​​

What is VSED?

​

• Voluntarily stopping eating and drinking (VSED) is when a mentally capable adult chooses to hasten their death by refusing all food and fluids.

• It is not usually experienced as painful; thus, the focus is on comfort, calm, and symptom relief.

• It is a conscious, intentional, and informed decision.

• It is lawful in the UK when chosen by an adult with mental capacity.

• It normally takes place at home (sometimes in a hospice if they support such a choice).

• Death usually occurs within one to two weeks, depending on health, hydration status, and other factors.

• It can be a choice for people with an incurable illness, advanced frailty, or experiencing unbearable suffering from a chronic or progressive illness(es) who wish to avoid further decline.

• Support from health and social care professionals should be obtained.

• It should involve Advance Planning for End of Life, including an Advance Decision to Refuse Treatment (ADRT) and an Advance Statement to ensure the person’s wishes are respected if they later lose capacity.

​​

​​

Facts vs Myths

​​

For an overview, see here.

​​

 

Lawfulness

​

In the UK, an adult who has the mental capacity to make decisions has the legal right to refuse food and fluids, even if that decision may lead to their death. VSED is when someone makes this choice deliberately.

​

This choice is lawful. It is not assisted dying. No one is causing the person’s death. The law recognises that people have the right to decide what happens to their own body, including the right to refuse eating and drinking.

​

It is also lawful for family members, partners, friends, and others in a person’s close support network to respect the person’s decision, to remain present and offer companionship, and to provide comfort, care and emotional support.

​

Doctors may lawfully palliate symptoms should the need arise. This was established in a Decision of the Supreme Court of the United Kingdom (SCUK).

​​

​

What You Need to Know About Health and Care Professionals​

​

In the UK, there is no single national clinical guideline on VSED for health and care professionals. Advocacy and some end-of-life charities note a lack of formal UK guidance, which can leave healthcare professionals uncertain about how best to support a person considering or undertaking VSED.

​

We believe access to medical support is necessary to ensure that a person choosing VSED receives appropriate medical care if the need to palliate symptoms arises. At present, UK health and care professional bodies do not have clear, consistent, or comprehensive statements specifically addressing VSED.

​

Regardless of the absence of national guidelines and considering the statements of professional bodies, our view is that health and care professionals should hold in mind the following key principles:

​

• People have the legal right to refuse food and fluids, even if this may result in death.

• Health and care professionals must respect a person’s autonomous decisions, provided the person has mental capacity.

• When a person chooses VSED, professionals should continue to offer care, comfort, and symptom relief. If they feel morally unable to do so, they should not abandon the person and instead make arrangements for alternative support and care.

​

Our experience of a person speaking to professionals about VSED is mixed: some are supportive and willing to engage, while others may be unfamiliar with VSED or hesitant due to uncertainty or lack of guidance. In these situations, you may find yourself in the position of having to educate health and care professionals about VSED, including providing factual information to address objections rooted in misunderstanding or risk aversion. A calm, patient, and sometimes tenacious approach may be required here.

​

Further on this page, you will find a section on Talking to Your GP, and you may also wish to look at the information we have provided for Health and Care Professionals.

 

​​​

Why People May Choose VSED

​

Health Reasons

​

People choose VSED for different reasons. Broadly, there are two common situations:

​

1. Some people choose VSED because they are already suffering in ways that feel intolerable to them.

2. Others choose VSED to avoid what they fear may be a difficult or distressing final phase of life and to retain a sense of control before their condition worsens.

​

This may include, for example:

​

• Someone living with a progressive or terminal illness who has decision-making capacity

• Someone whose independence has been greatly reduced by frailty or long-term health problems, and who has decision-making capacity

• Someone with suspected or diagnosed early stages dementia, fearing a prolonged death from advanced dementia, who has the mental capacity to make the decision to VSED

​

An important distinction: VSED is a deliberate end-of-life decision made by a person who has the mental capacity to make this choice. It is different from anorexia or other eating disorders, where not eating is part of a diagnosed clinical condition that affects a person’s relationship with food and their ability to eat. Those situations involve very different needs and require specialist assessment and treatment. VSED is also different from stopping eating and drinking due to a diagnosed psychiatric disorder, which again calls for appropriate clinical care and support.

 

​

Purposeful Choice

 

People who consider VSED are rarely motivated by a single emotion. More often, the decision emerges from a deep inner process shaped by personal values, lived experience, and a desire for peace at the end of life.

