VSED: The Benefits of Fasting for Ending Life

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Perhaps, in an ideal world, every patient with a life-limiting illness would receive optimal hospice and palliative care, such that no one would ever wish to hasten their own death. Unfortunately, the reality is that despite our best efforts, some with terminal illness continue to suffer, leading increasing numbers of patients across the country to explore VSED—voluntarily stopping eating and drinking—to escape intolerable suffering.

Some of the pros include dying at home, which is most people’s preference. You don’t have to spend your fleeting hours dealing with doctors and lawyers. There is no waiting period. In Oregon, for example, their Death with Dignity Act requires a 15-day waiting period before you can get physician assistance, whereas choosing to stop eating and drinking would seem to afford more control. Even just knowing it’s an option can be a comfort.

Those who learn about VSED may feel empowered by the knowledge that they can choose this option without seeking anyone’s permission, and because it’s legal, it can be openly discussed. Just knowing that there’s “a way out’’ can provide relief from feelings of desperation and entrapment. And that feeling of control may itself be therapeutic. It can also prevent people from contemplating a more violent way out, and patients don’t have to feel pressured to end their life prematurely while they still can. Physician-assisted death with dignity laws require patients to take the lethal drug cocktail themselves. If you have ALS and are worried about losing your muscular function, you might feel the need to end your life before you’re ready, while you still have the capacity. In fact, Dr. Kevorkian’s first was a woman diagnosed with Alzheimer’s, who wanted to end it before it got too late––potentially depriving her and her family of years she might have still been able to enjoy.

And while physician-assisted suicide entails a single instantaneous and irrevocable act, death from VSED occurs over several days, allowing time for the patient to change their mind and for healing goodbyes. But what is it actually like? There are lots of anecdotes floating around describing death from VSED as peaceful, painless, and dignified. Fortunately, the evidence is more than just anecdotal. There have been several independent studies. So, let’s look at the data.

Average time of death after stopping eating and drinking was about seven days, though 8% lasted more than two weeks. And how was it? Ask a hundred hospice nurses, and on a scale from 0 (a very bad death) to 9 (a very good death), the average score for the quality of these deaths, as rated by the nurses, was 8. The researchers concluded that people usually die a “good” death within two weeks after stopping food and fluids, according to the nurses rating those last days of life as peaceful, with low levels of pain and suffering. More so, even, than those who chose physician-assisted suicide. This was in Oregon, and so, patients could have chosen that instead. But nearly twice as many patients decided instead to take matters in their own hand by voluntarily stopping eating and drinking.

Interestingly, loved ones seem to agree, with voluntary refusal of food and fluids perceived as carrying less ‘‘emotional baggage’’ for the family, more letting go than taking a more active approach. A study in the Netherlands that interviewed confidants, like friends or family that witnessed it, found that most considered it a “dignified death.” Hospice physicians seem to agree, with nearly 90 percent surveyed reporting that their VSED patients experienced peaceful and comfortable deaths.

The state of terminal dehydration may even have some analgesic effect, some pain-killing effects, presumed to be due to the release of endorphins, which act as natural pain blockers. So, concluded this review, VSED may reflect all 12 principles of a “good death,” retaining control, dignity, etc.

One of the most famous accounts was Dr. David Eddy’s description of his own mother’s VSED: “My mother was elated. The next day happened to be her 85th birthday, which we celebrated with a party, balloons and all. She was beaming from ear to ear. She had done it. She had found the way. She relished her last piece of chocolate, and then stopped eating and drinking.
Over the next four days, my mother greeted her visitors with the first smiles she had shown for months. She energetically reminisced about the great times she had had and about things she was proud of. (She especially hoped I would tell you about her traveling alone across Africa at the age of 70, and surviving a capsized raft on Wyoming’s Snake River at 82.) She also found a calming self-acceptance in describing things of which she was not proud. She slept between visits but woke up brightly whenever we touched her to share more memories and say a few more things she wanted us to know. On the fifth day it was more difficult to wake her. When we would take her hand she would open her eyes and smile, but she was too drowsy and weak to talk very much. On the sixth day, we could not wake her. Her face was relaxed in her natural smile, she was breathing unevenly, but peacefully. We held her hands for another two hours, until she died.”

“Without hoarding pills, without making me a criminal, without putting a bag over her head, and without huddling in a van with a carbon monoxide machine, she had found a way to bring her life gracefully to a close.” “Write about this, David. Tell others how well this worked for me. I’d like this to be my gift. Whether they are terminally ill, in intractable pain, or, like me, just know that the right time has come for them, more people might want to know that this way exists. And maybe more physicians will help them find it.”

Please consider volunteering to help out on the site.

• Corbett M. Vsed: death with dignity or without? Narrat Inq Bioeth. 2016;6(2):109-113.
• Schwarz JK. Hospice care for patients who choose to hasten death by voluntarily stopping eating and drinking. J Hosp Palliat Nurs. 2014;16(3):126-131.
• Pope TM, Anderson LE. Voluntarily Stopping Eating and Drinking: A Legal Treatment Option at the End of Life. Social Science Research Network; 2010.
• Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA. Nurses’ experiences with hospice patients who refuse food and fluids to hasten death. N Engl J Med. 2003;349(4):359-365.
• Lachman VD. Voluntary stopping of eating and drinking: an ethical alternative to physician-assisted suicide. Medsurg Nurs. 2015;24(1):56-59.
• Belkin L. Doctor tells of first death using his suicide device. New York Times. June 6, 1990:A1, B6.
• Bolt EE, Hagens M, Willems D, Onwuteaka-Philipsen BD. Primary care patients hastening death by voluntarily stopping eating and drinking. Ann Fam Med. 2015;13(5):421-428.
• Harvath TA, Miller LL, Smith KA, Clark LD, Jackson A, Ganzini L. Dilemmas encountered by hospice workers when patients wish to hasten death. J Hosp Palliat Nurs. 2006;8(4):200-209.
• Chabot BE, Goedhart A. A survey of self-directed dying attended by proxies in the Dutch population. Soc Sci Med. 2009;68(10):1745-1751.
• Printz LA. Terminal dehydration, a compassionate treatment. Arch Intern Med. 1992;152(4):697-700.
• Volicer L, Stets K. Acceptability of an advance directive that limits food and liquids in advanced dementia. Am J Hosp Palliat Care. 2016;33(1):55-63.
• Ivanović N, Büche D, Fringer A. Voluntary stopping of eating and drinking at the end of life - a “systematic search and review” giving insight into an option of hastening death in capacitated adults at the end of life. BMC Palliat Care. 2014;13(1):1.
• Smith R. A good death. An important aim for health services and for us all. BMJ. 2000;320(7228):129-130.
• Eddy DM. A piece of my mind. A conversation with my mother. JAMA. 1994;272(3):179-181.

Motion graphics by Avo Media

• fasting
• mental health
• mortality
• pain