Health Care

‘Death with Dignity’ signed into law in Vermont

 Sen. Dick McCormack (left)  and Dick Walters, president of Patients Choice Vermont, greet supporters of a bill allowing physician-assisted death in Vermont. Photo by Alicia Freese/VTDigger
Sen. Dick McCormack, left, and Dick Walters, president of Patients Choice Vermont, greet supporters of a bill allowing physician-assisted death in Vermont. Photo by Alicia Freese/VTDigger

A decade of lengthy and divisive debate ended Monday when Vermont became the first state in the U.S. to enact legislation allowing terminally ill patients to obtain medication to help them end their lives.

In a room jam-packed with lawmakers and supporters of the so-called physician-assisted death bill, Gov. Peter Shumlin signed into law S.77, which takes effect immediately.

The bill grants doctors civil and criminal immunity if they follow a series of required steps before prescribing a lethal dose of medication to a patient with a life expectency of fewer than six months who requests it. The steps include ascertaining that the patient is capable of making the decision and can self-administer the medicine. The requirements expire after three years, by which point lawmakers hope doctors will have developed their own guidelines.

Shumlin told the crowd, “This bill does not compel anyone to do anything that they don’t choose in sound mind to do. All it does is give those who are facing terminal illness, are facing excruciating pain, a choice in a very carefully regulated way.”

Shumlin and House Speaker Shap Smith praised lawmakers for positioning themselves at the vanguard of “patient choice.” Oregon and Washington passed similar laws through referendums and a court decision prompted a law in Montana, but Vermont is the first state to pass the measure through the legislative process.

Attorney General Bill Sorrell predicted that court action could compel other states to follow in Vermont’s footsteps. “Quite frankly I see litigation in the future. This could be the next, or a next, big civil rights issue,” Sorrell said.

Sorrell said that like race and gender orientation issues, he expects the tide of changing public opinion — propelled by aging baby boomers — will prompt the Supreme Court to act on the issue. “I see this being another of those civil rights where the mood in the country changes and the judiciary will follow suit.”

The president of Patients Choice Vermont, Dick Walters, who spearheaded an 11-year push for the legislation, said in a statement, “Vermont has taken a huge step forward for the autonomy rights of terminally ill patients.”

Health care systems weigh the implications

Vermont hospitals are not jumping on board just yet, however. S.77 gives health care facilities the option of prohibiting their staff from prescribing a lethal dose of medicine to patients who are staying at the facility.

And most hospitals will take advantage of that option, at least in the short term, according to Jill Olson, vice president of policy and legislative affairs for the Vermont Association of Hospitals and Health Systems (VAHHS).

Fletcher Allen — the state’s largest hospital — informed its staff Friday that it is enacting an interim policy to prohibit the practice for patients on its premises.

That policy will stand until the Ethics Committee and hospital leadership has had a chance to work through the “unique issues from an ethical standpoint” that the legislation poses, according to chief medical officer, Dr. Stephen Leffler.

Olson said the quick turnaround — the Legislature passed the bill on May 13, and Shumlin signed it one week later, making it effective immediately — is leading many hospitals to prohibit the practice.

“I’m certain that we’ll have many [hospitals and health facilities] that use the exemption because of the quick implementation time frame,” Olson said.

Even two weeks, Olson said, would have allowed hospitals to consult their ethics committees ahead of time.

Sen. Claire Ayer and Bob Ullrich,  an active proponent of physician-assisted death, talk after Gov. Peter Shumlin signed into law a bill allowing terminally ill patients to obtain a lethal dose of medication. Photo by Alicia Freese/VTDigger
Sen. Claire Ayer and Bob Ullrich, an active proponent of physician-assisted death, talk after Gov. Peter Shumlin signed into law a bill allowing terminally ill patients to obtain a lethal dose of medication. Photo by Alicia Freese/VTDigger

But Sen. Claire Ayer, D-Addison, who played a key role shepherding S.77 into law, said the quick turnaround was necessary for procedural reasons. Normally, a bill has to sit in the Senate for 24 hours after passing. With S.77, the legislative session would have ended before the clock ran out. The only way to expedite the process was to have the governor to request the bill, but when he makes that sort of request, he has to sign the bill within five legislative days. Ayer said they chose not to delay the effective date within the bill itself because “there are people who want it now, and they’ve been here day after day hoping that when its time for them they’ll have that option.”

