several lower court decisions have supported a patient’s right to stop eating and drinking to hasten death, though no definitive Supreme Court ruling has addressed it directly. Many ethicists and medical organizations consider VSED distinct from suicide because it involves refusing sustenance rather than taking an active step to end life. The person is exercising a right to refuse treatment or intervention, a principle well established in American medical law.
This distinction matters practically. In states where medical aid in dying is not available, VSED remains an option. It does not require a prescription, a specific diagnosis, or residency in a particular state. It does, however, require the person to have the mental capacity to make the decision. That means they must be able to understand the consequences of stopping food and fluids, weigh those consequences, and communicate their choice. Having a condition like dementia or a brain injury does not automatically disqualify someone, but the capacity to make this specific decision must be present at the time it is made.
Who Considers VSED
VSED is most commonly chosen by people with terminal illnesses who want more control over when and how they die. It is also considered by people with serious chronic conditions who feel their quality of life has become unacceptable. Unlike medical aid in dying, which is limited to certain states and requires a terminal diagnosis with a life expectancy of six months or less, VSED has no such legal restrictions.
The process requires significant support. Most people need a caregiver, whether a family member, hospice team, or both, to manage comfort care as they become weaker. Hospice enrollment is common for people choosing VSED, as hospice teams are experienced in managing symptoms during the dying process and can provide medications, equipment, and emotional support for both the patient and family.