Death with Dignity Legislating a Matter of Life and Death in Vt.

Author: Kate Doorley

What would you do if you or someone you loved had a terminal disease that caused great pain? Would you want them to be able to end their suffering?

Legislators in Vermont are answering yes to this question. Through new legislation, the state wants to grant Vermont residents the ability to choose to end their lives in the case of terminal illness through the controversial process of physician-assisted suicide.

Vermont is not the first state to consider legalizing euthanasia. The state of Oregon pioneered the so-called "Death with Dignity" legislation in 1992, when doctor-assisted suicide was legalized under certain circumstances, including extensive documentation of the terminal nature of the patient's illness. The Netherlands and Belgium also have assisted suicide laws, which allow patients to request drugs to end their lives if they believe the circumstances of their health warrant such an action.

There are currently bills in committee in both the state House and Senate to add Vermont to the list of states with "Death with Dignity" acts. The House bill, H.318, is sponsored by a number of legislators, including Middlebury's Betty Nuovo. The stated purpose of the bill is to "allow terminally ill Vermonters, who have fewer than six months to live, to choose to end their lives by taking medication to end their suffering."

The bill places a number of conditions upon presiding physicians and patients, including the requirement of two witnesses to the patient's mental ability to make the request. Neither witness can be related to the patient, be in a position to inherit money or property from the patient or be an employee of a medical facility where the patient is either in residence or receiving treatment. The patient is also required to make two oral requests and a written request for medication as well as have the opportunity to refuse the drugs after having made the three requests, in order to ensure that the request is not a spur of the moment decision.

The Senate bill, of which Senator Claire Ayer of Addison County is a sponsor, is written with similar intentions. Like the House bill, the Senate bill aims to "affirm and protect the rights of mentally competent individuals to control end-of-life medical decisions when they are suffering from terminal illness, and when they have no reasonable medical expectation of living longer than six months."

Senator Ayer stated, "I tend to favor the idea from two perspectives [including that of] a nurse who has seen a number of people who should have had more support/comfort in their final days. Services were spottily available on a home care basis and they were forced to go to the hospital where their choices were even more limited."

She added, "The Oregon legislation requires that lethal drugs be self-administered. To me, that means a conscious choice and deliberate action on the part of the patient. I find that a better choice than family and hospice, for example, making the choice, and I see little difference in terms of physician's prescription practices."

However, these two bills supporting "Death with Dignity" are not the only bills in the Legislature relating to euthanasia. The House is also considering a bill, H.275, which would make it a crime to commit or assist another person to commit suicide, and proposes the revocation of the licenses of any physician or other medical personnel who chose to disobey the law.

The various bills relating to assisted suicide have provoked a great deal of discussion in the state. The Vermont Medical Society (VMS) has held a series of meetings to decide what its position on the issue should be, and for the moment has decided to remain neutral.

According to the VMS, such neutrality will allow each member doctor to decide according to his or her conscience whether or not to participate in euthanasia, in the case that it should be legalized. This is a position similar to that taken by the Oregon Medical Society, in response to the 1992 passing of Oregon's Death With Dignity legislation.

Various groups have taken polls in Vermont on the issue of assisted suicide, achieving significantly different results. The End of Life Choices Society (formerly titled the Hemlock Society) polled Vermont physicians and found that 75 percent supported legalizing assisted suicide. On the other hand, the Vermont Alliance of Ethical Healthcare, a group of Vermont physicians who have gathered together with the purpose of "promoting the provision of excellent health care at the end of life in an ethical manner and to oppose efforts to legalize physician-assisted suicide of euthanasia in Vermont," conducted a poll which shows a 70 percent opposition rate to euthanasia.

Senator Ayer noted one of the difficulties embedded in the bill, mentioning the fact that "we need to be sure that patients asking for prescriptions are screened and treated for depression. Depression is an understandable reaction to impending death or great suffering, but it's important that such choices are made with as clear a mind as possible."

The Vermont Alliance argues that there have been numerous abuses of the right-to-die legislation, and also that hospices could help cease the suffering of terminally ill patients without killing them. However, supporters of the bill counter these arguments by pointing out that since the Oregon bill has been passed, barely 100 people have chosen to end their lives. Furthermore, the use of hospices has actually increased, not decreased, as Vermont opponents of the bill claim. Senator Ayer noted this fact, saying, "I'm impressed with the results of the law in Oregon. Only a few patients have asked for the option, and a small percentage of them used it. The best part is that end-of-life care has improved in quality, quantity and availability."

A further obstacle to the passage of the "Death with Dignity" Act is Gov. James Douglas' declared opposition to the bill. If the House and Senate pass their versions of the bill, they will have to also obtain the necessary majorities to override a potential veto from the Governor. However, both bills have yet to emerge from their respective committee sessions, so it may yet be a while before the Legislature in its entirety has the chance to debate the issue.

Whatever the outcome of the proposed legislation, it is clear that, in its thoughtful and active discussions on the topic of physician-assisted suicide, Vermont has once again stepped to the forefront of national debate over current ethical issues.