Health Commissioner Harry Chen said he doesn’t think the hesitancy among hospitals will be a setback because it’s unlikely that hospital patients will avail themselves of this option. Chen said information from Oregon shows most people who take the prescription do so at home.

Opponents refocus their efforts

Scattered among the law’s jubilant supporters was a somewhat sparser crowd that’s also been omnipresent at the Statehouse during the debate over the bill. Opponents of the legislation, each identified by a round orange sticker, said they resented the event’s festive atmosphere given the risks that accompany the law.

Mary Hahn Beerworth, a member of Vermont Right to Life, said, “I think they have a nerve being here today, having a party and celebrating when they have just floated vulnerable Vermonters out there at serious risk at feeling pressured into asking and requesting for a lethal dose of medication and then being bullied into taking it.”

After today, supporters and opponents are both pivoting their attention away from the Legislature and toward providing the public with information.

The Vermont Medical Society, which lobbied against the bill, is now focusing its efforts on telling physicians what they need to know about S.77. There are 15 steps doctors have to follow if they’re to receive civil and legal immunity, according to VMS executive director Paul Harrington.

“We are basically trying to let physicians know their responsibilities if they choose to prescribe a lethal medication,” he said.

The Department of Health will also be distributing information regarding the requirements.

True Dignity Vermont is taking a different tack. Carrie Handy, a board member for the anti-assisted suicide group, said they are refashioning the advocacy shop as a watchdog organization. They are launching a hotline for people to report abuse — opponents are concerned that vulnerable adults will be pressured to request a prescription — and they have plans to start a registry of “’safe’ doctors, nursing homes and other health care providers.”

“There are a couple of physicians who have come out strongly in favor of this legislation. Obviously they would not be on our registry. We hope to be able to get physicians on record saying they would not participate,” Handy said.

Chen said one of the potential “silver linings” of S.77 is that it will spur conversations between patient and doctors about end-of-life decisions, and a “safe doctors” registry could discourage that.

“I’m not sure it really serves any purpose other than putting off having those conversations,” Chen said.

On the other side of the issue, Patients Choice Vermont plans to retool itself to provide information to people interested in the option of obtaining a lethal prescription.

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  • David Dempsey

    Congratulations to the legislature for wasting valuable time and resources for 11 years to pass a bill that supporters estimate around 20 Vermonters a year will take advantage of. I don’t really care if a doctor and patient do this, but it is between them and it’s none of my business or the legislatures either. I have sent an email to my representatives to explain how they justify spending so much time on a bill that statitstics show is used by mainly by well educated, affluent white Americans. Just because the supporters of the bill are able to pay for seemingly unlimited lobbying efforts doesn’t justify the large amount of time spent to placate such a small minority of Vermonters

  • Bob Orleck

    In this article we read that “lawmakers hope doctors will have developed their own guidelines.” How unrealistic is that? This was not based on their hope of anything like that but resulted due to a deal that was cut by Senator Galbraith to get his way in the legislation. I can tell you from being there through the process that this irked Senator Ayer and all you had to witness to know this is how she spoke down to Senator Galbraith at a caucus in March when he was promoting his way. Doctors are opposed to this and yet without any reason to believe this can possibly happen, the legislators expect that the physicians will work out their own guidelines. All those protections the pro-choice bunch railed about needing would be gone! But you know really what happened” Certain legislators have made a fool out of Senator Galbraith and I think he knows it. They have a supermajority and will break the deal he made by passing legislation in the next few years to remove the sunset provision. Just wait and see!