 

A wish for control and agency
Many people fear losing autonomy, becoming dependent, confused, or unable to express their wishes. VSED can feel like a way to remain an active decision-maker in the face of an uncertain future.

 

Avoiding feared suffering
Some people are less afraid of death itself than of what may precede it: unmanaged symptoms, prolonged decline, or loss of dignity. VSED may be seen as a way to step away from a future that feels intolerable to them.

 

Preserving dignity and identity
For many, dignity is closely tied to identity, how they live, how they relate to others, and how they are seen. VSED can feel like a way of ending life in a manner that remains true to deeply held values.

 

Relief from emotional and existential distress
Living with ongoing illness, frailty, or the anticipation of deterioration can carry heavy emotional weight. Choosing VSED may bring a sense of relief, not because life has lost meaning, but because the struggle has become too much.

 

A wish for a calmer, more predictable ending
For some, VSED offers emotional reassurance: time to say goodbye, to put affairs in order, and to die in a way that feels quieter and more contained than repeated crises or medical interventions.

 

It’s not necessarily about giving up on life
Emotionally, VSED is usually about how someone wants to die, not a rejection of life itself. Most people remain deeply connected to relationships, meaning, and love right up to the end.

​​

​

What the VSED Dying Process May Look Like 

​

The length of time it takes to die by VSED can vary significantly from person to person. It depends on factors such as the individual’s underlying health, e.g. whether they are already frail or seriously ill, their physical reserves, and their hydration status. Where the person ceases the intake of food and fluids from the outset, the VSED process takes on average 7-21 days, most commonly 10-14 days. There is no predictable or guaranteed time frame.

​

A person undertaking VSED may approach the process in different ways. Some people stop all food and fluids completely from the outset. Others choose to gradually reduce their intake of food and drink over time before stopping altogether.

​

For some people, this tapering approach can feel more manageable or comfortable than stopping abruptly. Gradually reducing intake can allow the body and mind to adjust to the change. Reducing food intake in advance of stopping to drink may also allow the digestive system to slow down naturally. When a person chooses to taper, they will stay hydrated for longer and thereby lengthen the VSED process. 

 

Dying by VSED generally follows a pattern that is similar to other natural dying processes. The body gradually slows down, energy reduces, and the focus of care is on keeping the person as comfortable and settled as possible.

​

VSED is not usually experienced as painful. Some discomfort can happen, such as a dry mouth, weakness, or restlessness, but these are usually manageable with good care and support.

​

Not everyone experiences every part, as described below, in the same way.

​

Early Days

​

In the first few days, you will usually be awake, aware, and able to talk with those around you. You may still enjoy company and conversation.

​

You might notice:

• Hunger at first, which usually fades after a few days

• A dry mouth rather than strong thirst

• Tiredness and less interest in activity

• More time resting or lying down

​

Middle Period

​

As the body becomes weaker, you may sleep more and have less energy. You may be awake for shorter periods.

​

You may experience:

• Increasing weakness and fatigue

• Longer periods of sleep

• Less need to pass urine

• Occasional confusion, restlessness, or seeing things that others don’t

​

Final Stage

​

Towards the end, you may become mostly unconscious and no longer able to communicate.

 

You may also:

• No longer respond to voices or touch, though comfort from familiar presence may still be felt

• Experience changes in breathing, such as pauses or shallow breaths

• Sense your body gradually shutting down

​

This stage is similar to the final phase of many other deaths.

​

Two particularly vivid and informative descriptions are available through It's My Right: The Handmade Death of Herta Sturmann, a video recording of her dying and death, and through Choosing to Die, a book in which Phyllis Shacter recounts her experience of accompanying her husband at the end of his life.

​​

​

Where VSED Might Take Place

​

At Home

​

All our personal experiences of being alongside someone during VSED in the UK have been in the home environment. Many people choose to VSED at home, where surroundings are familiar, and those important to them can be close by. Being at home can offer privacy and a sense of control at the end of life.

​

It is important to have access to medical support during the VSED process, should it be needed. This is usually arranged through your GP, see here. Having GP involvement means that comfort-focused medications can be prescribed if required, helping to manage symptoms such as agitation, pain, or distress. GP involvement also makes it easier to access out-of-hours medical support and visits from community nursing services and hospice at home, which can provide additional reassurance and practical help for both the person choosing VSED and those supporting them.

