“VSED” – The Loophole to Death

The BMA’s [British Medical Association’s] new VSED (Voluntary Stop Eating and Drinking) guidance is not a British story. Canada ran this experiment years ago, and we already know how it ends.

Every time one of these documents lands, the same thing happens. A medical body publishes something careful and administrative, the language is so smooth you could skate on it, and the people who object are told they’ve misread it.

Nobody is being killed. Nobody is being pushed. This is only guidance, only clarification, only doctors being given the information they need to care for their patients well.

I have been on the other side of enough of these documents now to know what they are. I have sat in living rooms in this country with families who were handed exactly that kind of reassurance and then watched it turn into a funeral. I have testified in front of Parliament about what happens when a system built on that language is allowed to expand on its own momentum. So when the British Medical Association posted guidance in August on caring for patients who choose to stop eating and drinking in order to end their lives, I did not read it as a British story. I read it as a rerun.

The document is real, it is on the BMA’s own website, and the update stamp reads August 24, 2026. It is addressed to all doctors in the UK, and it defines its subject as a person with the mental capacity to decide, acting without coercion, making an informed choice to stop taking in food and fluids with the intention of ending their life.

Read that definition again, because the BMA has done something useful here without meaning to. It has said the quiet part in its own words. This is not the refusal of a ventilator. This is not declining a fourth round of chemotherapy because the treatment has become worse than the disease. The stated intention, in the association’s own framing, is to end a life and the guidance exists to tell doctors what they can lawfully do to support a patient through it.

The contents page tells you the rest. There is a section on the legal framework. There is a section on how to decide whether it is legally permissible to provide symptom relief. There is a section on building a care plan. There is a section on record keeping and reporting the death. There is an appendix on what to expect at the different stages and there is a section of wellbeing resources for the doctors, which is the detail I keep coming back to, because an institution does not write a wellbeing annex for a procedure it believes is routine.

The BMA is careful to say the guidance does not cover clinical information or symptom management. Fine. But you do not need a clinical annex to understand the architecture. A person decides to die this way. A doctor is told what the law permits them to do while it happens. A death gets recorded. That is a pathway, and pathways get used.

VSED. Four letters, no verbs, nothing in it that a person would have to say out loud with any weight behind it.

I have watched this exact trick run in Canada for years. We do not say a doctor ended a patient’s life, we say the patient received medical assistance in dying. We do not say suicide, we say provision. We do not say the state approved a death, we say the person met the criteria.

The acronym is not a shorthand for a longer phrase. It is a replacement for a sentence somebody would rather not finish.

Here the euphemism is doing something more specific than usual, because it borrows the vocabulary of fasting, which is a thing human beings have done deliberately and safely for as long as we have had religions. That association is not accidental and it is not harmless. What the guidance covers is not that. Whatever else is true about it, this is a course of action a person undertakes with the intention of not surviving it, and one that clinicians are being told they may lawfully help make bearable. Take those two facts together and the honest word for it is assisted death.

That is the part the British debate keeps missing. Westminster has spent years arguing about assisted dying legislation, about eligibility, about six-month prognoses and panels and judicial oversight. Meanwhile, a route exists that requires no bill, no vote, no terminal diagnosis, and no gate of any kind. All it needed was a professional body willing to write down what doctors may do while it happens.

Here is why I am not writing about Britain. In 2018, Policy Options — the journal of the Institute for Research on Public Policy, not a critic of assisted dying by any stretch — published an account of a Canadian case that should be taught in every ethics seminar in this country and is taught in almost none.

A fifty-six-year-old woman referred to as Ms. S., living with advanced multiple sclerosis, asked Dr. Ellen Wiebe for medical assistance in dying in June 2016. According to the published account, Wiebe found she met most of the criteria: incurable condition, advanced and irreversible decline, suffering she found intolerable and that could not be relieved by any means acceptable to her.

But Wiebe did not believe Ms. S. would die in the foreseeable future, so she was found ineligible on the final criterion, the one requiring that natural death be reasonably foreseeable. Ms. S. asked twice more, in December 2016 and January 2017, and was refused on the same ground each time.