    And I can tell you that this Governor does not really know what he has done. He spoke in a VPR interview and said that he is comfortable with the process since it had been in the legislature for 10 years and they had worked out any problems. Well, do you think Governor that there might have been good reasons why this legislation did not pass for those 10 years? Maybe the legislators were trying to tell you something. And even though more pro-choice legislators were elected, there were still so many Republicans and Democrats that were against this that only through a sleazy last minute deal between Senator Galbraith and Senator Ayer did it make it this year. And Governor, you speak as if the bill would only be used by those in pain, “those who are facing terminal illness, are facing excruciating pain”. You should look at the data from Oregon and pain was not the main reason for use of a lethal dose. In fact Governor, as a pharmacist who practiced for over 40 years, I have never seen a case of pain that could not be controlled. This is an overreaction to emotional pleas by individuals who don’t believe they can face the end of life naturally but want it to be artificially pleasant and beautiful. Well, death cannot ever be pleasant and beautiful and in fact what is being done here will result in pain and suffering as I will explain below.
    And it was obscene to have a party and celebrate what has been thrust on our society. The legislature is supposed to do no harm in passing laws and here they have just done that and the pain and suffering will play out over and over again. I applaud Mary Hahn Beerworth for speaking out on this sick party atmosphere that was exhibited at the Governor’s signing of this death bill.

    I submitted the following to the Governor for comment at his VPR “reflection on legislation passed” but he chose not to address it. It needs to be addressed and if not by the Governor then by the Department of Health. If you were Governor and were faced with this question, wouldn’t you want to know about this before signing the bill? Here is what I asked and a comment I made: “Governor, if you knew that 18% of those who would use the physician assisted suicide option would suffer horrific complications, would not die quickly and would have serious side effects that would include increased pain, would you want to explore that before signing such legislation? Comment: I am a pharmacist and know the medications that are to be used. Especially since people have to self-administer the drug, many due to their compromised condition will fail to complete the dosing or will not die from the calculated dose but will have some well documented serious complications. In Oregon, from the report of their Health Department, 66 out of 77 of those using the law were reported as “unknown” if they had any complications. Using information from the Netherlands! They report that 18% of those using physician assisted suicide had to have a lethal injection given by a physician due to failure of self-administration. Now because of political compromise, a bill is coming to you for signature that provides even less protection that the original offered Oregon styled bill. Would it not be wise for the sake of those who will suffer to send this back for further consideration before making it a law where people will die terrible deaths?”

    Or is the next step lethal injection?

    Folks, you better wake up and ask questions before you vote. We need to elect representatives who will promise to repeal this horrible inhumane law.

    Bob Orleck
    P.O. Box 174
    Randolph, VT 05060
    [email protected]

  • Peter Liston

    I’m proud of the Legislature and the Governor for this important law.

    When you read the actual law you learn how many safeguards are in place to ensure that the patient’s needs come first.

    • Bob Orleck

      Mr. Liston, with all due respect please answer the following scenario. Patient qualifies under the law and physician is clear to prescribe a lethal dose of medication. Patient says they just want the option when the time comes if they need it. So patient gets the prescription filled at the pharmacy. Six months past. Tell me what protections are there for this patient at this point in the process. Could be 3 months or could be a year or more. Where are the safeguards during that time? How can we be sure that the patient, who might have qualified under the law when the prescription was written might now be seriously depressed or unable to communicate and the lethal prescription is there to be improperly used by the patient or someone who wishes the patient to go away? And what will happen at the end of 3 years when the so call safeguards are sun-setted? Please read the law again and then reply to this if you would. Or if anyone else out there would like to try to answer this, please do so.

      Bob Orleck
      P.O. Box 174
      Randolph, VT 05060
      [email protected]

      • peter liston

        You seem to misunderstand the basic nature of a disease like ALS.

        • Bob Orleck

          Peter: This bill envisions a person taking this lethal dose without assistance. I am not sure of your knowledge of ALS but in the latter stages (and that is what we are talking about under this law) a patient has difficulty swallowing and would likely choke on such bad tasting and voluminous medication needed to cause death. So the chances of a botched attempt with even more pain and suffering for this person is likely. Even more than the 18% that the Netherland’s data reflects under normal circumstances. Disease management and pharmaceutical treatment offer less suffering and horrific complications than the barbaric procedure envisioned by this law. If you think physician assisted suicide is as simple as a lethal injection you are wrong and these patients will suffer greatly and many will not die quickly, peacefully or with dignity.