​

Considerations for the home environment include space and facilities. The space where the bed is located should feel calm, safe, and suitable for extended care. It needs to be large enough for carers to move around easily while remaining quiet and private. Ideally, there should be comfortable seating and a nearby place for a carer or family member to rest or sleep overnight, as a continuous presence is important in the later stages of VSED. Soft lighting, good ventilation, and easy access to a bathroom can help. 

​

​

Care Home or Nursing Home

​

We do not have direct experience of someone being supported during VSED in a care home or nursing home in the UK. Where this possibility has been raised, we have encountered predominantly negative responses, often linked to concerns about reputational risk and perceived legal or safeguarding implications. In principle, it should be possible, and there may be examples of this occurring that we are not aware of. In practice, however, it may not be a feasible option in many care and nursing home settings. 

​

We do not want, however, to rule out with a blanket statement that it is never possible, and you may wish to raise this as a request with a care or nursing home where you feel you would want to be supported should you choose to pursue VSED.

​

​

Hospice

​

There are some publicly known examples where a person has been supported in a UK hospice. Hospices differ in their familiarity with VSED, and decisions about involvement are usually made on a case-by-case basis. Our understanding is that some hospices will only consider supporting a person to VSED when they have a terminal diagnosis.

​

Access to inpatient hospice beds is often limited, which can affect whether this is a realistic option. Some hospices may feel unable to offer inpatient care in these circumstances.

​

Hospice-at-home support may be an option to explore, but responses can vary depending on a hospice’s experience and its resources.

​

The usual first step in general to access hospice support is to speak with your GP, who will make a referral to your local hospice. However, you may also choose to contact the hospice directly first to understand their position and what support may be possible. 

 

​

Hospital

​

Our understanding is that VSED is least commonly supported in hospital settings. Hospitals are often busy and focused on active treatment, which may not align well with a person’s wish for a peaceful death.

​​

​

Reflective Questions and Thinking It Through

 

The following are offered as areas for exploration, at your own pace. It is important to take time to reflect on why you are considering VSED. Many people find it helpful to talk this through with trusted individuals whose views they respect. Such conversations can help clarify thoughts, deepen understanding and support careful consideration of the decision.

​

By clarifying and shaping your thinking, you may find it easier to articulate your reasons to others in your close network and to health and social care professionals. This can also help demonstrate that your decision is well-considered and grounded in sound reasoning, which may be important if your choice is questioned or challenged.

​

You may wish to record your reflections in a written statement that can be shared with others and included within your Advance Plan.

​

We also suggest recording a short video summary of your reflections, if you feel comfortable doing so. This can help make your wishes clearer to others and reduce misunderstanding or uncertainty. For some people, hearing your spoken word can be a powerful way of understanding your intent and reasoning.

 

Understanding your driving wish

• How would you describe your life as it is now, and what makes it feel intolerable?

• What changes or losses do you anticipate in the future that influence your wish to die by VSED?

• What experiences, information, or observations have shaped these expectations?

• How do you describe that you feel your life is completed and that continuing no longer feels right for you?

​

Your understanding of VSED

• What do you understand about dying by VSED, including what the process may involve and where there are uncertainties and challenges?

• How long have you been considering VSED as a possible option?

• Is this something you see as one option among others, or as the only option available to you? What speaks for and against the option of VSED for you?

​

Who have you spoken to?

• Who else, if anyone, have you spoken to about your wishes (family, friends, close network)?

• How have those conversations gone, and do you feel heard and respected?

• Have you taken time to listen carefully to what others have said and to reflect on whether any of it resonates with you?

• Have you spoken with a medical professional about your wish to die by VSED, and what response did you receive?

​​​

Timing, urgency, and flexibility

• Does this feel important now?

• Are there specific symptoms, fears or future losses that make you feel you wish to pursue VSED in the near term?

• What are they?

• Or are you seeking to name VSED as a future option, while leaving the timing open or undefined?

• What circumstances, if any, might lead you to reconsider or change your mind?​

​

What support are you hoping for?

• From your family, friends and close network

• From privately arranged paid carers

• From health and care professionals

​

A Note on Support:

​

Our experience is that VSED should not be undertaken alone and that you need to be supported through the process.

​

As the process progresses, weakness and fatigue increase and everyday tasks can become difficult. Having someone present means there is help with basic practical needs such as safely moving and avoiding falls, mouth care, and taking prescribed medication. It also means that if symptoms become uncomfortable, someone can contact healthcare professionals to seek appropriate support.

​

Should your wishes be questioned by professionals or others, a trusted person(s) being present can help ensure that your decision and planning are understood and respected.

