FAQ – Voluntarily Stopping Eating & Drinking
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Frequently asked questions about Voluntarily Stopping Eating & Drinking (VSED).
Q: What is VSED?
A: VSED stands for Voluntarily Stopping Eating and Drinking. It is when a mentally capable person, often suffering from a chronic or terminal illness, deliberately chooses to stop consuming any food or drink in order to hasten their death. VSED is sometimes called end-of-life fasting.
Q: Who typically uses VSED?
A: VSED is used by people suffering from a variety of end-stage conditions including cancer, stroke, painful musculoskeletal diseases, and degenerative diseases like Alzheimer's, ALS, and MS. Sometimes it is chosen because you do not qualify for hospice care or medical aid in dying.
Q: Why would I choose VSED?
A: VSED may be the only legal option to put an end to interminable suffering. Sometimes, people choose it because it is a natural way of dying. Sometimes, it is chosen because it allows time for family bonding in the final weeks of life. To choose VSED, you must only have the mental capacity to make the decision and the willpower to stick to it.
Q: Is VSED legal? How does it affect insurance?
A: VSED is legal in all states. The Supreme Court has established that people have the right to refuse food and hydration. VSED is not considered suicide and should not affect life insurance payments. The underlying illness, not the fasting, is listed as the cause of death.
Q: Is VSED suicide?
A: Many eminent ethicists have considered, discussed, and published about this. Most agree it is not suicide. It is a decision to exercise a natural process that people have used for tens of thousands of years. If you have questions about this, talk to your minister, priest, imam, or rabbi.
Q: Is there anything I need to do to qualify for VSED?
A: No. You must only have the mental capacity to make the VSED decision and to carry it out.
There is no waiting period, no permissions needed. It will not affect your insurance and should not be recorded on your death certificate.
Q: How long does it take to die from VSED?
A: Typically, 7-14 days depending on how frail you are to start with. It rarely if ever takes more than 2 weeks if you completely stop eating and drinking. Even small sips of water if more than a couple a day can extend the time to death.
Q: What is the VSED process like?
A: When you simply stop taking in any food or fluids, at first you may be hungry. This typically subsides remarkably quickly – in just a few days. Thirst, however, remains and this becomes the most annoying or even distressing symptom. Over the days, you become weaker and finally go into a coma. Before that happens, you may become delirious and can get agitated. If you get agitated in the 2-3 days before death, you may benefit from medications to calm you such as sedatives or morphine.
Q: Tell me more about what to expect?
A: The first several days you typically have your usual energy. You can do the things you did before, you can finalize your affairs and spend loving time with friends and family.
In the second week, you typically have lost enough weight and strength that getting out of bed becomes more difficult. You become weak and sleepy. At this point you must have round-the-clock caretaking from friends, family, or staff.
In the final days, some people just sleep almost constantly. Others can become delirious and along with this can come agitation. That means you don’t know what you’re doing. During this time, you may lose sight of your goal and ask for water. You need to talk frankly with supporters before you start VSED to let them know it's okay to disregard these requests. Typically if they remind you that you’re wanting to fast, you will quiet down. But it can be painful for them to see you in distress unless they are given permission to deny you water and food so as not to prolong the VSED. During this time too, your caretakers may want to ask your doctor or hospice to prescribe sedatives or morphine. In fact, it is best to have these on hand at the beginning of the process, just in case.
Finally, you enter into a coma, and within a few hours or a day or two thereafter, you die.
Q: How will I feel while doing VSED?
A: At first you may be hungry but this subsides in just a few days. You will be thirsty. After you have been fasting for several days, you will grow weak and tired. You'll spend more time resting while caregivers provide comfort measures. You may have periods of alertness where you can be with loved ones and do meaningful activities together. You may have a day or two of agitation from delirium. Eventually you'll become unresponsive and enter a coma. This leads to a natural passing from organ systems shutting down, on average between 7 and 14 days, sometimes less. Typically death comes within two weeks unless you drink or eat. Symptoms such as thirst can be relieved with brushing teeth, mouth washes, and lip balm. Agitation can be relieved by medications from your doctor or hospice.
Q: What are the downsides to VSED? OR what are the problems I might encounter?
A: You will experience thirst which can be distressing. Symptoms can be soothed somewhat with good teeth brushing a few times a day, lip balm, and swish-and-spit mouthwash. You can also use a humidifier to add moisture to the air around you. If thirst becomes hard to tolerate, you can ask your doctor to prescribe sedatives or morphine.
