Journal of Pain and Symptom Management, Volume 72, Issue 2, pp. e147-e153, August 2026
By Hope A. Wechkin, MD, and Elizabeth T. Loggers, MD
Voluntarily stopping eating and drinking (VSED) is an increasingly recognized practice for patients seeking to hasten death. As VSED is legal throughout the U.S. and does not require medical provider involvement, it may be the only option for U.S. residents who live in a state in which medical aid in dying (MAiD) is illegal; who lack access to medical providers willing to participate in MAiD; or who do not have a six-month prognosis despite having a terminal illness (such as amyotrophic lateral sclerosis [ALS] or Parkinson’s disease). For some, VSED can be the preferred practice for hastening death as it may be perceived as less abrupt or more “natural” than MAiD.
Nonetheless, VSED has been described in the literature as “intense” and “fraught,” with concerns expressed about: 1). length of time to death; 2). delirium, sometimes of such severity that patients request hydration due to excessive thirst; and 3). anxiety and agitation. Indeed, some discussions of VSED mention continuous deep sedation and palliative sedation as possibly necessary for management of refractory symptoms. However, in Switzerland, where VSED is familiar to 85% of nurses, both physicians and nurses consider VSED a dignified way to die, leading some to characterize VSED as resulting in a “good death.” Further, among physicians, the probability of considering VSED to result in a dignified death increased by 52% if a physician had overseen the care of a patient pursuing VSED.
Regardless, a patient’s desire to initiate VSED has often been viewed as insufficient for U.S. hospice physicians to determine hospice eligibility, particularly in the absence of a qualifying diagnosis and six-month prognosis, both of which are strictly defined and monitored by Medicare. This concern may limit the hospice support received by VSED patients. Further, few empirical data exist regarding U.S. patient experiences when VSED is undertaken, with or without hospice support.
To address this, we report on a retrospective, consecutive case series of patients who pursued VSED with support from one hospice in the Pacific Northwest. We were interested in: 1). patient demographics; 2). primary underlying illness(es); 3). whether a prognosis of ≤ six months was present when VSED was begun; 4). involvement of support systems, including a patient advocacy group and/or a death doula; 5). time from VSED initiation to death; and 6). clinical course and management of symptoms, including thirst, hunger, pain, anxiety, agitation, and delirium.
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