​

In terms of support, we recognise that family can mean different things to different people. It may include relatives, close friends, neighbours, and links with people in community groups. We also recognise that some people may not have a close network around them for such reasons as bereavement, geographical distance, estrangement or other personal circumstances and are instead reliant on formal services and/or privately arranged paid carers.

​​

​

Opening Up the Conversation With People in Your Close Network

​

Talking with people in your close network about wanting to undertake VSED is important and may or may not be challenging. You may worry about how someone will react when you share your wish to die by VSED, for instance, that they won't be supportive of your choice or that it may upset them. Some people may be supportive of your choice from the outset. Often, others may not be familiar with VSED, may share concerns, or the conversation may bring up emotions. 

​

It can help to choose a calm moment and explain clearly what VSED means and why you are considering it. Speaking from your own perspective, for example, about your hopes, fears, or wishes for the future, can help others understand your thinking and choice.

​

It is important to recognise that people will need time to process the information. Some may have questions, while others may react emotionally.  Allowing space for these responses and emphasising that the conversation can continue over time can make the discussion easier. Often, talking with a close person about VSED may involve several conversations. Even after open conversations to support understanding, someone might disagree with your decision, and it may, therefore, be necessary for you to gently explain that ultimately the decision rests with you. 

​

These conversations are not about asking others to agree with your decision but about helping those close to you understand your wishes. Sharing your reflections and thoughts, any planning you have done, such as an Advance Decision to Refuse Treatment (ADRT) and Advance Statement or discussions with healthcare professionals, can also help reassure people that your decision has been carefully considered.

​

For many people, beginning these conversations early can reduce misunderstanding later and help those close to you feel informed and included.

 

You may find it helpful to share our page for family, friends and a person's close network.

​

​

Planning and Practicalities

​

Careful planning and practical preparation are central to VSED. They help ensure your comfort is prioritised, reduce the risk of unwanted medical intervention, and support those caring for you, including professionals, in understanding and respecting your wishes. We have outlined some of the key aspects below.

​

​

Advance Plan

People who are considering or who wish to plan for VSED should record their wishes in an Advance Plan while they have mental capacity. Two documents are particularly relevant: an Advance Decision to Refuse Treatment (ADRT) and an Advance Statement. We go into more detail here.

​

​

Mental Capacity 

​

VSED relies on a person having the mental capacity to refuse food and drink, so having a mental capacity assessment is very important. More information can be found here.

​

​

Care

​

We have assumed that VSED will take place in the home setting. It is important to recognise that as the VSED process progresses, continuous (24/7) care and presence will usually be needed.

​

• Who will be involved in providing care — for example, informal carers such as family and friends, paid carers, an end-of-life companion? Do they support your decision to VSED?

• How will each person be involved in your care, and what will their role be?

• If paid carers and/or an end-of-life companion are required:

  • What will they be expected to do?

  • Is there a budget in place to support this?

• Where will carers be able to rest or sleep during overnight or extended support?

• Has a discussion with your GP taken place so that they know that you intend to VSED?

• Has the GP agreed to provide support, for example, by providing a “just in case” box/bag/pack? The box/bag/pack allows health professionals (GPs, district/community nurses, out-of-hours doctors) to manage symptoms promptly, without delays caused by pharmacies being closed.

• Has the GP put a copy of your Advance Plan (including the Advance Decision to Refuse Treatment (ADRT) and Advance Statement) on your medical records?

• Is there a do not attempt cardiopulmonary resuscitation (DNACPR) or ReSPECT form in place? 

• In the context of VSED, ensuring the GP is aware of the person’s situation and is able to visit is particularly important. A GP visit within the last 28 days of life usually enables the GP to certify that it is an expected death, meaning referral to the coroner is not normally required unless other concerns arise.

​

​

People Speaking on Your Behalf

​

With VSED, it is especially important that you trust the people who may need to speak or advocate on your behalf. They must fully understand your decision, respect your wishes and preferences, and be willing to uphold them throughout the process. This can be an emotionally demanding role, particularly at a time of heightened stress with the anticipation of death and vulnerability for all involved. So those you choose need to be conscientious, reliable, and able to act as your ally and advocate with health and care professionals if you are no longer able to speak for yourself.

​

Important points to explore include:

​

• Are there one or more Attorneys appointed under a Lasting Power of Attorney (LPA) for Health and Welfare (or Power of Attorney in Scotland)?

