Voluntarily Stopping Eating and Drinking (VSED)

In addition to refusing life-sustaining treatment when close to death, you may feel strongly that if you were in a state of extreme suffering, you would want to hasten death by voluntarily refusing to eat or drink. (To be clear, this means eating and drinking normally, not receiving nutrients through a feeding tube.) If you lacked the capacity to make your own health care decisions—for example, due to a disease such as Alzheimer's—you might want your health care agent to enforce your wishes by telling health care providers to stop feeding you.

Though there is much evidence that voluntarily stopping eating and drinking (known as VSED) can lead to a natural, pain-free death—especially when used in concert with palliative care measures (see below)—the practice is not yet widely understood or accepted. Many health care providers hesitate or refuse to accept requests for VSED from patients or their health care agents. Some states, including New Hampshire and Missouri, explicitly forbid health care agents from authorizing the withholding of food or drink that you could ingest normally.

If you want your agent to be able to tell health care providers to stop feeding you or giving you liquids to drink by mouth, you have a couple of options. First, you can try to include your wishes in your health care directive. To do this, you should be clear that you want to be allowed to stop eating and drinking. Here's how one man expressed his wish:

• "If I ever suffer irreversible central nervous system damage to the point that I do not recognize my family, I believe that it would be best for me to die. … [D]o not place food or water in my mouth. Instead, place it on my bed table. If I feed myself, I live another day; if I do not, I will die and that is fine." (William A. Hensel, My Living Will, 275 JAMA 588 (1996).)

If you like, you can include in your written instructions the desire that your health care agent be able to enforce this wish for you if you lack the capacity to make decisions for yourself. Be aware, however, that your wishes may not be honored in some medical facilities, or even in some states. The best you can do is make your wishes clearly known. If this is an issue of special concern for you, consult an experienced estate planning attorney or elder law specialist to learn about the law in your state and to ensure that your document is drafted to maximize the chance that your wish to forgo eating and drinking will be honored.