…Now with even more dignity.

2023-06-05

Dear friend,

In 2013, Vermont became the third state to enact a "death with dignity" law, and the first to do so by legislative action.

Act 39 of 2013 allows Vermont physicians to prescribe life-ending, self-administered medication to a Vermont resident with a terminal illness and six months or less to live. The law includes several requirements and checks. Those include:

• an oral and written request by the patient to the physician;

• clear instruction that all steps in the process are voluntary for the physician, patient, and pharmacist;

• ensuring that the patient be capable of making such a decision;

• confirmation of the diagnosis and prognosis by a second Vermont physician;

• attestation to these steps by a non-interested witness.

For more info including FAQs -- see the State website, Patient Choice and Control at End of Life.

The Department of Health reports every two years on the usage of Act 39.

The most recent report gives data from 2013 to 2021, showing 116 cases, grouped into four diagnoses:

• 89 (77%) cancer

• 13 (11%) ALS

• 6 (5%) Neurodegenerative conditions

• 8 (7%) other

For context, Vermont counted 6,461 total deaths in 2020. We had about 8 deaths associated with Act 39 in 2020, or 0.1%.

The requirements of Act 39 create a narrow window, with some patient advocates saying it's too narrow.

Someone has to have a terminal condition -- the same requirement to opt for hospice care. You have to be of sound mind and present yourself twice, 15 days apart, to opt into this process. That might be hard to do with six months or less to live, at a time when you're likely on pain medications and dealing with heavens-knows-what.

This is a grave decision for a patient to make in consultation with a doctor based on their health condition.

There was one part of it that the Legislature decided no longer makes sense. With the enactment of H.190, now Act 10, a Vermont doctor will no longer have to ask to see someone's driver's license in the course of having this conversation.

Vermont faced a federal case challenging the residency requirement. As Rep. Golrang Garofano reported on the House floor, "End-of-life care is the only health care in Vermont that requires that the patient be a resident of Vermont."

I voted "Yes" on H.190, and Gov. Scott signed it into law on May 2. Act 10 makes a technical correction to a law that is demonstrated to be working for those who need it most.

I hope it makes patience choice at end-of-life available for someone who needs it.