What Is VSED (Voluntarily Stopping Eating and Drinking)?
By CRYSTAL BAI •
The short answer: VSED (voluntarily stopping eating and drinking) is a legal end-of-life option in all 50 U.S. states where a competent adult chooses to stop consuming food and fluids, typically resulting in death within 1–3 weeks. It is distinct from medical aid in dying, requires no physician prescription, and is managed through palliative care to ensure comfort. Death doulas can provide vigil support throughout.
What Is VSED?
Voluntarily Stopping Eating and Drinking (VSED) is a legally recognized end-of-life option in which a person with decision-making capacity chooses to stop consuming all food and fluids. This decision, once fully implemented, leads to death — typically within 1–3 weeks for a seriously ill person. VSED is legal in all 50 U.S. states as an expression of a competent adult's constitutional right to refuse medical treatment, including the treatment of nutrition and hydration.
Why People Choose VSED
VSED is most commonly chosen by people who:
- Have a terminal illness with significant suffering that they are unwilling to continue experiencing
- Live in a state without medical aid in dying, or whose physician will not participate in medical aid in dying
- Have a serious chronic illness that is not terminal enough to qualify for medical aid in dying but that significantly impairs quality of life
- Hold specific religious or ethical views that permit VSED but not medical aid in dying
- Have lost the ability to eat naturally (ALS, dementia) and have previously expressed VSED wishes in advance directives
How VSED Differs from Medical Aid in Dying
| Element | VSED | Medical Aid in Dying |
|---|---|---|
| Legal status | Legal in all 50 states | Legal in ~11 states |
| Physician involvement | Not required (though recommended for palliative support) | Required (two physician certifications) |
| How death occurs | Naturally, through dehydration | Through ingestion of prescribed medication |
| Timeline | 1–3 weeks (for seriously ill patients) | Hours after ingestion |
| Terminal diagnosis required | No — any competent adult can choose it | Yes — 6-month prognosis required |
| Can be reversed | Yes, at any time | No (once medication is ingested) |
The Medical Experience of VSED
When a person begins VSED:
- Days 1–3: Hunger sensations may be significant but typically diminish after 72 hours as the body shifts to ketosis. Thirst and dry mouth are the primary physical discomforts.
- Days 3–7: Increasing weakness, fatigue, and decreasing cognitive clarity. Many people sleep more.
- Days 7–14: Progressive weakness; transition to unconsciousness or significantly reduced responsiveness in seriously ill patients. This phase varies by the person's underlying condition and initial health status.
- Death: Typically peaceful, occurring through the natural progression of dehydration, which at its end stages involves unconsciousness before cessation of breathing and heartbeat.
Palliative care or hospice support during VSED focuses on oral care (mouth swabs, lip balm, ice chips) to manage thirst discomfort, positioning and skin care, and medication for any symptoms like agitation or pain that emerge.
Advance Directives and VSED
People can specify VSED wishes in advance directives — for example, instructions that if they develop advanced dementia and can no longer recognize family members, they do not wish to receive food and water. Some states specifically recognize such directives; others have uncertainty in their laws. Death doulas and attorneys with advance care planning expertise can help draft VSED-specific language.
Death Doula Support During VSED
Death doulas provide non-medical companionship and family support throughout the VSED process. They help families understand what to expect, sit vigil, assist with oral care logistics, and provide emotional presence through what can be an emotionally complex experience. Renidy can connect you with a death doula experienced in supporting families through VSED.
Frequently Asked Questions
Is VSED legal in all US states?
VSED is legal in all 50 U.S. states as an exercise of a competent adult's right to refuse treatment. It is not the same as medical aid in dying (which requires physician-prescribed medication) and is permitted even in states without medical aid in dying laws.
How long does VSED take?
For someone who is already seriously ill, VSED typically results in death within 1–3 weeks. For someone who is not terminally ill, the timeline may be longer (several weeks to months) and the experience of dying may be more prolonged. A person's hydration status at the start significantly affects the timeline.
Is VSED painful?
With adequate palliative care, VSED is not considered painful. Hunger typically diminishes within a few days; thirst (dry mouth) is the primary discomfort and is managed with oral care — mouth swabs, ice chips, lip balm. Hospice or palliative care teams experienced in VSED can manage any discomfort effectively.
What is the difference between VSED and refusing treatment?
VSED is a form of refusing treatment — specifically, the treatment of nutrition and hydration. Other forms of refusing treatment include turning off a ventilator, removing a feeding tube already in place, or stopping dialysis. All are legal expressions of the right to refuse medical intervention.
Can a death doula support a VSED process?
Yes. Death doulas provide non-medical support throughout VSED: sitting vigil, supporting family members, helping with oral care logistics, providing emotional presence, and being present through the dying process. They are not medical providers and do not administer medications, but their companionship is particularly valuable during VSED.
Renidy connects grieving families with compassionate end-of-life professionals. Find support near you.