A competent individual deciding to stop taking hydration and nutrition with the intention of hastening death. This is different from the loss of appetite that occurs during the transition phases of a terminal illness.
What VSED is NOT
- For everyone
- Withholding food/fluid
- Advisable if unsupported
- A rapid death
- Painful
- ”Starving to death”
- Symptom burden
- Expected duration
- Exploration of the cultural and emotional importance of eating and drinking
- Healthcare directives
- Hospice agencies
- Attending clinician
- Thirst
- Dehydration
- Incontinent
- Weakness
- Agitation/delirium
- Oral care needs
- Confusion
- Unconsciousness
- Who is the caregiver?
- Does the family/caregiver support the decision?
- Does the facility (if applicable) support the decision?
- What about medications?
- Is the medical provider supportive of the decision?
- Is VSED legal?
- Can I/we support a VSED request?
- What education will facility/agency provide to the client/family?
- What education will staff/volunteers need?
- What policies need to be developed or reviewed/revised?
- Will our agency/facility take a position of “non-participation and non-interference?”
- How will our agency/facility support a VSED request?
- How will we support staff/volunteers who have a conscientious objection to VSED?
- Legal in US
- ANA, AAHPM, IAHPM consider VSED legal option for terminally ill patients
- Autonomy vs Non-maleficence? (Hastening death, immoral act?)
- Autonomy vs Justice? (Hospice-qualifications for terminal prognosis without VSED?)
- Veracity vs. Confidentiality?
- Family fractures?
- Different than MAiD?