  • Bob Stannard

    An emotional issue such as Patient’s Choice draws out strong feelings on both sides. That’s expected. This has been a long fight, but as of yesterday the fight is over; the bill has now become law.

    Although the opponents were in their right to attend the bill signing ceremony, and the governor graciously recognized them and their efforts, their presence was in poor taste.

    Attending the bill signing ceremony showed them to be nothing more than sore losers. It was sad to see them there still opposing legislation that the majority of Vermonters support.

  • Sheryl Rapee-Adams

    While only a few Vermonters a year will request the lethal prescription and fewer still will use it, many, many more (including my husband and me) feel comforted knowing the option is there. The idea that one of us would suffer pain that could not be eased while in the last months of death is intolerable to both of us. Patient choice is the only way to go. Don’t like it? Don’t use it.

  • sandra bettis

    sheryl – you said it perfectly.

  • Kathy Callaghan

    Bob Stannard: It’s never in poor taste for a Vermonter to stand up for what they believe in. That’s who we are. If more people did so, we might not have some of these inappropriate laws.

    To all: Vermonters really need to decide how much of their personal business is the business of the state government. Really think about this. If you cherish your privacy and individuality as most Vermonters do, the answer is “not that much”, or perhaps, “not THIS much”.

    Think about this when you vote next time. And get involved. Ask the candidates the tough questions. Don’t just assume that because they are elected, they will do the will of the majority of Vermonters, or those who elected them. That is ALWAYS secondary to the will of the political party. Ask them who they were elected to represent? Voters, or a political party? If it’s the political party, then we really don’t need voters or elections. And we’re really not a democracy.

    I once had a statehouse conversation with an Republican House member in which we both decried some legislation that was coming up for a vote. It would have required Republicans to vote against it for it not to pass. After the vote, I learned that he had indeed voted for it. And he really knew that it was a disaster. I asked him why, and he just shrugged and said he had to vote the party line. WHY??????

    Do legislators not have personal scruples, morals and/or beliefs that they take with them to the job, and stand up for when the going gets tough? Or do those just leak out when they pass through the doors of the Statehouse? I know mine don’t. And yours probably don’t either.

    Hold your legislators accountable if they have voted against your wishes. The only way to be heard is to speak up.

    • Bob Stannard

      To Ms. Callaghan – there is nothing wrong with people standing up for what they believe. Of course I support people’s right to speak out and fight hard on all sides of any issue.

      To Mr. Woogmaster – I, too, see nothing wrong with opponents expressing concerns on any issue.

      What I was saying, apparently inarticulately, was that there’s a difference between standing up, speaking out and fighting for or against an issue, verses showing poor taste by crashing a bill signing ceremony.

      There was nothing to be gained by showing up at the event other than to grandstand a capture the presses attention. The bill was being signed into law. The opponents lost. If they are unhappy at their loss then work to build a majority and overturn it. Continue their campaign to try to convince Vermonters that they are right.

      Appearing at the bill signing did little to accomplish their goals. The governor was gracious in recognizing them, but they came across as sore losers, which is really too bad. It’s not clear that this is how they wish to be perceived; but yes as an insider that is how they came across.

      Holding strong feelings is one thing. Exhibiting poor taste is another.

  • Fred Woogmaster

    Mr. Stannard’s view is that of an insider and therefore should be read in that context. As a lobbyist (recently retired), he was a participant in the game, albeit through the elected officials who are influenced by his point of view. Although I have been a proponent of such a bill for a long time and am happy with its passage, I see nothing wrong with the opponents expressing their concerns, whenever. Political correctness, as defined by the players in the “two party system” – when it stifles free speech – cannot possibly be correct, can it?
    By the way, I think this law to be quite humane!

