Learn · 6 min read

VSED and medical aid in dying are not the same

What VSED is

VSED means a person who can currently make their own decisions chooses to stop eating and drinking, allowing a natural death to come. It is a refusal, not a procedure. The person themselves stops. No one does something to them.

Because it is a refusal of food and fluids, VSED is broadly legal across the United States. It rests on the long-recognized right of any adult with decision-making capacity to refuse any treatment, including the intake of food and water. No prescription is needed. No terminal diagnosis is required. No special law has to be in place in the state where your family lives.

A physician can be involved, and often should be. A doctor can help confirm that the person has decision-making capacity, manage comfort medications as the process advances, and document the plan. As VSED progresses, swallowing becomes difficult, so comfort medications are typically given in ways other than by mouth. Hospice is often part of the care team and can provide meaningful support, though not every hospice will formally support a VSED plan. It is worth asking directly.

What medical aid in dying is

Medical aid in dying (MAID) means a clinician, usually a physician, prescribes medication that a patient then chooses to take themselves to bring about their death. The person who is dying takes the medication. A clinician does not give it to them. That distinction matters.

MAID is available only in certain states and the District of Columbia. As of mid-2026, a little over a dozen states plus DC have authorized it, and the list has been growing. Each state sets its own eligibility rules. Most require a terminal illness with a prognosis of approximately six months or less, demonstrated decision-making capacity, a formal written request, and confirmation by more than one clinician. Some states have residency requirements; others do not. Waiting periods and other details vary and continue to change as state laws are updated.

Because the rules differ by state and because they change, your family needs to confirm what applies in the specific place where your loved one lives and receives care.

How VSED and MAID differ from someone else acting

Families sometimes worry that VSED or MAID means a doctor or family member brings about death by giving the person something. That is a separate thing, and it is not legal anywhere in the United States. Both VSED and MAID are different from it.

With VSED, the person makes the choice and stops eating and drinking themselves. No one else acts upon them.

With MAID, the person who is dying takes the medication themselves. A clinician prescribes it; the patient decides whether and when to take it. A clinician does not give it to them.

This question sometimes surfaces in family conversations or in media coverage of end-of-life topics, and the worry is understandable. The key point is that VSED and MAID are both voluntary acts by the person who is dying. That is a meaningful difference, legally and in practice.

Putting the two side by side

VSED and MAID are both chosen by the person who is dying. In both, that person themselves acts. But they differ in almost every other way.

VSED requires no prescription, no specific diagnosis, and no law authorizing it in the person's state. What it does require is that the person currently has decision-making capacity, meaning they can understand their situation, think through the options, and communicate their choice. It can take anywhere from days to a few weeks. Comfort care during that time is important, and a good care team makes a real difference.

MAID requires a clinician's involvement, a terminal diagnosis meeting the state's criteria, the ability to take the medication yourself, and residence in a state where it is authorized. It involves a formal process with legal requirements that vary by location.

Neither path is better or worse. They suit different circumstances, different people, and different values. We are not here to guide you toward one or away from the other.

A harder question: VSED and dementia

Some families wonder whether a person with dementia can choose VSED, or whether someone can plan ahead through an advance directive to stop eating and drinking after they lose the ability to make decisions.

These are two different questions, and they deserve honest answers.

A person in the early stages of dementia may still have full decision-making capacity and may be able to choose VSED now, while they can. That is a decision they make in the present, and it is treated the same as any other VSED choice.

What is genuinely harder, and unsettled, is whether a person can write an advance directive that directs caregivers to stop offering food and fluids after they have lost capacity, sometimes called stopping eating and drinking by advance directive, or SED by advance directive. Some legal and clinical scholars support this; others raise serious concerns. Facilities vary widely in whether they will honor such a directive, and the legal protections are not uniform across states.

If this question is relevant to your family, we encourage you to speak with an attorney familiar with your state's advance directive laws and with a clinician who has experience in this area. This is not a question we can answer for your family, and we want to be honest that reasonable people, including clinicians and ethicists, hold different views.

What a doula can offer

An end-of-life doula is not a clinician. A doula does not prescribe, diagnose, or complete the clinical or legal paperwork involved in either VSED or MAID. What a doula can offer is consistent, non-medical presence: helping a family understand what questions to ask, sitting with the person who is dying, supporting the people around them, and helping everyone feel less alone in a hard time.

Doula support is generally not covered by insurance or the Medicare hospice benefit, so families plan for that cost separately. If you are wondering whether a doula might help your family, we are glad to talk through what that can look like.

Questions worth asking your care team

Whether your family is exploring VSED, learning about MAID, or simply trying to understand what options exist, a few questions can open the right conversations.

For VSED: Does our hospice or primary care team have experience supporting a VSED plan? Can they help us understand what the process looks like and how comfort will be managed?

For MAID: Is MAID authorized in our state? Does our loved one meet the eligibility requirements as written in our state's law? Is there a clinician in our area who is willing and able to participate?

For either path: Does the facility where our loved one lives or receives care have a clear policy, and does it align with what our family is asking for?

You do not have to figure this out alone, and you do not have to decide anything today.

When you are ready, the next section of the learning guide walks through what to expect in the days and weeks ahead, and how families have found ways to be present through all of it.

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