Key points ○ The conventional approach to voluntary stopping of eating and drinking (VSED) assumes physicians may set aside ethical disagreement in communication and clinical decision-making, which neglects the ethical problem of complicity. ○ The alternative approach to VSED, for those who view VSED as ethically wrong, allows clinicians to advise against VSED and to provide palliative medicine while resisting interventions that facilitate VSED. Why does this paper matter?