  • Anne Donahue

    There are a number of inaccurate assumptions about the law as it finally passed, even in the Digger article, for example, which states that “The steps include ascertaining that the patient… can self-administer the medicine.”
    The objective qualification that a person be able to “self-adminster” was one of 29 elements in the bill that were removed in the Senate from the “Oregon” version in order to gain the one extra vote needed to pass it.
    The final Vermont bill is not equivalent to Oregon any more. Even the requirement for written informed consent — what you would need for routine surgery! — was eliminated by the Senate.
    Whether one believes that this is good social policy or not, it is very unfortunate that neither news media nor public appear to understand the depth of the last minute changes that occured. It was drafted “on the fly” (Sen. Claire Ayer’s own words on the Senate floor) and fails to meet the promises made to Vermonters for years about what the bill would include.

  • Peter Everett

    So, just because the Gov’t allows a person to take his/her life….it’s with dignity. How about those that take their lives without the Gov’ts OK, it isn’t dignified? Please explain why ONLY Gov’t can make suicide a dignified act.

    • Jason Farrell

      While the author of this post used the phrase “Death with Dignity” in the headline, the law signed by the Governor does not. Check the link.

      http://www.leg.state.vt.us/docs/2014/bills/House/S-077.pdf

      The word dignity isn’t in this law.

      In no way does the law attempt to “make suicide a dignified act”, rather, as its title suggests, the law does recognize the “RIGHTS OF QUALIFIED PATIENTS SUFFERING A TERMINAL CONDITION”.

      While a qualifying patient may find that the rights bestowed upon them with the passage of this law provides them with a path toward a dignified death, the law itself makes no such assumptions.

  • Paul Donovan

    Now perhaps we can grant to ourselves what we routinely grant even to farm animals, a painless death.

  • Peter Everett

    This is just a thought, or example. Can anyone explain with certainty.
    Law is now in effect.
    A person purchases a Life Insurance policy today. Most of these have a two year suicide clause written into the policy voiding said policy if suicide is committed within the first two years.
    Now, this person, within 3 months of writing the policy, develops a Terminal Illness that will take this person’s life within a year’s time (eg:Pancreatic Cancer). Time remaining will be very painful for this person.
    The person consults with his/her Dr and they agree to write the prescription to end life with “dignity”.
    The person takes the medicine, well before the two year time frame, and ended their life. Has this person voided the contract with the Insurance company, or, does the State law supercede the contract? Either way, it can be proven the patient would have passed away before two years had lapsed. Any thoughts or comments???

  • Senator Dick McCormack

    To answer Mr. Everett’s question, there have been no insurance problems in Oregon where this has been the law for years. When, for example, a person dying of cancer hastens his/her pending death medically, cancer is the cause of death, not the medication. This has also long been the case with people who die under “double effect” terminal sedation. This standard insurance practice is consistent with the law and it’s common sense.

  • Paul Bilodeau

    It is somehow fitting that the generation that gave us legalized death in the womb has now given us death of the elderly.

    It won’t be long before other inconvenient categories of individuals will be given the “opportunity” to get out of the way.

    Soon we’ll have Obamacare kicking in so I hope you’re in the “correct” political party when you need some serious medical help. The IRS will be making a list and checking it twice.

  • Carl Jenkins

    I believe that if someone is going to end their life they will do it no matter what. So why not give them a safe and painless way to do it. I have spent many years working on an ambulance and have taken my fair share of attempted suicide victims to the ER. These people were in more pain than you can imagine and it was absolutely heart-wrenching to watch. So if we can provide a humane way for these people to end their lives I firmly support that. If this even lessens these painful attempted suicides by 10% I would count this bill as a success.

  • Barbara Sliger

    How many Vermonters would protest if a religious majority succeeded in binding their religious beliefs and practices to state law enforcement power and legitimation? Religion used to serve as the predominant system of control—whereby state authorities enforced what religious authorities deemed to be the right beliefs and actions. But, as much as some folks might like to see their particular religious beliefs and practices backed up by state legitimacy and enforcement power, that has not been reality in the U.S. since the witch trials.