Your skin may get dry and cracked. You can use lotions and massage to help this. humidified air for dryness, and medications as needed for discomfort and anxiety.
You may become delirious and agitated before going into a coma. That means you don’t know what you’re doing. During this time, you may lose sight of your goal and ask for water. You need to talk frankly with supporters before you start VSED to let them know it's okay to disregard these requests. Typically if they just remind you that you’re wanting to fast, you will quiet down. But it can be painful for them to see you in distress unless they are given permission to deny you water and food so as not to prolong the VSED. You may want to ask your doctor to prescribe sedatives or opiates for discomfort.
Depending on where you live, you may have problems getting a doctor or hospice to support you so you may not have access to medications to calm you. Consider consulting a death doula to help navigate the health system for you.
Q: How important is it to have support from family or friends?
A: It is critical. VSED requires significant caregiver support. You will need 24/7 care at least after the first few days. Your caregiver may be family or friends. Or it can be hired helpers or facility staff if you are in a long-term-care facility willing to support VSED. Supporters are important to help you with physical needs such as helping you to the bathroom and mouth care but also to provide emotional support and distract you since the hours seem longer when you are not eating.
Your family will benefit from helping you. VSED is a time for family bonding, clearing up any bad feelings, and sharing memories. The great majority of families say their loved one died peacefully and in full control. They say they are glad they could be involved.
Q: If I don’t have family or friends available, who can I call and what does it cost to hire helpers?
A: Almost every area has home health care services. Look up local providers. Costs are usually in the $25 an hour range. For two weeks of 24/7 care provision, you are looking at several thousand dollars cost. A death doula can also be helpful to coordinate the care team and support the family. Talk to them, ask their costs, what they provide, and how they might help you find home health aids.
For the 24/7 support you need, hospice will not suffice. Although having hospice support can be incredibly helpful, they provide only a few hours per week of home health aids. In addition, they’ll have a visiting nurse come and evaluate you up to every few days and they can give medications that ease any pain and thirst. But they cannot take the place of family/friend/hired staff support.
Q: How important and how easy is it to get medical support?
A: Medical support is not absolutely necessary, but the journey is harder without it. Research shows that the chances of a “good death” are much higher with a physician helping. The best case is if you have a trusted physician who is willing to support you. Some physicians will help and some will refuse.
A second good option is to reach out to palliative care programs in your area and ask for a consultation.
A third option is to get hospice involved. If you already reside in a long-term care facility, you’ll need to find out if staff will support you. This often means asking the administrator.
For all (physicians, palliative care, hospice, and long-term care), you will need a frank conversation before you begin, make a clear request, and often have an evaluation or consultation before getting an answer. So it’s best to do this while planning.
A death doula often knows the resources in your area and can help with this.
Q: What if my doctor and hospice refuse to help?
A: VSED can be done without medical support but the journey is harder without it. Research shows that the chances of a “good death” are much higher with a physician helping. Possibilities are talking to a trusted physician who is willing to support you. Or finding a palliative care program or hospice program that is willing to prescribe medications to calm you and to support you during the process.
If doctors and hospice refuse to support you, it is typically because they require you have only 6 months to live. You and your caretakers can start on your own and in 2-3 days, call again. At that point, they know you are serious and within the final six months of life. Some will then be willing to step in. If not, you always have the option to either continue without healthcare support or to stop. You can also consider hiring a death doula for suggestions for symptom relief as well as emotional support.
Q: If I can line-up medical support, how will they help?
A: A physician or hospice nurse can sometimes tell you what to expect. Even if they don’t have VSED experience, they can visit during the process and give advice about how to alleviate mouth dryness, best ways to get to the toilet or use a bedpan, and how to deal with agitation. They can prescribe medications that dissolve under your tongue or can be squirted into your mouth. Once your mouth becomes parched, you’ll become unable to swallow normal pills. The medicines used to make you more comfortable will calm you and make you sleepy.
If you qualify, hospice can also provide a nurse, social worker, bath aide, and chaplain. Some will loan you a hospital bed, oxygen, and other supplies that may be helpful.
Hospice does not provide 24/7 caregiving but can help guide the VSED process alongside your own caregivers. They willpay for some supplies. After death, they handle the death certificate. Hospice is covered by Medicare.
A death doula cannot prescribe medications but can help navigate the healthcare system and provide suggestions for symptom relief as well as emotional support.
Q: Will I qualify for hospice? What does hospice provide?
