Understanding VSED: A Legal End-of-Life Option That Centers on Autonomy

Traci Arieli
Jan 22
5 min read

Most people do not realize they have more than one option for how they die. Hospice is commonly known, and in some states, medical aid in dying is also available. But another legal option is available across the United States. It is called VSED, which stands for Voluntarily Stopping Eating and Drinking.

This post offers a clear look at what VSED is, how the process unfolds, and what it can mean for someone considering how they want their final days to play out.

1. What Is VSED and Is It Legal?

VSED is a choice made by a person who decides to stop taking in food and fluids so that their life will come to a natural end. A person who chooses this option does it with full awareness and intention. It is not the same as refusing a feeding tube or being in a hospital setting. VSED usually happens at home or in a place where the person feels safe. The process is usually supported through both emotional care and practical help from family, hospice staff, or a death doula.

It is legal in all 50 states. That is because adults have the right to decline food, water, or medical care. But just because something is legal does not mean it is easy. VSED requires planning, care, and the right kind of help.

2. How Is It Different from Medical Aid in Dying?

Medical aid in dying involves taking medication to bring about death more quickly. That option is only available in some states, and even then, only to people who meet specific criteria. You must have a terminal diagnosis with less than six months to live. You also have to be mentally capable of making the decision and able to take the medication on your own.

VSED is different. It is not limited to people with a terminal diagnosis. It is also not limited by physical ability. Someone with dementia, ALS, or another progressive illness may not qualify for medical aid in dying. However, they can still choose VSED while they are still able to make their own decisions. And VSED is not instant. It unfolds over several days, sometimes longer, and it is a natural process that allows time for reflection, support, and closure.

3. Who Might Consider This Option?

People who choose VSED often want a sense of control. Some have been living with a serious illness for a long time. Others are tired, in pain, or no longer able to enjoy the life they once had. They may not meet the criteria for other end-of-life options, but they still want to make a decision that feels right to them.

One woman described it this way: “I don’t have a terminal diagnosis, but I’m living terminally.” She had lived with MS for over 20 years and could no longer care for herself. Every part of her day depended on others, and she was ready to let go on her own terms.

4. What Happens During the Process?

VSED is not something that starts overnight. There is a planning period that may take several weeks. During this time, the person and their support team talk about comfort measures, emotional needs, legal documents, and what to expect each day.

Once VSED begins, the first few days often feel normal. The person may still be talking, moving around, watching TV, or spending time with loved ones. Around day three or four, dehydration starts to affect the body and brain. The person may feel tired, confused, or restless. At this point, support becomes critical. Comfort tools like frozen swabs, cool cloths, and soothing music can make a big difference.

By day five or six, many people are sleeping more. They might be in a coma-like state, which may last a few days before the person dies. The entire process is different for everyone, but most people die between day seven and day ten.

5. Is VSED Peaceful or Painful?

People often worry that VSED will be painful. That is a fair concern. But most of the discomfort comes from thirst, not hunger. The body can go without food for a long time, but it feels the loss of fluids much sooner.

With good planning and support, VSED can be a peaceful process. Comfort care plays a significant role. The process might include medications for anxiety or pain, cool compresses, lip balm, gentle touch, or calming music. What brings comfort will be different for each person. That is why planning matters so much.

6. How Long Does It Take to Die After Stopping Food and Water?

Most people who go through VSED die within one to two weeks. Some die sooner. Others may take a little longer, especially if they have more body weight or extra fluid in their system.

It also depends on how much support they have and how well their body was prepared. People who begin the process after tapering food and drink slowly tend to have fewer physical side effects. They are also more mentally prepared for the experience.

7. What Support Do You Need?

VSED should not be done alone. A strong support system is essential. Support can include hospice, a death doula, or people close to you who understand what you want and are willing to help.

Support extends beyond just physical care. It also means being there emotionally. It means knowing when to step in and when to sit quietly. It means offering comfort when the person feels uncertain. And it means being steady when things get hard.

8. What Conversations Should You Have With Family?

This is one of the most important parts of preparing for VSED. The people around you need to know what you are choosing and why. These conversations are not easy, but they are necessary.

Some families will be supportive. Others may feel unsure, or even upset. That is okay. Everyone brings their own beliefs and emotions to the table. The goal is not to get agreement from everyone. The goal is to be clear, honest, and grounded in your decision. That helps your loved ones show up for you in the way you need them to.

9. What Documents Should Be in Place?

Even though VSED is legal, it helps to have your wishes clearly written down. This might include:

An advance directive
A healthcare representative (someone who can speak on your behalf)
A list of what brings you comfort and what does not
Notes for your care team about how you want your final days to feel

Some doulas use a document that outlines everything from preferred lighting to favorite scents to music choices. These small details can make a big difference in the final days.

10. How Can Loved Ones Prepare Emotionally?

Watching someone you love go through VSED is difficult. You may feel helpless or unsure of what to do. That is normal. The best way to prepare is to talk about what is coming, ask questions, and take care of your own needs, too. Let yourself be a daughter, a son, a friend, a partner, not just a caregiver. Let the support team handle the tasks so you can be present in the relationship.

It is okay to feel sad, scared, or even angry. Those emotions have space here. The goal is not to make this easy. The goal is to walk through it together, with care and clarity.

VSED is a legal and thoughtful end-of-life option for people who want more control over how their final days unfold. It is not quick or simple. It asks for preparation, honesty, and support. With the proper care in place, it can offer a gentle path that respects a person’s values and personal choices at the end of life.