An end of life choice you may not have heard of: VSED
Exploring the difficult but empowering choice of voluntarily stopping eating and drinking
After spending the past year exploring midlife reinvention, I’m now focusing on managing life, work, and wealth in changing times from a GenX perspective. One often-overlooked yet crucial aspect of life is how we approach death and the choices surrounding it. This is a sensitive and sometimes controversial topic, and while I aim to approach it with empathy and understanding, I recognize that my perspective may differ from others.
My stepfather George passed away in his sleep in February. Isn’t that the way we all should go? Just a peaceful drifting away?
In his case, the ease of his death belies the difficulties he faced before that. He was living in an assisted living facility while his wife, my mother, lived with me. His eyesight was mostly gone and he had to use a walker to get around due to an ankle injury. He didn’t need round-the-clock care, but my mom could no longer support him on a day-to-day basis. He suffered from both congestive heart disease and kidney failure, requiring a complicated balance of medications as well as supplemental oxygen. He couldn’t read anymore. He could barely watch sports on television. His kids lived far away and could visit only occasionally.
He felt miserable and, in his pain, asked my mother to help him end his life. But she couldn’t bring herself to do it. I understand why—she was caught between her love for him and the overwhelming weight of such a request. No one should ever be asked to carry that responsibility, especially when it involves something so deeply personal and complex. It's a decision that only a trained medical professional should be in a position to make, should they choose to do so.
The State of Colorado, where we live, allows eligible terminally ill individuals with a prognosis of six months or less to live to receive and self-administer medical aid-in-dying medication. But George wasn’t terminally ill. He was just unhappy and uncomfortable and didn’t feel he had any reason to go on.
George used to write my mother poems on a yellow legal pad. The last one he wrote was:
I miss my life.
I miss my wife.
George’s death was peaceful, but his final two years were not. They were filled with confusion, loneliness, and frustration—frustration at the limitations his body had placed on him, and frustration with his inability to control his own fate. His experience makes me think about something I wish I had known about sooner: VSED (Voluntarily Stopping Eating and Drinking).
A practice that deserves more attention
VSED is a process in which a person voluntarily chooses to stop eating and drinking as a way to end their life. While it may sound extreme, it is one of the few options for individuals who want to control the timing and manner of their death in a way that doesn’t require external intervention or complicated legal steps.
I wonder why I hadn’t heard about this before. I only learned about it last week, when I was using ChatGPT to help me update my advance directive1, and I asked about various ways of choosing death rather than continuing to struggle, should I feel ready to do that at some point.
If only I knew about VSED, I could have helped George. I could have at least talked to him about it. He was a determined and strong man, and he still had all his cognitive faculties (which made his life worse than if he didn’t know what was going on).2
VSED is no easy solution, and it’s not a choice to be taken lightly. The process is deeply personal, and it involves a range of physical and emotional challenges. How long it takes for someone to pass after stopping all food and hydration can vary based on their overall health. For many, the journey is uncomfortable—dry mouth, weakness, and fatigue are common. It can also bring up feelings of ambivalence or doubt, which might make the process harder to endure. The decision to stop taking anything, even ice chips, would likely be a monumental step. But for some, it is the only path that allows them to take control over their own end, which can provide a sense of peace in a situation where so much feels out of their hands.
VSED offers a voluntary and autonomous choice that someone can take themselves. They don’t need to travel to Switzerland, have a doctor state they are within six months of death, or make complicated plans to end their life another way. Healthcare providers, especially those with hospice experience, have ways of reducing the inevitable discomfort.
In my mother’s previous senior living community, a man on her floor chose to end his life by inhaling helium. The process involves sealing a bag around your head and filling it with helium, eventually leading to suffocation. It’s a method that some may consider, but it’s fraught with risks—it's not always effective, and the person can suffer brain injury but still remain alive. This makes it even more important to consider alternatives like VSED, which offers a more peaceful and self-directed path.
VSED is legal nationwide in the U.S., based on the landmark Supreme Court case Cruzan v. Director, Missouri Department of Health (1990), which affirmed that a competent individual has the constitutional right to refuse life-sustaining treatment, including nutrition and hydration. This legal framework allows people to choose VSED as an option for ending their lives, providing an autonomous choice that many people may not be aware of.
