Voluntarily Stopping Eating and Drinking (VSED) is an end-of-life option in which a mentally capable adult chooses to stop taking all food and fluids, including those provided by mouth or by medical means. Death occurs naturally from dehydration.
In every state, including New Hampshire, capable adults have the right to refuse food and hydration, just as they may refuse other medical treatment.
VSED requires planning and strong support. It should never be undertaken alone.
Families most often encounter VSED when a loved one is facing advanced illness, intolerable suffering, or profound decline in quality of life—especially when other medical or palliative treatments no longer meet that person’s goals and medical aid in dying is not available.
VSED does not involve medications to cause death. It relies on the body’s natural response to the absence of food and fluids. Many families choose this path because it can allow a person to remain at home, in familiar surroundings.
Some people with progressive illnesses, including dementia, choose VSED earlier—before cognitive decline prevents capable decision-making.
Planning and Support
VSED requires preparation. Families are encouraged to:
- Speak with a healthcare provider about all end-of-life options
- Involve hospice early, if eligible
- Identify caregivers who can provide practical support
- Make legal and financial plans in advance
Non-family caregivers or end-of-life doulas can reduce strain on loved ones by handling physical care tasks.
Consult VSED-preparation-checklist-
While VSED is legal, some hospitals or long-term care facilities have policies that limit staff participation. If someone lives in a nursing home or assisted living facility, it is important to ask about these policies early.
Clear communication with clinicians, hospice providers, and family members helps prevent confusion and conflict.
What Happens During VSED
Once VSED begins, death typically occurs within one to three weeks, most often due to the metabolic effects of dehydration. The experience varies from person to person and depends on overall health, body condition, and the level of supportive care.
Many people near the end of life already experience a natural decrease in appetite and thirst. However, during the early days of VSED, symptoms may include:
- thirst (often relieved with mouth swabs and oral care)
- weakness and fatigue
- agitation or restlessness
- delirium or confusion
- bowel and bladder changes
As the process continues, individuals usually become increasingly sleepy and less responsive.
While it is possible for someone to withdraw to a private setting and die alone, symptoms are generally lessened when supportive care is present. In New Hampshire, hospice programs may provide medical oversight and medications for comfort but do not provide around-the-clock bedside care. Families often need additional caregiving support.
Preparing for VSED
VSED requires commitment, preparation, and support. People considering VSED are encouraged to:
- talk with a healthcare provider about all end-of-life options
- have open conversations with family and loved ones
- identify potential care partners including friends, family members, paid caregivers, end-of-life doulas, or others who can provide support
- learn what to expect during the process
- complete legal and financial planning in advance
Understanding the physical and emotional course of VSED ahead of time helps many people feel more grounded and confident in their decision. Review Guide-to-Managing-VSED_Nov-2020
VSED Directives
A VSED Directive is a document detailing your end-of-life wishes about receiving food or drink from care providers.
VSED Directives do not replace your living will or advance directive. It also doesn’t replace other documents like a POLST that decline emergency medical treatment. As with your living will/advance directive, the best way to ensure that your wishes will be honored is to talk with your medical team, your care facility, your caregivers, and your family members about your intent to use VSED. You can use a letter such as this: VSED-statement-notary
Download a sample VSED Directive: Advance Directive for Voluntary Stopping of Eating and Drinking VSED (5)