What Is VSED and Why Is It Controversial?

VSED is an acronym for voluntarily stopping eating and drinking as a means of hastening one’s death. It is most often chosen by persons who are terminally ill and experiencing increasing suffering but who do not qualify for medical aid in dying either because they are expected to live beyond the requisite 6 months or because they live in a state where medical aid in dying is prohibited by law. In some instances, an elderly person may choose VSED because they are simply “done” with living and are ready to die. 

Proponents of VSED cite it as a compassionate, relatively painless means to end one’s life, and for many people who choose the option, this is true. Depending on the person’s physical health, level of commitment and the amount of support available, the process can take as few as several days or as long as several weeks to complete. According to Compassion & Choices, the factors that most often impact the length of time it takes a person to die in this way include their:

• Age 
• Underlying illness
• Physical condition, including nutritional and hydration status
• Kidney function
• Ability to avoid all fluids, even ice chips
• Readiness to die

During VSED, the person undergoing the process usually needs a significant amount of support to maintain their fast. Hospice or a physician who is willing to provide symptom management are often, but not always required. Some people will require medications to alleviate anxiety or restlessness that comes from extreme thirst. Others can manage their discomfort with distractions such as reading, engaging with friends and family, or in spiritual pursuits. Again, the amount of time it takes for the person to succumb to starvation and dehydration varies greatly. Some people become unconscious in a matter of days while others remain alert and, in some cases uncomfortable for a considerable period of time. The latter scenario can be quite difficult for family members and caregivers, so it’s important to have adequate supports in place

It should be noted here that because VSED is voluntary, it does not require a doctor’s order and is completely legal in every state. Nevertheless, if you are contemplating VSED you may wish to spell out your wishes in your advance directive and, of course, let your health care proxy know what you plan to do. Additionally, you may create an advance directive that specifies that you do not want “assisted feeding” if you develop dementia and are unable to take in food on your own. These “dementia directives” are somewhat controversial, however. Those who oppose them argue that a person with capacity cannot impose that decision on their future self, who, despite being incapacitated, may very well wish to continue to eat and drink. For this reason, they are not legal in every state and, practically speaking, are often ignored.

Another ethical objection to VSED that has been raised by some is that it is tantamount to suicide, which an ethical society cannot support. However, this objection is generally considered unsustainable by the bioethics community, since in the vast majority of cases the person choosing VSED is already dying. They are simply taking control of the timing and manner of their death. 

Sources

“Washington Post Boosts Suicide by Self-Starvation”. National Review. https://www.nationalreview.com/corner/washington-post-boosts-suicide-by-self-starvation/