A: Hospice sometimes (but not always) requires a terminal diagnosis with a prognosis of 6 months or less. Some hospices will consider you eligible because the VSED process itself will lead to death in that timeframe. Discuss your plans with hospice beforehand. Check around for a hospice, or palliative care program, or doctor who will help. If a hospice initially refuses to admit you, ask again after 2-3 days of fasting because at that point, they may consider you to have a life expectancy of 6 months or less.
If you qualify, hospice can provide a nurse, social worker, bath aide, chaplain, medications, and other palliative care support. They do not provide 24/7 caregiving, but can help guide the VSED process alongside your own caregivers. They will pay for some supplies. After death, they handle the death certificate. Hospice is covered by Medicare.
Q: Can VSED be done at home? Does the family need to agree?
A: Yes, About three quarters of VSED is done at home. It is a setting of comfort and love. VSED can also be undertaken in a care facility or hospice that allows it. If you reside in a facility, talk to them before you start to make sure they will support you.
Family does not need to agree with the decision, but their emotional support is very helpful during the process. Have an open discussion about VSED beforehand. Make sure all family members that may show up are on the same page. Family meetings should include why you decided to VSED, your desire for support, and your permission for them to ignore pleas for drink should you become delirious.
Q: What does VSED feel like?
A: VSED is not associated with any unique end-of-life symptoms. You will get thirsty and have dry mouth which can be helped with brushing teeth and tongue a few times a day, mouthwash that you swish and spit out, lip balm, and a room humidifier.
You may be anxious about it or get anxious as delirium sets in. Typically, once you start and see that it’s not so bad, the initial fears resolve. But you may want to have anti-anxiety medications from the start. The anxiety or even agitation that comes later with delirium is best treated with prescribed medications from a supporting doctor or hospice.
Near the end, a few people have shortness of breath, which can be eased with oxygen.
Q: How often is VSED a bad experience?
Research shows that 80% of people who undertake VSED feel, near the end, that they had a “good death”. Benefits described among hundreds of people who have used VSED include being in control, bonding with family, lack of hassle, and improved attitude, among others. Completing VSED typically feels like a proud achievement.
The peace and simplicity of just spending time with loved ones can be one of the most special times in a person’s life.
Q: Do I need to prepare before starting VSED?
A: Yes. Research shows that preparation is key to having a good death.
Here are the most important things in brief. If you want to know more, I can also give you a more complete answer.
Learn as much as possible by talking to someone who has witnessed VSED or a death doula.
Make sure all family members are on board.
Make sure someone is available 24/7 to care for you.
Find a doctor or hospice who will support you. If you cannot find one, you can try VSED on your own and then call again. They may step in once you’ve started.
Get a POLST (out-of-hospital do-not-resuscitate or DNR order) signed by a physician and post it where EMS personnel, if accidentally called, can see it.
Make sure your Living Will specifically says you do not want to be taken to a hospital if you have a terminal illness or are unconscious. For more information, have a conservation with Fiona.
Q: What are the benefits of VSED vs. MAID
A. During the week or two it takes you to die, you may find you become calm because you’ve taken control over you life. You have time to share stories, music and other meaningful experiences with loved ones. Time seems to stretch out when you’re not eating and drinking but keeping engaged can be a wonderful time of sharing. and a sacred time of closure and connecting. Those last days can be some of the most meaningful you ever experience with the people supporting you. The time also allows you to put your affairs in order. Unlike MAID, it does not require any paperwork or waiting times or authorizations.
Q: Why should my loved ones support me in VSED?
By supporting your request, your loved one is respecting your autonomy and dignity. It is a profound gift.
During the week or two it takes you to die, you can share stories, music and other meaningful experiences. Time seems to stretch out when you’re not eating and drinking. Keeping you engaged can be a wonderful time of sharing. and a sacred time of closure and connecting. Those last days can be some of the most meaningful you ever experience with the people supporting you.
Q: Are there any supplies I need to have on hand
A: For a full set of suggestions, a list can be found on the Fully Informed Conversations website.
Q: Can I request VSED in my Advanced Directive?
A: You can complete a separate Advanced Directive specifically for VSED. You can find a link to this form and information on how to complete it under the VSED tab on the Fully Informed Conversations website. However even with this explicit written request, not all medical facilities may honor it. Thus, if you are really determined to end your life early, it is safest to do so while you still have the mental capacity to carry it out yourself.. In other words, if you have Alzheimer’s disease and wait until you are at the end stage, you may not be able to carry through a plan to completely stop eating and drinking.
