Learn · 6 min read

Questions families often carry

Is this legal?

VSED is broadly recognized as legal across the United States. The right to refuse food, fluids, and medical treatment has long been recognized in this country. No special law, no terminal diagnosis requirement, and no prescription is needed. What is required is that the person choosing VSED has current decision-making capacity, meaning they can understand their situation, weigh the consequences, reason about their options, and communicate their choice.

For context, VSED is distinct from medical aid in dying (MAID), which involves a clinician prescribing medication that a terminally ill, decisionally capable adult chooses to take themselves. MAID is legal in a number of US states and Washington DC, but not everywhere, and each state has its own eligibility rules, which commonly include a terminal prognosis, capacity, and waiting periods. These laws vary and change over time, so it is worth confirming what applies where you live. VSED and MAID are both different from a third thing, where another person administers something to cause death. That practice is not legal anywhere in the United States. In both VSED and MAID, it is the person themselves who acts. If you want to understand the differences more fully, our article on understanding your options goes deeper.

Will it hurt?

Hunger and thirst are the natural concerns here, and they are worth taking seriously. Most people who have been through this process report that the sensation of hunger fades within the first couple of days. Dry mouth, which tends to be the more persistent discomfort, can often be managed with mouth swabs, ice chips, and products available without a prescription.

That said, we cannot promise a painless experience for everyone. What we can say honestly is that a good care team, often through hospice, can provide comfort medications for pain, agitation, difficulty breathing, and other discomforts that may arise as the process advances. These medications come from clinicians, and as the process goes on they are generally given in ways other than by mouth. Managing symptoms well is exactly what palliative and hospice care is designed to do. Talk with the hospice team about what they can offer and what to expect.

How long does it take?

We cannot promise a specific number of days, and anyone who does is not being honest with you. For someone who is already seriously ill, the process is often shorter. For someone who is relatively healthier, it tends to take longer, sometimes up to two or three weeks.

A general pattern that clinicians describe: after all food and fluids stop, there is commonly a period of several days to about a week before the person loses consciousness, followed by another several days before death. But this varies meaningfully from person to person, and underlying health plays a large role. Even small amounts of fluid can lengthen the process. Your hospice team or physician can give you a more grounded picture of what to expect for your specific situation.

Is choosing this giving up?

That question carries a lot of weight, and it makes sense that it comes up. It can feel, from the outside, like a door being closed.

What we would offer is this: VSED is a choice about how to live the time that remains. It is not a refusal of life. It is often a decision made by someone who has thought carefully about what matters to them, and who wants to have some say in how their dying unfolds. That is not giving up. That is the kind of agency that many people spend their whole lives hoping for.

It is also worth knowing that many families, after going through this, describe the experience as one of the most meaningful and connected times they had together. That is not always the case, and we would never promise it. But it is a real possibility, and it is worth holding alongside the grief.

Can they change their mind?

Yes. At any point, especially early in the process, the person can choose to resume eating and drinking. That is their right, and the care team should support it fully. Caregivers can help by slowly reintroducing fluids and food.

Later in the process, as the person becomes less alert, changing course becomes more complicated medically. This is one reason why planning conversations, held early and with clarity, are so valuable. It also helps to think in advance about what to do if the person asks for something to drink when they are in a confused or delirious state.

What do we do if they ask for food or water later?

This question sits right at the heart of what is hardest about this process for families. When someone you love asks for something and you do not give it to them, that is painful, regardless of the reasons.

Planning ahead helps. Before VSED begins, the person can talk with their family and care team about how they would like these moments handled. Many families find it useful to have a short script, or just a reminder of the person's own words, to return to in those moments. The hospice team or a doula can help you prepare. And if the person persistently asks and you choose to give them something small, that is an act of care, not a failure.

Will hospice still care for us?

Many hospice programs can support a VSED plan, and hospice care is often a good fit because it focuses on comfort rather than cure. The hospice team, which typically includes a nurse, aide, social worker, chaplain, and medical director, can help manage symptoms and support the whole family throughout.

However, not every hospice will formally support VSED, and some facilities have their own policies. It is worth asking directly, before the process begins, whether a particular hospice is willing and experienced in supporting VSED. If the first one you contact is not, others may be.

How do we talk to other family, or to children, about this?

There is no single right script, and families differ. What tends to help is plain, honest language, matched to the age and capacity of the listener. Children, in particular, often do better with the truth told simply than with vague reassurances that leave them confused.

Something like: "Grandpa is very ill, and he has decided to stop eating and drinking so that his body can rest and he can die at home, the way he wants to." Children can hold more than we expect when we give them clear words and space to ask questions. For extended family members who may not understand or who disagree, a social worker or end-of-life doula can help you think through those conversations in advance. You do not have to justify the choice, but having a calm, clear way to explain it can reduce conflict at an already tender time.

What if this conflicts with our faith?

This is a question many families carry quietly, and it deserves honest acknowledgment. Different faith traditions hold genuinely different views on end-of-life decisions, and within any tradition there is often a range of interpretation. We are not in a position to tell you what your faith requires or allows, and we would not try.

What we can say is that many families find ways to hold both their faith and this choice at the same time. Some faith traditions draw a clear distinction between deliberately ending a life and allowing a natural death to unfold. A chaplain, whether through hospice or your own community, can be a meaningful conversation partner here. Many hospice programs have chaplains who are experienced in sitting with exactly these kinds of questions, without pressure in any direction.

These questions do not have to be carried alone. The next section gathers more on what the process looks like day to day.