About
Frequently asked questions about Voluntarily Stopping Eating & Drinking (VSED).
FIC Staff · Last reviewed: October 23, 2026.
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 they 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. Choosing VSED takes decision-making capacity, a firm and well-considered decision, and support. A clinician can help make sure the decision is informed and your own, and that other ways of relieving your suffering have been considered. You can change your mind at any time. If you decide to eat or drink again, that is your right and it is not a failure (Wechkin et al., 2023).
Q: Is VSED legal? How does it affect insurance?
A: A mentally capable adult’s voluntary refusal of food and drink is generally recognized as lawful in the United States. Court decisions about refusing medical treatment, including artificial nutrition and hydration, should not be confused with every situation involving oral food and drink. Insurance coverage and death-certificate practices depend on individual circumstances and applicable rules; discuss these questions with your clinician and insurer.
Q: Is VSED suicide?
A: Whether VSED should be called suicide is debated among ethicists. Many clinicians and scholars see it as different, because it means declining food and fluids and leads to a natural dying process that can be stopped along the way, while others disagree (Quill et al., 2018; Jox et al., 2017). Clinical guidelines advise recording the death as natural, caused by the underlying illness (Wechkin et al., 2023). 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: VSED is a voluntary decision by a person with decision-making capacity. It does not use the statutory application process required for MAID. A clinician should assess capacity, symptoms, and treatable causes of suffering, and discuss care options and support. Hospice eligibility and facility policies are separate questions.
Q: How long does it take to die from VSED?
A: Most people die within about one to three weeks, often around 10 to 14 days (Wechkin et al., 2023). It can take longer, especially if small amounts of fluid are taken, so plan for support that may last three weeks or more. Ask your healthcare team what to expect in your situation.
Q: What is the VSED process like?
A: When you stop taking in any food or fluids, at first you may be hungry. This usually fades within the first few days. Thirst and dry mouth remain, and they are the most common discomforts. Over the days, you become weaker and finally go into a coma. Before that happens, you may become delirious and can get agitated. If that happens, your clinician or hospice team can assess you and prescribe medicine to calm you.
Q: Tell me more about what to expect?
A: In the first several days, many people still have much of their usual energy. You can do many of the things you did before, finalize your affairs and spend loving time with friends and family.
Many people find the middle days the hardest. As you lose weight and strength, getting out of bed becomes more difficult, and you become weak and sleepy. At this point you need round-the-clock caretaking from friends, family, or staff.
In the final days, some people sleep for much of the time; others develop delirium or agitation. Discuss these possibilities with the clinical team in advance. If someone asks for food or drink, or appears to change their mind, seek clinical guidance about their wishes, capacity, and comfort rather than assuming the request should be disregarded.
Finally, you enter into a coma, and within a few hours or a day or two thereafter, you die. Everyone's experience is different.
Q: How will I feel while doing VSED?
A: Hunger usually fades after the first few days. Dry mouth and thirst are the most common discomforts, and careful mouth care (moist swabs, sprays, brushing your teeth, lip balm, a humidifier) is the main remedy. After several days you will grow weak and tired, and you'll spend more time resting while caregivers provide comfort measures. You may have periods of alertness when you can be with loved ones. Many people become restless, confused or anxious in the middle days, and some have pain. Your clinician or hospice team can assess each of these and prescribe medicines suited to that symptom (Wechkin et al., 2023). Eventually you'll become unresponsive and enter a coma. Death most often comes around 10 to 14 days, though it can be sooner or later. Everyone's experience is different, so plan ahead with your care team rather than expecting a set course.
Q: What are the downsides to VSED? OR what are the problems I might encounter?
A: You will experience thirst, which can be distressing. Careful mouth care is the main remedy: brushing your teeth a few times a day, moist swabs or mouth sprays, lip balm, swish-and-spit mouthwash, and a humidifier to add moisture to the air. If thirst, anxiety or other symptoms become hard to bear, tell your clinician or hospice team, who can assess the cause and prescribe medicine suited to that symptom.
Your skin may get dry and cracked. Ask your healthcare team about skin care, dry air, discomfort, and anxiety.
Delirium and agitation may occur and require clinical assessment and symptom relief. Caregivers should contact the healthcare team if the person appears distressed, asks for food or drink, or changes their wishes.
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.
Many families describe the early days of VSED as a meaningful time for conversation, memories, and saying goodbye. Caregiving can also be physically and emotionally demanding, and support for the family matters (Ness & Pope, 2025). In one Oregon survey, hospice nurses rated most VSED deaths they had seen as good deaths (Ganzini et al., 2003).
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 care services. Look up local providers. Hired caregivers cost a national median of about $35 an hour in 2025, and rates vary widely by area (CareScout, 2026). At that rate, two weeks of round-the-clock help would cost about $12,000, so many families combine paid help with shifts covered by relatives and friends. 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 aides.
