What is Voluntary stopping eating and drinking (VSED) - Meaning and definition

Published by Roberto Wenk. Reviewed by Alison Ramsey. Last updated date: July 8, 2019.

Voluntarily deciding to stop eating and drinking is defined as a self-initiated effort to accelerate dying in the following contexts: refractory suffering due to aggressive disease, symptom management, the patient's perception that the dying process is prolonged, or a progressive functional decline that the patient finds intolerable. A patient who makes this decision may be seriously ill, but not necessarily in the dying period.

Voluntary stopping of eating and drinking (VSED) is different from illness-associated anorexia-cachexia, which reflects the natural history of certain diseases.
- It is physiologically similar to discontinuation of artificial nutrition, but differs in both anticipatory guidance for families and ethical foundations (because it is not withdrawal of an invasive medical intervention).
- It is uniquely accessible, including when palliative sedation may be inappropriate due to the absence of severe symptoms.
- It can be enacted in almost any environment and may avoid legal entanglements in jurisdictions where the principles of right to privacy and self-determination are strongly supported.
- VSED differs from other palliative measures of last resort, such as palliative sedation, because it can be accomplished without physician participation and may be implemented in a patient with a serious — but not imminently lethal — illness (e.g., early dementia).
However, health care professionals need to participate in the process because they should be in charge of initial assessment, anticipatory guidance, and the control of suffering once VSED is started.

Depending on an individual's overall health and adherence to the method, the dying process secondary to VSED tends to last 10 days to 2 weeks. This time may allow for reflection, family interactions, and potential reversibility early in the process.

Most patients considering VSED are aged 80 and older, have a significant burden of disease, and depend on others for daily care. Their reasons for considering the method include: readiness to die, their perception that continued life is "pointless," poor quality of life, a desire to die at home, and the wish to control the circumstances of their own death.
The majority of patients who explore VSED do it only as a hypothetical option, and are satisfied knowing that is a future possibility as a means to escape their situation.

See reference for more information.

Adapted from Medscape News & Perspective. Voluntary stopping eating and drinking. Available at https://www.medscape.com/viewarticle/894008_1 . Accessed on May 2, 2018. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.

Published by Roberto Wenk. Reviewed by Alison Ramsey. Last updated date: September 17, 2019.

Voluntary stopping of eating and drinking (VSED) is the decision of a competent individual to stop taking hydration and nutrition with the intention of hastening death. VSED is different from the anorexia due to a progressing terminal illness, and different also from the diminished oral intake due to a psychiatric disease.
How often VSED occurs is unknown; one survey reported a median time from stopping eating/drinking to death of seven days.
The scarce available data suggest that VSED is not associated with any exclusive symptom burden; pain, dry mouth, thirst, dyspnea, and agitation/delirium are commonly reported, but hunger is not a common symptom. Symptom management is the same as with other palliative care patients.

Ethical, legal, and practical concerns
• VSED is considered to be different ethically and legally than physician assisted suicide, as VSED can be completed without any clinician involvement or knowledge.
• VSED is also considered by many to be ethically different than suicide. A medically healthy individual who stops eating and drinking as a result of a psychiatric illness could have psychiatric treatment and medical nutrition forced upon them. However, many terminally ill patients participating in VSED are not psychiatrically ill. Forcing artificial nutrition against the will of a palliative care patient would be an extraordinary intervention with small benefit.
• Some ethicists argue that even the limited clinician participation in VSED — by providing counselling or managing symptoms — cannot be distinguished from assistance for hastening death and thus should not be done.
• Other ethicists argue that while a clinician may judge VSED to be unethical, it is still important that clinicians continue to provide proper care and palliation for patients dying due to VSED.

Health professionals should not underestimate the complexity and challenges of caring a patient who is pursuing VSED; those who want to support the patient should be prepared to coordinate ethical, legal, and psychiatric input.
Basically, a clinician’s responsibility is to ensure that the decision is well-informed; that it is made by a non-coerced patient with decision-making capacity; and that methods to reduce suffering are not restricted.
Furthermore, the clinician should engage the patient in a thorough discussion of what VSED looks like, including symptom burden, expected duration, and any alternatives available to the patient.

See reference for more information.

Adapted from Chargot J, Rosielle DA, Marks A. Voluntary stopping of eating and drinking. Palliative Care Network of Wisconsin. Fast facts and concepts # 379. Internet. Accessed on June 1, 2018.

Voluntary stopping eating and drinking (VSED)

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