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What Is Voluntary Stopping of Eating and Drinking (VSED)?

By CRYSTAL BAI •

What Is Voluntary Stopping of Eating and Drinking (VSED)?

The short answer: Voluntary stopping of eating and drinking (VSED) is a legal, ethical option by which a person with decision-making capacity chooses to stop consuming food and fluids as a means of hastening death. It typically results in death within 1–3 weeks, is supported by hospice, and is available in all 50 states — including those without Medical Aid in Dying laws.

VSED is one of the most misunderstood end-of-life options. It is not starvation in the conventional sense — the dying process involves significant reduction in hunger and thirst perception. When properly supported with hospice care and good mouth care, most people who choose VSED report that the dying process is manageable and, importantly, on their own terms.

Who Chooses VSED and Why

People typically choose VSED when:

  • They live in a state without Medical Aid in Dying and want control over the timing and circumstances of death
  • They do not qualify for MAID (e.g., diagnosis is dementia rather than a terminal illness with 6-month prognosis)
  • They are suffering significantly — physically, existentially, or both — and want to hasten death
  • They want to align their dying with personal or religious values about not introducing exogenous substances

The Medical and Physical Process

When a person stops eating and drinking:

  • Days 1–3: Hunger and thirst are present; mouth is dry. This is typically the most uncomfortable phase. Good mouth care (swabbing with moisture, lip balm) significantly reduces discomfort.
  • Days 3–5: The body enters ketosis; hunger diminishes significantly. Energy decreases; sleep increases. Many people report feeling relatively peaceful at this stage.
  • Days 5–14+: Deepening unconsciousness, reduced perception of thirst, organ systems shutting down gradually. Death typically occurs 1–3 weeks after VSED begins, though ranges vary widely based on baseline hydration, nutrition, and health status.

VSED is legal in all 50 states. The legal framework rests on the established right to refuse medical treatment — including artificial nutrition and hydration — which courts have consistently upheld since Cruzan v. Director (1990). Hospice organizations and palliative care specialists broadly support VSED as an ethically appropriate option.

Role of Hospice in VSED

Hospice care is the optimal support structure for VSED. Hospice can:

  • Manage symptoms including mouth dryness, agitation, and pain
  • Provide 24/7 nursing availability for questions and symptom management
  • Support family members through the process
  • Coordinate medications that manage discomfort

Not all hospice organizations are experienced with VSED; ask directly whether the hospice team is comfortable and experienced with supporting VSED before enrolling.

Decision-Making Capacity Requirement

VSED requires the person to have decision-making capacity at the time they initiate the process — they must understand what they are choosing and be able to make and express the choice. This is different from MAID, where the capacity determination is formal. For people with early-stage dementia who want to preserve the option, advanced care planning that explicitly addresses VSED can help, though legal questions about late-stage capacity to continue or stop VSED are complex.

The Role of a Death Doula in VSED

A death doula can provide significant support during VSED — both for the person dying and for family members. They can: provide continuous presence, help with mouth care, support the family's questions and fears, facilitate the conversations about what is happening, and hold the space during what can be an extended, emotionally complex dying process.

Frequently Asked Questions

Is VSED painful or suffering?

With proper hospice support, most people who choose VSED report manageable discomfort, particularly in the first few days when thirst may be present. Good mouth care (frequent moisture swabbing, lip balm) significantly reduces dryness. Hunger diminishes rapidly with ketosis. Hospice medications can manage agitation or discomfort. The dying process is typically described as peaceful by those present.

Yes, in all 50 states. VSED rests on the legal right to refuse medical treatment, including artificial nutrition and hydration, which has been upheld consistently by courts since Cruzan v. Director (1990). It is not the same as assisted suicide and carries no legal risk for family members, caregivers, or hospice providers.

How long does VSED take?

Most people die within 1–3 weeks of stopping all food and fluids. The timeline varies significantly based on baseline health, hydration status, and individual metabolism. People who are already very ill or malnourished may die sooner; those with high baseline health may take longer. Hospice teams can provide estimates based on the individual's condition.

Can someone with dementia choose VSED?

VSED requires decision-making capacity at the time of initiation. People with early-stage dementia who retain capacity may choose VSED while they can still make and express the decision. For later stages of dementia, advance directives can express a wish to refuse artificial nutrition and hydration — which courts generally uphold — but active VSED requiring ongoing choice is more complex. An elder law attorney can advise on specific situations.

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