In the 40 states where Medical Aid in Dying (MAID) is illegal, terminally ill people who want to control the time and manner of their deaths have other options. The most natural option is to stop eating and drinking. When someone stops eating and drinking to hasten death, this is called VSED (pronounced vee’ said): Voluntarily Stopping Eating and Drinking.
Unlike MAID, a choreographed process where a doctor prescribes lethal medication, VSED can be done without a doctor’s help. The time to death after a person stops eating and drinking is variable; it could be several days or several weeks, depending on health and age.
MAID can be used only by people who have a prognosis of 6 months or less to live, but anyone can choose death by VSED. For example, in 2019, Rosemary Bowen, a 94-year-old Maryland woman, documented her death by VSED. Bowen did not have a terminal illness but had become unable to live on her own. She was not willing to live in a nursing home. Against the wishes of her family, Bowen planned her death by VSED. In her final days, Bowen said: “I … think of all those people who are wringing their hands and saying ‘If only God would take me,’ and all they need to do is give God a little help by holding back on eating and drinking.” She died in her sleep eight days after she stopped eating and drinking.
The law has long recognized that competent adults have the right to decline life support treatments like feeding tubes and breathing machines. A preference against being kept alive by machines or dying in an ICU is a strong motivator for those of us who have done advance care planning.
VSED is controversial because it goes beyond opting out of artificial feeding by opting out of normal eating and drinking. The choice of VSED is particularly fraught when chosen by those with a dementia or Alzheimer’s diagnosis, who often lose the ability to feed themselves. Some people who have been diagnosed with dementia create a Dementia Directive while they are still mentally competent with detailed instructions about their nutritional support. For example, a New York organization offers this clause in a Dementia Directive:
“If I am suffering from advanced dementia and appear willing to accept food or fluid offered by assisted or hand feeding, my instructions are that I do NOT want to be fed by hand even if I appear to cooperate in being fed by opening my mouth.” (emphasis added)
Few healthcare facilities will honor a Dementia Directive that includes VSED language, and VSED provisions in Dementia Directives are legally enforceable in only one state: Nevada.
The visual image conjured by the VSED provision in a Dementia Directive is difficult: denying food to an elderly person who is opening their mouth for spoon-feeding. But ignoring a VSED directive means denying a dying person’s end-of-life wishes. All the more reason to talk about end-of-life wishes early and often. If we understand what matters most to others we will be better able to accept their choices. Let’s talk about dying.