Medical Aid in Dying (MAID) vs. Voluntarily Stopping Eating and Drinking (VSED): Understanding Your Options

First and foremost, before we dive into the educational aspect of VSED and MAID, a couple of precautionary things for those who may seek services from me.

I will honor your choice if you consider a medically assisted death. I won’t encourage you to pursue it, nor will I urge you to wait for a natural passing. I won’t push you to hold out for a miracle or more time, and I won’t tell you that one path is more ‘right’ than the other.

I respect your journey and your reasons, but I won't dictate what’s right or wrong for you. If you seek information about Medical Aid in Dying (MAID), I will share what I know—about the laws, the timing, the medications involved. Yet, I can’t tell you how it feels to take that step, or how those you love will respond. I can’t explain the experience of dying, but I can be there with you through it.

I neither condone nor condemn; I hold no judgment. I don't shape the laws, nor do I advocate for or against them.

I am here, present with you, attuned to your needs. I will help you say goodbye—whether by writing letters, opening doors, or creating a peaceful space. I will pray with you, help you find peace, and share in your awe when you feel the presence of those you love.

I will stay by your side as you take your final breath, and in the stillness that follows, I will focus on my own breath.

My purpose is to ensure you feel loved, safe, and witnessed as you transition. This is what a doula-assisted death means—a compassionate presence during your final moments.

When faced with terminal illness or an irreversible decline in quality of life, many people start exploring their end-of-life options. Two choices that often come up are Medical Aid in Dying (MAID) and Voluntarily Stopping Eating and Drinking (VSED). Both paths offer ways to exert control over one’s death, but they differ significantly in their processes, legalities, and emotional impact. Understanding these differences can help individuals and their families make informed, compassionate decisions.

What is Medical Aid in Dying (MAID)?

Medical Aid in Dying allows a terminally ill, mentally capable adult to request and receive prescription medication that they can self-administer to bring about a peaceful death. It’s often referred to as “death with dignity” or “physician-assisted death.” MAID is legal in several U.S. states and countries like Canada, but it comes with stringent legal requirements.

Pros:

• Control and Predictability: MAID provides a clear, controlled, and relatively quick way to end life, often occurring within minutes to hours after administration.

• Legal and Medical Oversight: In places where MAID is legal, it’s carried out under strict medical supervision, ensuring that the patient’s decision is informed and voluntary.

• Reduced Suffering: MAID can prevent prolonged suffering, particularly in cases of terminal illness where pain or other symptoms are poorly controlled.

Cons:

• Legal Restrictions: MAID is only available in certain jurisdictions, and even where it’s legal, strict criteria must be met, including a terminal prognosis, mental competence, and multiple requests.

• Social and Ethical Concerns: There may be stigma or disagreement among family members or within communities about the use of MAID.

• Limited Timeframe: MAID is usually an option only when death is expected within six months, limiting its availability to those with terminal diagnoses.

What is Voluntarily Stopping Eating and Drinking (VSED)?

VSED is a decision to hasten death by voluntarily choosing to stop consuming food and fluids. Unlike MAID, VSED is legal in all 50 states of the U.S., regardless of the patient’s diagnosis. It requires the individual to be mentally competent and committed to the process, as it involves a gradual decline over days or weeks.

Pros:

• Widespread Availability: VSED is an option for anyone who is mentally competent, regardless of where they live or whether they have a terminal diagnosis.

• Personal Control: VSED allows individuals to make a private, autonomous decision about the timing of their death, free from legal restrictions.

• Time for Reflection: The process of VSED is slower than MAID, offering the individual time for final conversations and closure with loved ones.

Cons:

• Lengthy Process: VSED can take anywhere from several days to a few weeks, during which symptoms like thirst, hunger, and fatigue may cause discomfort.

• Emotional and Physical Toll: The extended nature of VSED can be emotionally and physically draining for both the individual and their caregivers.

• Need for Strong Support: VSED requires a committed support system to manage symptoms, provide comfort care, and assist with decision-making.

Making the Decision: MAID or VSED?

Choosing between MAID and VSED is deeply personal and depends on individual values, legal considerations, and the availability of support systems.

Consider Your Values: Think about what matters most to you in your final days. If you prioritize a quick and predictable process, and you meet the legal criteria, MAID may be the right choice. If you prefer a process that allows more time for reflection and closure, and you value autonomy in decision-making, VSED might align more with your values.

Evaluate Your Support System: Both MAID and VSED require a strong support system, but the needs are different. MAID involves a one-time administration of medication, usually in a controlled environment, while VSED requires ongoing support over an extended period. Make sure your loved ones are aware of your wishes and prepared to provide the necessary care.

Consult with Healthcare Professionals: Discuss your options with a trusted healthcare provider. They can help you understand the medical, legal, and ethical aspects of each choice and provide guidance based on your individual circumstances.

Document Your Wishes: Whatever you decide, it’s crucial to document your wishes in an advance directive and communicate them clearly to your family and healthcare team. This ensures that your decision is respected and that you receive the care you desire.

Both MAID and VSED offer pathways to a death that aligns with your values and wishes. While they differ in process, legality, and emotional impact, each option allows individuals to exert control over their end-of-life experience. By carefully considering your priorities and consulting with loved ones and healthcare professionals, you can make an informed choice that provides peace of mind in your final days.