What is Voluntarily Stopping Eating and Drinking (VSED)?

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Voluntarily stopping eating and drinking, known in the medical community as VSED, is a legal way for mentally stable and cognizant patients with a terminal illness to hasten death. For a person who has decided that their terminal condition has progressed to a point where their quality of life is unacceptable, the options include VSED, palliative sedation and, in states where it is available, medical aid in dying or physician-assisted death.

Why would someone choose VSED death?

People choose VSED because they prefer the initial discomfort of thirst and hunger to prevent the impending suffering or loss of autonomy from their primary disease process. With voluntary stopping eating and drinking, a patient decides not to eat or drink anything. Unlike physician-assisted death, VSED does not require a health care provider’s assistance. For many people it allows them a measure of control over the end of their life. Hospice nurses in one study in the New England Journal of Medicine caring for patients who had decided to stop eating and drinking describe the patient’s experience as peaceful and with minimal suffering.

What can someone expect from VSED?

Once a patient decides to voluntarily stop eating or drinking, side effects include dry mouth, pain, restlessness, agitation, and dyspnea (shortness of breath). Dry mouth can be treated with oral lubricants and sponges, but patients should not swallow liquid from them. Any medications with anticholinergic properties (for example, those for COPD, diarrhea, nausea, Parkinson’s) will make these symptoms worse. Most patients stop their routine medications while going through the VSED process.

For pain and shortness of breath, opiate medication such as morphine is effective but should not be given with sips of water. Using high concentration drops of morphine is the most effective way to treat symptoms without giving a lot of liquid. Fans and oxygen can also be used for shortness of breath.

Is VSED legal?

Since all people have the constitutional right to refuse medical treatments, the U.S. Supreme Court has extended this right to food and hydration. It is essential that the person who wants to hasten death is mentally sound and aware of the risks and benefits and intended outcome of their decision. It is also crucial that the person choosing VSED has the support of their caregivers as they enter into this process. The caregivers are not held legally responsible for the patient’s death and the death certificate will list the original diagnosis, not dehydration or malnutrition, as the cause of death.

At any point a patient may decide to stop the process and their caregivers should feed and hydrate them as requested. In some states patients can sign advanced directives stating that if they cannot feed themselves they do not wish to be fed. This would allow someone with early dementia to designate their wishes ahead of time and before they lose the ability to make their decisions around not just feeding tubes but being spoon-fed. (Related: Putting Plans in Place for a Loved One with Alzheimer’s or Dementia.)

How long does it take for someone to die if they choose a VSED death?

Typically, the process lasts between one to two weeks. This can be shorter or longer depending on the patient’s starting condition and the amount of liquid they consume during the course. Our bodies can go long periods of time without nutrition, months even, but without fluids we become dehydrated. Dying from dehydration is considered a relatively painless process as it very quickly causes the kidneys to fail which then leads to both electrolyte disturbances and a build up of waste products normally filtered by the kidneys. The main symptom is sleepiness. The electrolyte disturbances can also cause abnormalities in the heart beat which is not painful but can lead to life-ending heart rhythms.

VSED is a very different process than the normal disinterest in food that one sees as someone dies naturally. Most people who have begun the dying process will not want to eat or drink. This is a normal reaction, as opposed to an intentional desire to not eat or drink so that one can hasten death.

As the patient becomes weaker, they will need help with basic tasks and with control of symptoms. This is why it is so crucial that someone’s decision to stop eating and drinking be part of a larger conversation with their caregivers. As they get weak, they will need help with bathing, dressing, and moving in bed. Because they are not eating and drinking, they would not be expected to have many toileting needs.

Maggie Carpenter, MD, is a doctor in New Paltz, NY, and the founder of Nightingale Medical

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