• Is there clarity and confidence that the Attorney(s) understand and will support your decision to VSED?

• Who will be the lead decision-maker(s) and coordinator in relation to your overall care?

• Who will be the lead person(s) responsible for supporting and communicating decisions relating specifically to your refusal of food and drink?

• Who will take responsibility for advocating on your behalf with health and care professionals?

• Do all those involved in your care hold the Advance Plan, including an Advance Decision to Refuse Treatment (ADRT) and an Advance Statement?

• Do you have a DNACPR or ReSPECT form or a Treatment Escalation Plan, and do all those involved in your care know how to access the document?

• Do you wish for medical information held by your GP, consultant, or hospital to be shared with other named people (family member, friend, close network)? If so, you will need to provide written consent for your information to be shared.

​

​

Timing and Commencement

​

It is important to clarify how and when you wish to start VSED.

​

• The proposed start date

• Whether you wish to:

  • Stop eating and drinking immediately, or

  • Taper food and fluids over a short or longer period (for example, reducing over a few days before stopping completely)

• Do you have any substance dependencies that need to be considered and planned for in advance (for example, alcohol, nicotine, or other substances)?

​

​

Medications

 

• Are there any life-prolonging medications you wish to stop?

• Are there medications you would wish to continue, particularly those that provide comfort or symptom relief but do not prolong life?

• Have anticipatory (“just in case” box/bag/pack) medications been discussed and arranged through the GP, hospice, or palliative care team?

​

​

Affairs in Order

​

Having your affairs in order means that your legal and financial documents and administrative matters are organised and recorded, so there is no undue burden for those left to access, manage, and sort things when you have died. See checklist here.

 

​

Comfort Care

 

Comfort care is the non-medical care given to help someone feel as comfortable, safe, and supported as possible as they approach the end of life. It includes gentle bodily care, emotional support and reassurance, as well as creating a calm, peaceful, and familiar environment. Comfort-focused care information for those in your close network who may be involved in your care is provided in our guide here.

 

​

Logistics

 

Practical and logistical arrangements need to be made. See checklist here.

 

​

Supplies Needed

 

It is helpful to gather certain supplies before VSED begins. See checklist here.

​​

​​​

Advance Planning

 

Advance Decision to Refuse Treatment & Advance Statement

​

There is a summary relating to this here.

 

When a person has chosen to VSED, we believe it is essential to have an Advance Plan (sometimes known as a living will) in place that includes an Advance Decision to Refuse Treatment (ADRT) and an Advance Statement. This documentation should be shared with your close network, health and care professionals and placed on your medical records. Together, these documents help make your wishes clear and guide decision-making. They clearly record your refusals and wishes in your own words, so there is no uncertainty about what you want or why. Please note that different arrangements apply for ADRTs and Advance Statements in Scotland and Northern Ireland. The benefits of those documents are:

​

• They help prevent confusion, crisis decision-making, unwanted interventions, or emergency calls that go against your wishes.

• Making your choices clear removes a burden on those involved in your care. As they know about your wishes, they won’t be asked to decide on your behalf.

• They should be shared with GP, nurses, carers, and other health or care professionals and your close network. This ensures everyone involved in your care understands your wishes and can focus on comfort and reassurance.

• They make clear that choosing VSED does not mean stopping care — comfort, presence, and compassionate support continue throughout.

​

In short, an Advance Plan protects your wishes and supports those involved in your care to act with clarity, confidence, and compassion at a difficult time.

​

Advice and guidance on Advance Decisions to Refuse Treatment (ADRTs) and Advance Statements is available on the Compassion in Dying website.

​

Specific wording relating to VSED for inclusion in an ADRT and Advance Statement is still evolving and has not yet been tested in practice or case law. However, we can share wording we've seen previously used in this context and support you to explore this further, should you wish to make contact.

 

​

Emergency Care/Treatment Plans

​

An emergency treatment plan, such as a ReSPECT form or do not attempt cardiopulmonary resuscitation (DNACPR) decision, is important for anyone considering VSED. The applicable form depends on your geographical location and is completed in consultation with a health professional. It helps ensure that your wishes are understood and respected if your condition changes or an emergency arises.

​

Having this placed on your medical records reduces the risk of unwanted or inappropriate interventions, such as emergency hospital admission or attempts at resuscitation, which may be contrary to your expressed wishes. A DNACPR or ReSPECT form tells emergency services not to try to restart the heart or breathing and helps them to respect it if your wish is to remain at home.

