Voluntarily stopping eating and drinking (VSED) in California

What is VSED?

VSED is a decision by a person with decision-making capacity to stop eating and drinking, with the aim of dying sooner. People who choose it usually have a serious illness and feel their suffering has become too great. No drug is prescribed to end life, and no one else acts to cause death. The person can change their mind at any time and start eating and drinking again.

In its 2017 position statement, the American Nurses Association says VSED is a decision only the patient can make, never a surrogate. It says people with decision-making capacity have the right to stop eating and drinking as a means of hastening death, and that the decision should not be clouded by depression or anything else that gets in the way of deciding.

Is VSED legal in California?

No California law addresses VSED directly. California courts protect a competent adult's right to refuse medical treatment, including food and fluids given through a feeding tube (Bouvia v. Superior Court, 1986, and Thor v. Superior Court, 1993). In Thor, the California Supreme Court said that honoring a patient's refusal of treatment is not aiding suicide.

California law also gives every adult the right to make decisions about their own health care (Probate Code section 4650). It says a death that results from withholding health care under the state's advance directive law is not suicide (Probate Code section 4656).

VSED is not part of the End of Life Option Act. It has no forms, waiting periods or doctors' approvals, and no one prescribes anything to end life. This page is general information, not legal advice. For a specific situation, such as an advance directive or a care facility's rules, talk with a lawyer.

How is VSED different from the natural end of eating, and from the End of Life Option Act?

For the natural decline, read stopped eating and drinking near the end of life. For the Act, read the End of Life Option Act and hospice.

What happens during VSED?

Most people die within one to two weeks. Some take up to about three weeks, and small sips can make it longer. Hunger usually fades in the first days. Thirst and a dry mouth are the hardest parts. The hospice team eases them with mouth care: moist swabs, mist sprays, lip balm and a humidifier. As the days pass, the person becomes weaker and sleeps more. Near the end, confusion is common, and some people become restless.

The hospice team talks with the patient and family ahead of time about how symptoms will be treated and who will be with the person. A person may become confused near the end and ask for a drink. Plan ahead with the hospice team for that moment, so the family does not have to decide alone.

Does a patient who chooses VSED keep hospice care?

Yes. Choosing VSED does not end the hospice benefit. The hospice team keeps treating symptoms, giving mouth and skin care, and supporting the family with social work and chaplain visits. The family is offered grief support for 13 months after a death.

Choosing VSED does not by itself make a person eligible for hospice. Eligibility depends on the illness. A doctor must certify a terminal illness with a life expectancy of six months or less if the illness runs its usual course. Our medical director and your doctor make that determination, and we look at each request case by case. A website cannot decide it.

Choosing hospice is your decision. You can stop hospice at any time and return to regular Medicare coverage. You have the right to choose your hospice.

What is Beta Hospice's approach to VSED?

We respect the patient's choice, and we keep caring for them. Beta Hospice does not take a side for or against VSED. If a patient in our care who can make their own decisions chooses to stop eating and drinking, they stay our patient. We keep visiting, keep them comfortable and support the family, through the end of life and into bereavement.

We will talk about it. Our staff will not refuse to discuss VSED or turn a patient away for asking. We will ask what is behind the wish, look for pain, depression, fear or other suffering we can treat, and make sure the decision is the patient's own, made without pressure from anyone.

The patient can change their mind. If a patient decides to eat or drink again, we help them do it safely.

Can VSED be written into an advance directive?

This is not settled in California. A person can write their wishes about food and fluids in an advance directive, and those wishes guide the people caring for them. California's advance directive law speaks of artificial nutrition and hydration, such as tube feeding (Probate Code section 4617). Whether an instruction can require others to stop offering food and water by mouth after the person has lost the ability to decide, for example in advanced dementia, has not been decided by a California court. Care homes may also have their own rules. Talk with a lawyer and with your doctor. See advance directives and POLST in California.

Common questions

Where to learn more

Start with your own doctor and the hospice team. Read the End of Life Option Act and hospice, stopped eating and drinking near the end of life, does morphine speed up death? and talking about hospice.