At the end of February, she stopped eating and drinking, with palliative care support. Fourteen days later Wiebe assessed her again and concluded that “the significant malnutrition and dehydration were incompatible with continuing survival.” The foreseeability criterion was now satisfied. She qualified.

Sit with the structure of that, because the structure is the entire argument. Parliament wrote a safeguard. A woman did not meet it. She then took an action that made her meet it. And the safeguard held, technically, right up until the moment it was worth nothing.

This is what a workaround looks like from the inside. Not a scandal, not a rogue actor, not anybody breaking a law. Every step defensible. Every box ticked and a criterion that Parliament debated and passed and told the country was a limit turned out to be a hurdle you could clear by refusing water for two weeks.

I want to be precise about what I am and am not saying. Nobody in that account did anything unlawful. That is the problem, not the exoneration. A safeguard that can be satisfied by the patient’s own deterioration is not a safeguard; it is a waiting period. The account did not come from me, or from anyone in the movement I work in. It was published by academics who support the law.

The BMA’s guidance does not create this. It documents it. That is the thing worth understanding, because the British conversation is still being conducted as though the question is whether to open a door, when the guidance is really a set of instructions for a door that was already unlocked.

The pressure will not come from the guidance. It will come afterward, the way it came here. It will come from a hospital that finds it cheaper. From a family that is exhausted. From a facility that would rather not be the one with a policy against it. From a doctor who declines to participate and discovers that declining now carries a professional cost, which is the piece of this that the British commentators have been right to flag hardest.

Once a body like the BMA writes down what care looks like in these circumstances, the doctor who wants no part of it is no longer exercising judgment. They are deviating from guidance.

That is how it went in Canada. Not through one law, but through the slow conversion of a permission into an expectation, and an expectation into a standard of care.

I have spent a long time being told I am alarmist about this. That the safeguards will hold. That the Canadian experience is a special case, a product of our particular politics, not a preview of anyone else’s. I have stopped arguing about it, because the record argues better than I do.

Nine years ago, a woman in this country was told she did not qualify. She found the way that did not require anyone’s permission and the system that had refused her three times looked at what she had done to herself and called her eligible.

Britain, you are not writing a first draft. You are copying ours, and that should terrify you.

Have surveys been done on what percent of the population in the US or UK feel people in these severe circumstances should have the right to make this kind of choice, or if they should be prevented by the State from doing so. Obviously if people can make these choices, then hospitals and nursing homes might not be able to milk the estates of such people for their own profit.

My mother and my husband did NOT want to die in a hospital, so I cared for them at the end period. My mother who lived to 90 was dying because a pig mitral valve she received at 78 was now failing and she was too frail for another surgery. My husband had Alzheimer’s and I cared for him during the entire 10 years it took for him to die at age 75. More later if this story is visited by others.

My mother had difficulty sleeping because she knew she was dying. A doctor prescribed Atavan for her anxiety. When she entered a coma, the visiting Hospice nurse said not to try to wake her, let the natural dying process proceed. When she became restless with some moaning noises, I dissolved an Atavan pill in a little water and used a dropper to give her some without waking her. She became peacefully comatose again and died the next day.

When my husband lost interest in eating, I phoned the 2 VA system doctors who had met with us several months earlier when I realized he was not going to last much longer. We had confirmed with them his “do not resuscitate”, do not hospitalize orders we had prepared 4 years earlier with a lawyer while his mind was still working adequately. As I and my visiting son listened, they explained that we should give him food or water if he asked, but not give if he did not ask. The next day he was in a coma. the hospice nurse came by and gave me items for final care. One item was morphine which she said I could give if he appeared to be in pain. He died in 6 days without ever exhibiting any distress, and the nurse picked up the morphine from me.

I hope that the people caring for Shivo’s final days had similar means to reduce distress if it occurred. A friend who was slowly dying of cancer contacted people to say she was going to stop eating and drinking any more and was soon dead. I don’t know what immediate care she had during that process, but it was her choice. I am just glad my mother and husband did not have something very painful like cancer or I might not have been able to give them their wish to die at home.

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