​

For more information on DNACPR decisions, see here, and for ReSPECT, see here.

​​

​

What is Mental Capacity?

​

We have frequently referred to mental capacity. When someone chooses VSED, an important question is whether they have the mental capacity to make that decision.

​

Having mental capacity means the person is able to:

• Understand what stopping eating and drinking involves

• Recognise that this decision will lead to death

• Think through and weigh up their options

• Communicate their decision clearly, in words, writing, or other ways

​

If a person can do these things, they are regarded as having the capacity for this decision, even if others feel uncomfortable or disagree with their choice.

​

Making this choice does not mean the person lacks capacity
A decision can feel very difficult or upsetting to others and still be a valid, capacitated decision.

 

Capacity can change over time
Someone may have capacity now but not later. This is why it can help to talk openly and record wishes early.

 

Capacity is not about age, illness, or disability
People who are frail, living with serious illness or in the early stages of dementia may still have the capacity to decide about VSED.

​

 

Mental capacity assessments

​

Assessing capacity for VSED is typically conducted by qualified health and care professionals and independent, expert mental capacity assessors. Accessing a formal mental capacity assessment is not always straightforward. A person’s GP is usually the first point of contact, but in practice, they may not always feel able to undertake the assessment. Where this happens, people may need to consider approaching an independent, suitably qualified and reputable mental capacity assessor.

​

If you would like to know more about mental capacity, here is the link to the Code of Practice for the Mental Capacity Act (England & Wales), which explains how the Act should be understood and applied in practice.  There are different versions for Scotland and Northern Ireland. 

​​

​

Talking to your GP about VSED

​

Where possible, you should build a relationship with your GP as early as possible around your wish to consider VSED. Ask what they already know about VSED and be prepared to share information. You can signpost them to resources on this website and to the Compassion in Dying website.

​

You may want to ask for a double appointment (usually 20–30 minutes). Clearly explain to the receptionist that more time is needed, ensuring they understand the necessity for a longer, 20-minute, rather than standard 10-minute slot. You may find it helpful to take a trusted person with you to act as an extra pair of ears, ask clarifying questions, and make notes.

​

Go to the appointment ready to explain why you are considering VSED, as clearly and calmly as you can. Take your Advance Plan with you, including your Advance Decision to Refuse Treatment (ADRT) and Advance Statement and be prepared to talk through the practical, logistical, and care arrangements you have in place.

​

It is important to emphasise that you are seeking medical support, rather than permission to VSED, for example. This support can take the shape of providing comfort medications and, where appropriate, a “just in case” box/bag/pack to help manage symptoms at home, out-of-hours support if needed, and a ReSPECT or DNACPR form. You can ask directly whether your GP feels able to support you in this way.

​

If you encounter resistance that you do not feel can be resolved through discussion, you can ask for a referral to another clinician you can speak with.

​​​

​

Changing Your Mind: Why People May Decide Not to VSED After Exploring it as a Choice

 

Exploring VSED is part of making sense of mortality, autonomy, and limits. Changing one’s mind is not failure, indecision or weakness; it is a valid and meaningful outcome of reflection.

​

It is not unusual for people to explore VSED and later decide not to proceed, or to pause their decision. This does not mean the earlier consideration was mistaken. Often, it reflects a natural human response to changing circumstances, emotions, and support.

​

People sometimes consider VSED during periods of intense fear, exhaustion, pain, or emotional overwhelm. When emotional distress is acknowledged and supported, or symptoms are better managed, the urgency of the decision may lessen.

​

Being deeply listened to without judgement, pressure, or dismissal can be profoundly reassuring. For some people, once their fears and wishes are genuinely heard and taken seriously, the need to act on VSED reduces.

​

Access to better symptom control, palliative care, practical help at home, or consistent companionship can change how a person experiences daily life and future decline.

​

Knowing that plans are in place, such as Advance Decisions to Refuse Treatment (ADRT), clear documentation, and trusted people who will advocate for their wishes can bring emotional relief and reduce the sense of urgency.

​

A change of hope may also lessen urgency. Having renewed hope does not always mean hope for recovery. It may mean hope for comfort, connection, or meaningful moments. You may find yourself thinking “not now,” while keeping open the possibility of returning to this decision in the future.

 

People may change their mind at any stage - while exploring VSED, planning VSED, or in the early stages of having started VSED.

 

However, it is very important to recognise that once the VSED process has begun, there will come a point at which it cannot be safely or practically reversed, even if a person were to change their mind. This is why careful reflection, preparation, and ongoing discussion are so important before starting VSED and during its early stages.

