both contemporaneous and (most) non-contemporaneous decisions for VSED are legally permissible. Individuals may refuse nutrition and hydration just as they may refuse other intrusions on their personal autonomy. This right is grounded in the common law of battery, statutes, state constitutions, and even the U.S. Constitution. Moreover, VSED does not, as many believe, constitute abuse, neglect, or assisted suicide. Even ex ante decisions for VSED (exercised through an advance directive or a surrogate decision maker) are legal in most United States jurisdictions.The legality and ethics of VSED is now getting more attention. There is a new lawsuit against a nursing home for disallowing VSED. And in its September 2013 monthly publication NewsLine, the National Hospice & Palliative Care Organization has encouraged its 2000 member hospices to develop policies on VSED:
If a patient decides to forgo eating and drinking in order to hasten his or her own death, how should a hospice respond?
From a legal standpoint, “voluntarily stopping eating and drinking” (VSED) is an option for individuals in all 50 states and distinct from the natural reduction in nutritional intake that accompanies the dying process. It is a voluntary decision by patients with decision-making capacity, with the explicit intention of hastening death.
While legal, however, the peer-reviewed literature does not reflect strong ethical consensus about whether, how, and for what reasons hospices should or should not participate in patients’ care decisions about VSED. . . . The Council also encourages each hospice to explore these questions in their organizational ethics committees, with the ultimate goal of establishing a policy or guidelines to address VSED so staff is prepared when such situations arise.