What Is VSED (Voluntarily Stopping Eating and Drinking)?

Families sometimes encounter the term VSED when a loved one with a serious illness says they want to stop eating and drinking. It is easy to confuse with something that happens on its own near the end of life, and it raises legal, medical, and ethical questions. This article explains what it is, in plain terms. It is not a guide to doing it.

What is VSED?

VSED stands for voluntarily stopping eating and drinking. Clinical sources define it as a process in which a person who has decision-making capacity chooses to stop eating and drinking, with the intention of hastening death. An ASCO Post article describes it as stopping all food and fluids except small amounts needed for mouth comfort or to take medication, and notes that people with capacity can resume eating and drinking if they change their minds.

How is it different from the natural loss of appetite near death?

Near the end of life, people often eat and drink less because the body is shutting down, not because they have chosen to. That is a symptom of dying, not a decision. See changes in eating, drinking, and comfort. VSED is a deliberate choice by someone who could still eat and drink, and the intention to hasten death is what sets it apart.

How is it different from medical aid in dying?

Medical aid in dying (MAID) requires a state law that authorizes a physician to prescribe medication to a qualified patient; see what is medical aid in dying. VSED doesn’t depend on a special law, doesn’t involve a prescription, and isn’t limited to certain states. A clinical education summary says VSED is broadly considered different from MAID, ethically and legally, because it is a refusal of food and fluids, not an act that causes death. Not everyone agrees about the ethics of VSED, as described below.

Is it legal?

Clinical education sources say VSED is considered legal in the United States. They also say several lower-court decisions have favored a patient’s right to stop eating and drinking, though there hasn’t been a definitive ruling by a higher court. A review notes that refusing medical treatment is legal and that hand-feeding has been legally established as a medical treatment in the U.S. The American Nurses Association’s position statement states that people with decision-making capacity have the right to stop eating and drinking to hasten death.

What do professional groups say?

• American Nurses Association. Its 2017 statement says the decision to stop eating and drinking to hasten death can be made only by patients with decision-making capacity, not by surrogates, and that nurses will support patients in the decision-making process. It also says a patient’s decision remains binding even if they later lose capacity, which is a point of controversy
• Other groups. A clinical summary reports that the ANA, the International Association for Hospice and Palliative Care, and the American Academy of Hospice and Palliative Medicine all consider VSED a legal option for terminally ill patients
• Disagreement. The same summary notes that some ethicists argue even limited clinician participation (counseling or managing symptoms) amounts to assisting an immoral act, and that organizations such as nursing homes and hospices may not support a patient’s decision for ethical or legal reasons. Another review describes two views: that facilitating a suicide is morally wrong, and that suffering from any cause should be met with palliative care. A 2016 ethics critique also argues that promoting VSED raises concerns for the nursing profession

How common is it, and why do people consider it?

How often it occurs is unknown. A 2024 systematic review cited in the literature found VSED accounts for between 0.4% and 1.7% of all deaths. In one survey, 40% of hospice nurses recalled caring for a VSED patient. Nurses reported that commonly cited reasons included readiness to die, poor quality of life or fear of it, seeing continued existence as pointless, wanting to die at home, and wanting to control the circumstances of death.

What do clinicians report about the course?

Reports are consistent that it is a physically and emotionally demanding process for patients, families, and caregivers, and that clinical support matters:

• Timing. In a published hospice case series of 20 patients, all who started VSED completed it, and death occurred after an average of 9.6 days (range 4 to 23). A nursing article says death occurs in one to three weeks
• Symptoms. An overview describes thirst and difficulty urinating in the first few days, increasing sleepiness, and a coma several days before death. The case series reported that symptoms were typical of hospice patients and could be managed with standard hospice approaches
• Hospice. The authors of the case series argue that people beginning VSED may be eligible for hospice and that care should begin quickly. In that series, three-quarters of patients or families declined one or more hospice services
• Clinical support. A 2018 article in The ASCO Post says that, although VSED was once viewed as something a person could do without clinician involvement, doing so is now strongly discouraged

The practice can be hard on care teams as well: a study of a German palliative care team describes the moral distress and burden that clinicians can feel.

Who can choose it?

The person must have decision-making capacity. Surrogates can’t make the decision for them. A debated question is “advance VSED,” an instruction in an advance directive to stop eating and drinking if the person later loses capacity, such as with dementia. The ASCO Post notes that the main unanswered questions concern this situation, not contemporaneous VSED. See advance directives.

If you’re considering this or someone close to you is

• Talk with the palliative care or hospice team first. If someone is considering VSED, a clinician who knows their situation can discuss it, the person’s symptoms and what else could help, and what support and policies are available. Not every hospice or facility will support it
• Ask what’s behind the wish. Wanting to stop is often tied to pain, loss of independence, fear, or other suffering, and some of it can be eased. See comfort care
• Involve family and spiritual or mental health supporters early

If you are struggling with hopelessness or thoughts of ending your life, please call or text 988, the Suicide & Crisis Lifeline, or call 911 in an emergency. If you are caring for someone who has made this choice and you are overwhelmed, tell the care team; caregivers need support too.

Practice and law vary, and clinical guidance changes. This is general information, not medical or legal advice and not instructions; a palliative care or hospice clinician can discuss your situation.