​

​​

After Death

​​

There are a few things for you to consider about what happens after you die:

​

• You may wish to leave instructions for your funeral, or you may feel happy for others to make those decisions. Even so, some broad guidance is often helpful, so those left behind are not left guessing.

• You may want to leave a list of people you want notified.​

• You may want to nominate one or more people to take on the responsibilities that follow your death, e.g. contacting a funeral director and registering your death. There may also be an Executor(s) named in your will who will be involved.

​

If you would like to read more about what happens after death and the responsibilities of your nominated people, you can find more information on our page for family, friends, and close network here.

​​

​

Some of the Challenges We Have Encountered

​

Emergency services become involved

​

When the shared aim, based on the wish of the person having initiated VSED, is to avoid hospitalisation and unwanted or futile medical intervention, calling emergency services can unintentionally undermine that objective, for example, the individual being hospitalised and receiving treatments they do not want. 

 

If a call to paramedics cannot be avoided, the priority is for those involved in your care to remain calm and grounded and to have the following documents immediately to hand:

 

• the Advance Plan (including the Advance Decision to Refuse Treatment (ADRT) and Advance Statement)

• the Emergency Treatment Plan, such as a DNACPR or ReSPECT form

​

A lead person should take responsibility for calmly communicating that:

​

• You have chosen VSED

• You wish to remain at home and die peacefully

• Agreed plans and documentation are in place to support this choice, and the documentation is to hand to be viewed

​

Where plans are visible on the medical record and the GP is informed and involved, then unnecessary hospital admission should be avoidable.

 

​

A safeguarding referral is made

​

A safeguarding referral may arise for a variety of reasons. For example, it may come from a concerned neighbour, a friend or carer who does not agree with the person’s choice, or a health professional who does understand VSED and the person’s decision. It is important to know that a safeguarding referral does not mean someone has done something wrong, and it does not automatically mean that VSED must stop.

​

Safeguarding processes exist to protect vulnerable people, for example, to check if there is coercion or abuse. When VSED is a capacitous, informed, and voluntary decision, concerns can usually be addressed through clear explanation and documentation.

​

Key things for the person(s) supporting you and for you to know are:

​

• A safeguarding referral is not an accusation

• It can be triggered by uncertainty or lack of familiarity with VSED

• Many referrals are resolved quickly once the situation is understood

• Referrals commonly close with “no further action”

​

What to do:

 

For the following, you may be able to speak for yourself, or if you are unable, a trusted person may take the lead in communicating with a safeguarding professional.

​

Stay calm
Safeguarding referrals are often made out of professional anxiety or misunderstanding. Try not to assume the worst or feel you are under suspicion.

​

Clarify the concern
Ask what the safeguarding issue is actually about, such as mental capacity, coercion or pressure, or misunderstanding VSED as neglect or withholding care. A clear understanding helps prevent unnecessary escalation.

​

Re-establish mental capacity
Mental capacity is central. Where possible, show that you understand what VSED is and its consequences, have made the decision to VSED freely, and have expressed this decision consistently over time. Helpful evidence may include GP notes, a mental capacity assessment, and the Advance Decision to Refuse Treatment (ADRT) together with the Advance Statement.

​

Make your wishes visible
Safeguarding teams respond best when wishes are clearly documented. This may include an Advance Statement, an Advance Decision to Refuse Treatment (ADRT), written confirmation of who should speak on your behalf, and notes (and if it exists, a short video recording made by you) showing that food and fluids are being declined by choice, not withheld.

​

Be clear about care
A common misunderstanding is that VSED means care is being withdrawn. Clarify that you are refusing food and drink and that comfort care continues, such as mouth care, symptom relief, hygiene, repositioning, and emotional support. Demonstrating that comfort care is provided can help resolve concerns about neglect.

​

Identify a lead communicator
Agree on who will be the main point of contact with safeguarding services, such as a family member, friend, an attorney nominated in your Lasting Power of Attorney, or clinician. This helps avoid confusion and mixed messages.

​

Ask for proportionality
If there is no evidence of abuse, neglect or coercion, it is reasonable to ask that enquiries are proportionate, distress to you is minimised, and unnecessary delays or intrusive assessments are avoided. Safeguarding should protect well-being as well as investigate risk.

​

Safeguarding involvement can feel alarming, but it is often a temporary step. Clear communication, calm explanation, and visible respect for the person’s wishes usually bring the process back into balance.

