“Now, for the biggest challenge and greatest reward - VSED. To end my life as I’ve lived my life - with the spark of love and inspiration from the heart, a determined mind, and undaunted spiritual will, come what may.” 

~ M.Z., 2024 (shared with permission)

What is VSED? 

Voluntarily Stopping Eating and Drinking (VSED) is a conscious, intentional decision by a person to stop eating and drinking in order to end their life. It is a competent person's right to determine how they wish to die — a deeply considered act of self-determination, not suicide. Hospice nurses in Oregon rated VSED a "good death" giving it an 8 out of 9 as a peaceful way to go.

VSED is an option when the degree of suffering outweighs quality of life, and is particularly relevant when someone does not qualify for Medical Aid in Dying (MAID), as is often the case with diseases like ALS, MS, or Alzheimer's.

VSED is legal in all 50 states, grounded in the Self-Determination Act of 1990 and the U.S. Supreme Court decision Cruzan v. Director, which established Americans' right to refuse unwanted medical treatment, including nutrition and hydration. The underlying illness — not VSED — will appear on the death certificate, and life insurance benefits are not affected.

What does VSED require?

VSED requires commitment, willpower, and resolve from the person who has chosen it, as well as careful preparation across several areas. Legal and financial affairs — including documents, end-of-life directives, and financial matters — should be in order before beginning, as should decisions about body disposition, such as burial or cremation.

Medical support is strongly recommended. Hospice can typically be engaged by day three under a secondary diagnosis such as "failure to thrive," and provides palliative medications for pain, anxiety, and shortness of breath. 

On the physical and emotional side, 24/7 care is an absolute requirement, as falls and disorientation are real possibilities as the process progresses. While family and friends can rotate shifts, bringing in hired caregivers and doula coordination helps ensure loved ones get adequate rest as VSED is a 'marathon, not a sprint.'

How do people die with VSED? 

Once all oral intake stops, the body dies of dehydration, not starvation. The body's systems begin to slow during the first week. The kidneys shut down, blood sodium and creatinine levels rise, and further biochemical changes lead to heart failure and death. Most people lose consciousness between days 3 and 8, with death typically following within 5–8 days after that. The total duration can vary greatly, ranging from a few days to two to three weeks.

Is VSED painful? 

Based on research in palliative medicine, VSED is not painful. Hunger is rarely reported. The most common discomforts are thirst and dry mouth, both of which can be eased through misting the lips with a fine spray of water, applying cool cloths to the face, running a humidifier in the room, and swabbing the mouth and throat with glycerin or coconut oil. Shortness of breath and anxiety can be managed with medications such as morphine and lorazepam, typically provided through hospice.

The early days can be surprisingly gentle. The person is often still able to enjoy conversation, to listen to favorite music, or to be read to. It can be a precious, sacred time for everyone present.

How can North Bay Doulas help?

Our collective of three doulas specializes in VSED support. We serve as compassionate case managers throughout the process — helping families understand what to expect day by day, coordinating caregiving schedules, guiding loved ones on how to be present and supportive, and communicating with healthcare providers and hospice staff. We also support after-death planning and coordination, and grief support.

We offer pre-VSED consultations for anyone considering this path who wants to understand the process fully before any decisions are made. We are honored to walk alongside families throughout this profound passage.

We sourced from VSED Resources Northwest and End of Life Choices California for our FAQ and highly recommend them for further reading.