A person may choose to control their own dying by making a conscious decision to refuse nutrition and hydration of any kind, including artificial nutrition and/or hydration.
This option, also known as VSED, can be chosen by a decisionally-capable adult who consciously refuses foods and fluids in order to advance the time of their death. The U.S. Supreme Court has affirmed the right of a mentally capable individual to refuse medical therapies, including food and fluids.
If the person planning to undertake VSED has dementia, depression or other conditions impacting their decision-making capacity, VSED may pose challenges to caregivers. It is important to have frank conversations with your caregivers, medical providers and legal advisors about your wishes.
REASONS ONE MAY CHOOSE VSED
- Intolerable suffering of terminal illness
- Unrelieved suffering of a chronic or incurable and progressive disorder
- Choosing to complete a fully lived life
Preparing For VSED
Learn as much as you can about this process before beginning. You cannot do this alone. You will need 24-hour care during this process, and ongoing hospice care or support by your physician. Even though the U.S. Supreme Court has affirmed the right of a decisionally capable individual to refuse food and fluids, not everyone is understanding and supportive of this choice.
Begin by discussing your end-of-life wishes and concerns with family, caregivers and your primary physician. Be sure your advance directive paperwork is up to date and expresses your specific wishes. You can also talk with your doctor or hospice nurse about completing a Do Not Resuscitate (DNR) order and/or Physician Orders for Life-Sustaining Treatment (POLST) form. Be sure all your caregivers know who to call when death occurs.
Caregivers or healthcare providers can help manage unwanted symptoms. The most frequently reported symptoms include thirst or dry mouth, hunger and feelings of uncertainty about the approach of death.
It is important to review all medications with a physician before beginning the fast. Stopping some medications, such as those for heart disease or diabetes, may speed up the dying process without increasing discomfort. Medications for pain, agitation, anxiety or other symptoms may be available in forms that don’t require drinking fluids, such as drops that go under the tongue, skin creams, skin patches or suppositories. Many medications used at the end of life have a sedative property and cause drowsiness, which may lessen possible symptoms of discomfort in the VSED process.
Can I Just Stop Eating And Continue To Drink?
A person can live for a very long time without eating, but dehydration (lack of fluids) speeds up the process. VSED is ultimately a process of dehydrating the body. Lack of food alone can be more prolonged and uncomfortable than dying from lack of hydration.
The Dying Process
It is difficult to predict the duration of the dying process through VSED. Influencing factors are: the person’s physical condition, age, medications taken, illness, height and weight ratio, fluid retention, ability to remain completely free of all fluids, and perhaps a readiness to “let go.”
For a terminally ill person the process may take several days to several weeks after intake of food and water stops. Some people experience unconsciousness in as little as two to three days. For those without terminal illness the length of time to death tends to be longer.
During the early stages of VSED the individual remains in control of the process and can stop VSED by resuming intake of food and fluids. Individuals and their loved ones who consider this option should understand the importance of stopping all fluids, including ice chips, once the fast has begun in order for death to occur within the shortest interval. Intake of even small amounts of food or water can prolong the dying process, but it is up to the patient to determine their own intake.
In the first few days of the fast, some people may remain as active as before but many soon will become weak, fatigued and increasingly sleepy. Once they begin to feel light-headed and weak, movement requires assistance in order to prevent falls or accidents. Mental alertness is replaced by longer and longer periods of sleeping.
In many cases people eventually cannot be roused and remain in an unconscious or coma state. Some people have periods of alertness throughout the process up until death. The dehydration from VSED affects the kidneys and the heart, and the other organ systems in the body begin to shut down.
As death nears, breathing becomes more shallow and irregular. Moaning or “rattling” breathing may occur. Patients may become restless or agitated at some point in the VSED process. The body may change temperature, and there can be discoloration in the face (flushed red, or pale with bluish or yellowish tones), as well as purple or bluish mottling in the hands or feet.
You may resume eating and drinking in the early stages of VSED. But later, food and liquids can be taxing to your system, which has begun shutting down.
Body's Reponse During VSED Process
| Stage | Patient Status | Symptoms | Duration |
|---|---|---|---|
| Early Stage | alert | thirst, hunger (minor), difficulty urinating | 1 - 4 days |
| Mid Stage | weakening, more sleep | weakening, more sleep, thirst, weakness, delirium | variable |
| Late Stage | largely unresponsive, coma | largely unresponsive, unconsciousness, pain, delirium | 1 - 4 days |
Factors that may prolong VSED:
- Excess weight
- Fluid retention
- Healthy kidneys and heart
- Intake of fluids, such as ice chips
This document contains general information and is provided to inform those who may consider this option and should not be considered legal advice that applies to your specific situation.
For resources to document your end-of-life wishes and for more information on VSED, click here