    We can’t say the same thing for that other system of control, the system of control that supplanted religion in directing how people are to believe and behave. That system of control, therapeutics, really IS wedded to the state. We can see the unholy alliance of therapeutics and the state in certain of the specialty courts in which the guilt or innocence of a person accused of a crime no longer matters. Medical practice, and all the myriad specialties “fixing” every facet of our lives (since every natural thing about a person’s life has been biomedicalized) has become thoroughly enmeshed with the law. Doctors must do such and such a thing as the law compels them. And now when they commit medicide, they have the protection of the law. No unsavory Kevorkians in Vermont, the quintessential therapeutic state. Amen.

    btw, I can’t wait to see how the ubiquitous Brain campaign plays out—if you think the relentless public relations chats in which the latterday four minute men spin The Brain to literally everybody—if you think that’s about curing Alzheimers, etc, you might also want to engage in wishful thinking about what our political structure has morphed into.

    Medicide Vermont is one more way of inuring people to killing the vulnerable, even as it’s spun as the patient’s choice.

  • rosemarie jackowski

    And in today’s paper the AP is reporting that a hospital in Syracuse nearly removed the organs from a woman while she was still alive. “…The organ harvesting procedure continued until the woman opened her eyes…… The hospital did not undertake an intensive and critical review of the near-catastrophic event in this case…”.

    Medicine is not a zero-defects science.

    • Bob Orleck

      Well Rosemarie, so much for trusting doctor’s ability to decide if a person has 6 months or less to live or not! Some apparently cannot even tell if a patient is currently dead or alive! So we should trust them with predicting when death will happen?

      Throughout the debate on this bad physician assisted suicide law, it amazed me how easily the majority of Vermont lawmakers accepted the fiction that physicians can accurately predict the amount of life left in a person. Medicare and hospice require that a patient to be eligible for coverage must have a terminal illness with a prognosis of six months or less to live if their condition was allowed to run its natural course. It was never intended that this physician’s prognosis be the basis for making a person eligible for a procedure to make that death happen rather than just waiting for it to occur naturally. So many times these predictions are wrong and the patient lives much longer. In fact under the care provided by hospice their life can and is often prolonged beyond what it would have otherwise have been before the 6 month prediction. This was not meant to be a life ending procedure but one to provide care to a person who is dying.

      But the death proponents had to have a test so they latched on to these often used but scientifically lacking guesses that physicians are called upon to make. For widespread acceptability of physician assisted suicide the proponents had to limit the application to those patients who appeared to be facing imminent death. Without such, they would have failed. But what is troubling to my thinking is that I believe they knew quite well that the test was flawed but were willing to accept that.

      I am a pharmacist and so many times I tried to point out to the lawmakers that there were dangers in the dosing procedure that was intended to bring about the death and those dangers would result in botched attempts, horrific side effects and even exacerbation of already painful situations for patients. In some cases the patient would not even die from the procedure but would surely suffer greatly. I asked our legislators to address the objective facts supporting my opinion but could not get them to even respond other than to say they thought the bill had safeguards and was a good bill. They had to avoid this evidence as they accepted the fictional certainty of a six month physician prognosis in order to get their death bill passed. They had to realize there would be casualties along the way but that would be acceptable in order to accomplish their death on demand objective. They wanted this death law, they considered the cost and considered the price affordable. For these folks, physician assisted suicide was more important to them than the wrongful and tragic loss of an innocent human life.

      • Ashley Lewis

        I do not understand why you feel the need to shove your opinion down the throats of others. An endless argument isn’t worth carrying on. Do I believe this law is a relief to terminally-ill patients? Absolutely. But I refuse to make people listen to what I think. The way I see it, if a person chooses to end their own life, they will find a way. Whether they release helium in a bag placed over their head, or create a noose, kicking the chair out from underneath. Regardless of what you want, ask yourself this. If you were on the brink of death, would you choose “Death with Dignity”?