Legality of VSED in the UK
The UK legal situation,
an overview of statements from medical professional bodies, and other legalities
This summary was produced by us in June 2025 to summarise the legal situation and publicise the position statements from medical professional organisations.
It is intended as information for people with an interest in VSED in the UK, including individuals considering this choice for themselves and the people close to them. We also intend it to be used as a resource to be shared with GPs and other healthcare professionals who are supporting or considering supporting someone during VSED. In the absence of formal guidance on VSED, the position statements demonstrate the legality of VSED, and the legality of providing palliative care to support someone choosing VSED.
1. Decision of The Supreme Court of the United Kingdom (SCUK)
The SCUK is the final court of appeal in the UK for civil cases, and for criminal cases from England, Wales and Northern Ireland. It hears cases of the greatest public or constitutional importance affecting the whole population.
The 2014 Supreme Court decision in the Nicklinson, Lamb and Martin case ruled that:
“A person who is … mentally competent is entitled to refuse food and water, and to reject any invasive … treatment … even though without it he will die. … Medical practitioners must comply with his wishes.”
“The doctor is in no danger of incurring criminal liability merely because he agrees in advance to palliate the pain or discomfort involved should the need for it arise.”
2. Statements from medical professional bodies
2.1. The General Medical Council (GMC)
The GMC is an independent regulator responsible for overseeing doctors, physician associates (PAs), and anaesthesia associates (AAs). Its key functions include setting standards for medical practice, ensuring doctors have the necessary education and training, maintaining a register of qualified professionals, and investigating concerns about patient safety or public confidence.
The 2015 GMC guidance on patients seeking advice or information about assistance to die states that, where patients ask for information that might encourage or assist them in hastening their death:
“Medical professionals should be prepared to listen and to discuss the reasons for the patient’s request.”
“Medical professionals should limit any advice or information in response to … objective advice about the lawful clinical options (such as … palliative care) which would be available if a patient were to reach a settled decision to end their own life.”
“For avoidance of doubt, this does not prevent a doctor from agreeing in advance to palliate the pain and discomfort involved for such a patient should the need arise for such symptom management.”
2.2 British Medical Association (BMA)
The BMA is a trade union and professional body for doctors and medical students in the UK.
In 2019, the BMA stated in its guidance on responding to requests to assisted dying:
“An informed refusal by a competent adult must be respected, even if it will result in serious injury or death. This includes a competent refusal of food and fluids. In these cases, it would be appropriate to discuss with the patient in advance what pain and symptom relief will be available at such a point in time that it becomes necessary.”
“The courts have been clear that there is a fundamental distinction between assisting suicide and a decision not to provide, or to not to continue life-sustaining treatment including clinically-assisted nutrition and hydration.”
“A patient with capacity can make an informed and contemporaneous refusal of … food and fluids, which must be respected. Where patients have reached a settled intention to hasten their death in this way, [the doctor] can provide objective advice about the lawful clinical options that would be available to them at that point and agree in advance to provide symptom relief should the need arise.”
2.3 The Royal College of Physicians (RCP)
The RCP is a professional membership body dedicated to improving the practice of medicine, chiefly through the accreditation of physicians by examination.
In its 2021 guidance on supporting people who have eating and drinking difficulties it states:
“Some patients with capacity may choose for themselves to stop eating and drinking, as they are free to do. Some staff may find this particularly challenging and need support to respect the patient’s decision.”
2.4 The Nursing and Midwifery Council (NMC)
The NMC is the independent professional regulator for nurses and midwives in the UK.
We could not find any statements relating to VSED in their Code and Standards.
2.5 Royal College of Nursing (RCN)
The RCN is a nursing union and professional body.
The RCN doesn't offer specific guidance on VSED but it emphasizes the importance of clinical support and patient safety, and encourages nurses to seek guidance from the GP, local hospice, or other clinicians involved in the patient's care.
Different legal frameworks apply in Northern Ireland and Scotland. The following relates to England and Wales.
3. Advance Decision to Refuse Treatment (ADRT) enshrined in the Mental Capacity
Act 2005 (MCA) - England and Wales
An advance decision to refuse treatment (ADRT) is a legally binding document about what medical and healthcare treatment a person wants to refuse in the future; in case they lose the mental capacity to make these decisions.
Mental capacity means the ability to use and understand information to make a decision, and communicate any decision made. A person lacks capacity if their mind is impaired or disturbed in some way, which means they're unable to make a decision at that time.
Whilst a person has capacity they can refuse to drink or eat by mouth. If a person loses capacity there is a lack of clarity as to whether a previously stated wish in an ADRT not to be fed and watered by mouth should be respected by health and social care professionals.
Therefore, some people refer to their choice to die by VSED in their ADRT and then in an accompanying Advance Statement express their wish to refuse food and water by mouth which should be taken into account when best interests decisions are made by clinicians.
4. Medical certificate of cause of death (MCCD)
A Medical Certificate of Cause of Death (MCCD) is a permanent legal record that specifies the cause of a person's death. It is used for registering the death, arranging the disposal of the body, and settling the deceased's estate.
When someone dies after choosing VSED the death certificate should be completed by the medical practitioner and it is hoped that what will be recorded is that the death occurred naturally and that the immediate cause was dehydration. Any primary illness(es) that led to VSED should be listed as contributing co-morbidities. Medical examiners review MCCDs and make referrals to the coroner when necessary.
To the best of our knowledge the information above is accurate at the time of writing. If you come across any missing information or updates please get in touch with us: info@talkvsed.org.uk