 

 

Family members and those close to the individual

​

Sometimes concerns or disagreements may only emerge once the VSED process has begun, or a person who initially appeared supportive may later become uncomfortable with the decision.

 

Hence, it is important that family members and others closely involved in your care, including any Attorneys under a Lasting Power of Attorney, understand and, where possible, support your decision to VSED. Shared understanding, both before and during the process, helps reduce the risk of conflict, particularly if concerns are raised or if someone later seeks to halt the process once it is underway.

​

​

Existing paid carers and care agencies

​

Paid carers may have supported a person choosing VSED over a period of time and may hold emotional, practical, and financial connections to their role. Yet some may experience VSED as being in direct conflict with their professional identity or previous care goals.

​

Concerns may include:

​

• Moral or ethical objections

• Fear of professional consequences

• Anxiety about future employment

​

Where possible, you should have an open conversation with carers to:

 

• Explain your reasons for the decision to VSED

• Explore whether the carer feels able to continue in a supportive role

​​​

Where care is provided by an agency with multiple staff, the agency manager should be contacted to:

 

• Explain your decision to VSED

• Outline the VSED process and Advance Plan

• Seek clarity on whether the agency and its staff are able to support your choice

 

If carers or the care agency are unable or unwilling to provide the commitment to support your choice, the care arrangement should be ended in a planned and respectful way, with alternative arrangements explored if needed.

​

​

Threats of sectioning or inappropriate use of mental health powers

​

There have been instances where people who are thinking about or who have chosen to stop eating and drinking and who have the mental capacity to make that choice, are referred to mental health services. We refer you to the distinct legal frameworks of the Mental Health Act and the Mental Capacity Act on our page for professionals.  

 

If a mental health referral is mentioned because you are considering VSED, it is important to know that choosing VSED does not imply having a mental illness.​ What matters is whether you have the mental capacity to make this specific decision at this time. Capacity should not be questioned simply because the decision is serious or unconventional.

​

If a referral is raised, you can ask what the specific concern is, whether it relates to mental capacity, and how that will be assessed if you do not already have an assessment. You can also ensure that your Advance Decision to Refuse Treatment (ADRT), Advance Statement, and any written or recorded explanation of your wishes are shared.

​

​

When eating or drinking continues, sometimes surreptitiously, or is requested or offered 

​

There are a variety of reasons why such a situation can emerge. When it happens, it can be confusing and emotionally difficult for carers. It is important that they respond to you calmly, respectfully, and without judgement, while keeping your well-being and expressed wishes at the centre.

​

Pause and observe

​

If you eat or drink secretly, or repeatedly ask for food or fluids, it should not automatically be interpreted that you have changed your decision.

​

It may reflect:

​

• Fear, anxiety, or uncertainty

• Dry mouth or discomfort, rather than true hunger or thirst

• A need for reassurance or control

• Natural fluctuations in resolve, particularly early on

​

Your carer should gently check in with you

​

We hope that your carer will ask you open, non-pressured questions, for example:

​

• “Can you tell me what’s feeling hardest right now?”

• “Are you feeling unsure, or needing comfort?”

• “Do you feel the same about your decision today?”

​

They should be there to listen, not persuade.

​

Revisit wishes and capacity

​

If eating or drinking continues, or your requests are persistent, it is important for the carer to check whether:

​​​

• You still wish to proceed with VSED or are ambivalent

• You know that eating and drinking will prolong the process

• You would like to be reminded of your original decision

• Requests for fluids are related to dry mouth, and if you would like additional mouth care

​​

If offers of food and drink are made to you 

​

So that unsolicited offers of food or drink are not made, it is important that all those involved in supporting you understand from the outset that you have chosen to stop eating and drinking. If someone nevertheless offers food or drink, it can help for you or a member of your support network to gently remind that person of your decision. They may be offering because they are unaware of the situation or feel uneasy about it. A calm explanation of your choice and that it should be respected will usually resolve the situation. If a person repeatedly goes against this despite having been informed, it may be necessary to limit their involvement or visits in order to ensure your wishes continue to be respected.

 

Changing your mind

 

VSED must always remain voluntary, and you can change your mind. As previously stated, though, it is very important to recognise that once the VSED process has begun, there will come a point at which it cannot be safely or practically reversed, even if you were to change your mind. This is why careful reflection, preparation, and ongoing discussion are so important before starting VSED and during its early stages.

​​

​

 

Checklists and Guides​​​​​​