Vermont is likely to soon become the first state in the country to make aid-in-dying medication available to people who have terminal illnesses but do not live in the state.
The state Senate gave preliminary approval to H.190 Tuesday morning, following House approval of the bill in February. The legislation would remove the current requirement that only Vermont residents can be prescribed a lethal drug cocktail after following a multi-step physician-assisted process.
The bill will now be sent to Gov. Phil Scott, who told reporters at a press conference on Friday that he was “okay” with the change.
“I think it’s something that has to be open to any and all,” Scott said. “I mean, I wouldn’t use it as a way to draw more people here, but at the same time, I don’t think the (state) border should be the barrier.”
Sen. Ginny Lyons, D-Chittenden Southeast, struck a similar note, telling her colleagues that there was no justification for distinguishing aid-in-dying from other forms of medical care.
“We know that medical care is available regardless of your zip code, and that is a central tenet of health and public health,” said Lyons, chair of the Senate Committee on Health and Welfare, which recommended the bill. Only one committee member, Sen. Terry Williams, R-Rutland, voted against the recommendation.
In Tuesday’s voice vote on the Senate floor, some “nos” were audible, but the “ayes” dominated.
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To be eligible for the prescription, a patient must be older than 18, capable of making an informed decision and be diagnosed with an illness likely to result in death within six months. Requests two weeks apart must be made verbally and in writing, observed by two unrelated parties. The diagnosis and ability to consent is made by the patient’s physician and reviewed by another physician.
Over almost 10 years, from the law’s enactment in mid-2013 through the end of 2022, 173 people have gone through that process. According to reports through June 2021, most of the 115 patients suffered from cancer. Around two-thirds of them went on to utilize the prescription to hasten death.
Diana Barnard, a palliative care physician at Porter Medical Center in Middlebury, said that every person has their own way of approaching death. For a small number of people, aid-in-dying is the right choice, she said.
“The patients I care for, they want to live. They are desperate to live,” Barnard told the Senate health committee in testimony earlier this month. “When they have to accept that they are dying, they also want a say in how they will die.”
Vermont’s aid-in-dying law was one of the first of its kind in the U.S. The process is now legal in 10 states and the District of Columbia. The language in all cases was largely modeled on a 1997 Oregon statute, which included a residency requirement.
However, advocacy groups have been challenging that requirement as unconstitutional in federal civil rights lawsuits filed first in Oregon and, last summer, in Vermont. The state settled the case in March, allowing access to aid-in-dying for the plaintiff, Lynda Bluestein of Bridgeport, Connecticut. The Vermont Department of Health also agreed to support the legislative change. Dr. Barnard was a co-plaintiff in the case.
Oregon state officials also settled a similar lawsuit out of court. A bill in the Oregon Legislature to remove its residency requirement is active, but has not yet come to a floor vote.
State law still requires that the procedure be carried out under the care of a physician licensed in Vermont. The law’s protection from legal liability also applies only if the prescription is also filled and consumed in the state.
Patients Choices Vermont, an advocacy group, is prepared to answer questions and provide educational materials for out-of-state residents, Toni Kaeding, an oncology nurse and volunteer with the group, told the Senate committee.
“To be legal, it must be in Vermont, and we’re clear about that,” Kaeding said. “We want to be clear about that in our education.”