Hospice support can be incredibly helpful, but routine hospice care does not include round-the-clock caregivers in the home. Hospice provides visits from nurses, aides, social workers and chaplains, medications and equipment for comfort, and a nurse on call 24 hours a day. Medicare hospice can provide continuous nursing at home only during brief medical crises, plus short respite stays of up to 5 days (Medicare; 42 CFR 418.204). Most people doing VSED therefore need family, friends, or hired caregivers to cover the remaining hours (Wechkin et al., 2023).
Q: How important and how easy is it to get medical support?
A: We strongly recommend involving a doctor or nurse practitioner, and hospice if possible. A clinician can confirm the decision is informed and your own, offer other comfort options first, plan for symptoms such as dry mouth, pain and confusion, and coordinate hospice and paperwork (Wechkin et al., 2023; Quill et al., 2018). The best case is if you have a trusted clinician who is willing to support you. Some 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: Ask why support is unavailable and request a referral to another clinician, a palliative care service, or a hospice willing to discuss your needs. Policies and eligibility requirements differ. Arrange a symptom-management and caregiving plan with qualified professionals before making decisions. Starting VSED does not guarantee later hospice admission.
Q: If I can line up medical support, how will they help?
A: A clinician can assess symptoms, explain what to expect, and arrange appropriate treatment for discomfort or agitation. A hospice or palliative care team may provide additional nursing and emotional support. Ask each provider what it can offer and how to reach help when needed. A death doula can provide nonmedical support but cannot prescribe medication.
Q: Will I qualify for hospice? What does hospice provide?
A: To use the Medicare hospice benefit, the hospice doctor and your own doctor (if you have one) must certify that you are terminally ill, with a life expectancy of 6 months or less if the illness runs its normal course. You also choose comfort care instead of treatment aimed at a cure (Medicare.gov). A decision to undertake VSED does not automatically establish eligibility, and hospice policies on VSED vary, so ask your doctor to contact a local hospice before you begin. Palliative care may be available even when hospice eligibility is not met.
If you qualify, hospice can provide a nurse, social worker, aide, chaplain, medications and equipment for comfort, and a nurse on call 24 hours a day. Routine hospice care does not include round-the-clock caregivers; continuous nursing at home is available only during brief medical crises (42 CFR 418.204). Hospice can help guide the VSED process alongside your own caregivers. 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. Many people do VSED at home, 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 your wishes, support needs, and a plan to contact the clinical team if you become delirious, request food or drink, or appear to change your mind.
Q: What does VSED feel like?
A: VSED can involve distressing symptoms, including thirst, dry mouth, weakness, and delirium. Thirst and dry mouth can be helped with brushing teeth and tongue a few times a day, moist swabs or mouth sprays, mouthwash that you swish and spit out, lip balm, and a room humidifier.
You may feel anxious before you start or as the days go on, and many people become restless or confused in the middle days. Your clinician or hospice team can assess anxiety, agitation and pain separately and prescribe medicine suited to each (Wechkin et al., 2023). Your resolve may waver at times; that is normal, and you can change your mind.
Near the end, a few people have shortness of breath, which your care team can ease.
Q: How often is VSED a bad experience?
A: Experiences vary. A published survey of hospice nurses reported generally favorable assessments of patients’ deaths, but these were nurses’ observations, not a guarantee of an individual’s experience or a direct patient satisfaction measure. Symptoms and caregiving needs can be difficult. Discuss expectations and a plan for comfort and support with your healthcare team. Read the study.
Q: Do I need to prepare before starting VSED?
A: Yes. Discuss your wishes, alternatives, and support needs with your healthcare team and the people who may care for you.
Learn about the process and possible symptoms from qualified professionals.
Talk with family and caregivers about your wishes and their ability to help.
Arrange reliable caregiving and a medical plan for symptom relief.
Ask your clinician whether a POLST is appropriate. A POLST records medical orders about treatments such as CPR and other interventions; it is broader than a DNR order. Learn about POLST.
Review your Advance Directive and document your own treatment and hospital-transfer preferences. For help preparing an Advance Directive, have a conversation with Fiona.
Q: What are the benefits of VSED vs. MAID?
A: During the one to three weeks it usually takes, many people find calm in having taken control. 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 time of sharing, 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, waiting times or authorizations, and you can stop at any time.
Q: Why should my loved ones support me in VSED?
A: Loved ones can support your autonomy by listening to your wishes and discussing them openly. They may have questions or concerns of their own. A clinician, counselor, chaplain, or other trusted professional can help everyone understand the decision and the support that may be needed.
Q: Are there any supplies I need to have on hand?
A: Discuss supplies and comfort-care needs with your clinical team. The library’s VSED Checklist resource offers additional topics to review with caregivers.
Q: Can I request VSED in my Advance Directive?
A: You can document wishes about future eating and drinking in an Advance Directive. The library includes an Advance Directive for VSED. How such requests apply after loss of capacity, especially when someone still accepts food or drink, is legally and ethically complex. Laws and facility policies vary, and a written directive does not guarantee that a facility will honor every request. Review your wishes with your healthcare team and an attorney familiar with your state’s rules.