A real-life example
In Journal of My Mother’s Death: A VSED Chronicle, Marcia Sloane writes about her mother Opal’s decision to undertake VSED at the end of a long, good life. Having reached her late 90s, her mother was facing significant physical challenges:
Carpal tunnel syndrome made it difficult for her to use her hands; she dropped her fork at dinner, “couldn’t type, couldn’t wipe.” Her weight dropped to 85 pounds, her appetite decreased, and she had to sleep and rest for most of the day to have the energy to go to the main dining room or visit friends. She began to get sick more often and lost some control of bodily functions. She stopped driving, started taking advantage of her facility’s meal delivery service, and felt she soon wouldn’t be able to leave her apartment. Day-to-day living was getting harder and harder, and at the age of 98 going on 99, feeling she’d had a good full life, she decided it was time to go. Her husband, my father, had died many years prior, and as her only child and closest living relative, I wanted to support her wishes and do all I could to help her die in the way she wanted.
Her mother’s death after beginning VSED took seven days. She was provided with round-the-clock care by friends, family, and hired caregivers.
The day-by-day journal of Opal’s last days is poignant and at times harrowing. Opal faced the dry heaves, hallucinations, an uncomfortable dry mouth, discomfort lying in bed for so long, and anxiety.
Marcia’s husband Todd described the process as “remarkable and mundane, all wrapped in one”:
Sometimes I am overwhelmed by the pathos, the sorrow, the finality, the grave quality of this process, and other times this feels like some bizarre sit-com with people acting exactly as they always do, as if these are days just like any other days – the emotional dynamics unchanging.
We should talk about this more
When I think about George’s final years, I feel sadness—not just for his physical suffering, but for the emotional and psychological toll it took on him. His soul was full of life and energy, and knowing that he had no choice but to continue suffering, unable to escape it, is something that haunts me.
Do we not talk about options in dying often enough? I have started addressing my wishes with my children already. I am in the process of updating my advance directive to include my intention to choose VSED if the situation, for me, seems to call for it. I have told them I would fly to Switzerland to pursue assisted suicide if I am diagnosed with Alzheimer’s or other progressive dementia. I might have to do that early, earlier than it seems necessary, in order to meet the requirement that I am of sound judgement when I self administer the drugs that would end my life.3
I understand, however, why any compassionate person would hesitate to talk about things like this or, worse, promote hastening death. People at all stages of life can feel like they are a burden to those around them, and we might feel reluctant to provide easier avenues to end it (not that VSED is easy by any means). Unscrupulous caregivers might push for an earlier goodbye to lessen their own responsibilities or even get their hands on an inheritance. No one wants to encourage a too-early exit.
As we navigate our lives, we often think about how we’ll live, but not always about how we’ll end. The choices we make or don’t make around death can shape our sense of autonomy and peace at the end of life. I hope this discussion sparks some reflection for you. Have you thought about your own end-of-life wishes, and how do you envision taking control of that part of your journey?
🎧 P.S. I’m launching a new podcast this August, tentatively titled What Now, What Next—a show for GenXers rethinking work, wealth, and life in a world that’s changed. The first season explores 10 new rules for investing, working, and living in a time of uncertainty. It will be thoughtful, practical, and tuned into the deeper shifts shaping our future. To be notified when it launches, subscribe to this newsletter.
An advance directive specifies a person’s wishes regarding medical treatment to ensure that the wishes are carried out should the person be unable to communicate them to a doctor.
In some ways, I am glad I didn’t know about it. I don’t think it was my place to interfere in George’s decisionmaking and I’m not sure I would have felt ok about taking on the responsibility of informing him about this kind of practice. My hesitation reflects how taboo this kind of discussion is in our culture.
Dignitas requires that you have the cognitive capacity to choose death, so you can’t wait too long once cognitive decline begins. To learn more about this option, check out the Wall Street Journal’s article about psychologist Daniel Kahneman’s choice to end his life as well as the memoir In Love by Amy Bloom, about her husband Brian’s choice to do the same.