Vermont Doctors and Physician-Assisted Death: Understanding Your Choices

Vermont’s Patient Choice at End of Life law, also known as Act 39, allows terminally ill, capable adults to request medication from their physician to hasten their death. This option, often referred to as physician-assisted death or medical aid in dying, is a deeply personal and complex decision. For individuals considering this choice in Vermont, understanding the law and how to access it is crucial. This article provides essential information for patients and their families seeking clarity on physician-assisted death in Vermont, focusing on the role of Vermont doctors in this process.

Vermont’s Patient Choice at End of Life Law: Key Facts

Vermont’s law ensures that participating in physician-assisted death is entirely voluntary for healthcare providers. No physician, nurse, pharmacist, or other healthcare professional is legally or contractually obligated to participate in providing lethal medication. Furthermore, healthcare facilities are prohibited from penalizing any healthcare provider for either participating or refusing to participate in accordance with the law. This framework respects the autonomy of both patients and healthcare professionals in end-of-life decisions.

It’s important to note that while healthcare facilities cannot penalize doctors for participating, they do have the right to establish policies regarding the practice within their premises. A facility can prohibit a physician from prescribing lethal medication if:

The patient is a resident of the facility.
The patient intends to take the medication on the facility’s premises.
The facility has a written policy against prescribing such medications, and has notified the physician of this policy.

This provision ensures that facilities can operate according to their ethical or moral guidelines while still respecting the patient’s rights under the law.

The Process for Prescribing Physicians in Vermont

For physicians who choose to participate in Vermont’s Patient Choice at End of Life law, there is a defined process they must follow to ensure patient safety and legal compliance. This process is rigorous and designed to protect vulnerable individuals while respecting the wishes of informed, capable adults. The prescribing physician must undertake several critical steps:

Confirm Terminal Condition: The physician must determine that the patient is indeed suffering from a terminal condition. This involves reviewing medical records and conducting a physical examination to establish an irreversible condition that will inevitably lead to death.
Assess Patient Capability: The physician must evaluate the patient’s capacity to make healthcare decisions. This means ensuring the patient understands the nature of their condition, the available options, and the consequences of their choices, including the decision to seek physician-assisted death.
Verify Informed Decision: The physician needs to ascertain that the patient is making an informed decision. This requires a thorough discussion with the patient about their diagnosis, prognosis, treatment options (including palliative care, hospice, and pain management), potential risks and outcomes of taking the medication, and the probable result of taking the medication.
Confirm Voluntary Request: It’s crucial to determine that the patient’s request for medication to hasten death is voluntary and not the result of coercion or undue influence from others.
Evaluate Self-Administration Ability: The physician must ensure the patient is capable of self-administering the medication. The law requires the patient to be able to take the medication themselves.
Comprehensive Patient Information: Physicians are obligated to inform patients, both verbally and in writing, about their medical diagnosis, prognosis, treatment options (including hospice and palliative care), possible risks and results of the medication, and the likely outcome of taking the medication.
Second Physician Consultation: To provide an additional layer of protection, the prescribing physician must refer the patient to a second physician for medical confirmation of the diagnosis, prognosis, and to independently verify the patient’s capability, voluntariness, and informed decision.
Mental Health Evaluation (If Necessary): The prescribing physician must assess for impaired judgment. If there is any concern, the patient must be referred for evaluation by a psychiatrist, psychologist, or licensed clinical social worker to confirm the patient’s capability and absence of impaired judgment.
Primary Care Physician Consultation: With the patient’s consent, the prescribing physician should consult with the patient’s primary care physician to ensure coordinated care.
Right to Rescind: The patient must be informed of their right to rescind their request at any point, especially at the time of the second oral request.
Final Confirmation: Immediately before writing the prescription, the physician must confirm that all legal requirements have been met and that the patient is still making an informed decision.
Prescription Timeline: The prescription can only be written after the patient’s written request, the second oral request (no sooner than 15 days after the first), and after offering the patient the opportunity to rescind the request.
Medication Dispensing: The physician may dispense the medication directly if licensed to do so in Vermont, or they must contact a pharmacist, inform them of the prescription, and deliver the written prescription.
Reporting to Department of Health: After writing the prescription, the physician is required to promptly file a report with the Vermont Department of Health, documenting completion of all requirements under the statute.

Documentation and Reporting Requirements for Vermont Doctors

Detailed documentation is a critical component of Vermont’s Patient Choice at End of Life law. Physicians must meticulously record and file specific information in the patient’s medical record, ensuring transparency and accountability. This documentation includes:

Dates, times, and wording of all oral requests from the patient.
All written requests from the patient.
The prescribing physician’s diagnosis, prognosis, and basis for determining patient capability, voluntariness, and informed decision.
The second physician’s diagnosis, prognosis, and verification of patient capability, voluntariness, and informed decision.
Attestation of hospice enrollment or documentation that the patient was informed of all feasible end-of-life care services.
Verification of unimpaired judgment or documentation of referral for evaluation and the evaluator’s determination.
Reports from any mental health evaluations.
Date, time, and wording of the offer to rescind the request at the second oral request.
A note confirming all statutory requirements were met, steps taken, and medication prescribed.

Furthermore, physicians are obligated to promptly report to the Department of Health after writing the prescription, confirming adherence to all legal requirements. Standardized reporting forms are available to assist physicians in fulfilling these obligations, ensuring consistent and thorough reporting.

Legal Protections and Immunity for Participating Physicians

Vermont law provides significant legal protections for physicians who act in good faith compliance with the Patient Choice at End of Life law. Physicians are immune from civil or criminal liability and professional disciplinary action if they prescribe medication for self-administration to a terminally ill patient, provided they document in the patient’s record that all necessary steps were followed. This immunity encourages physician participation by mitigating legal risks associated with this sensitive practice. Similarly, nurses, pharmacists, and other healthcare professionals acting in good faith compliance with the law are also protected from liability and disciplinary action.

Finding Vermont Doctors Who Provide Physician-Assisted Death

For individuals seeking physician-assisted death in Vermont, finding a willing and qualified physician is a crucial first step. While the law does not mandate participation, many Vermont doctors are committed to providing comprehensive end-of-life care options to their patients.

To find a Vermont doctor who provides physician-assisted death, consider the following steps:

Talk to Your Current Physician: Start by having an open and honest conversation with your primary care physician. They may be willing to provide physician-assisted death themselves or can refer you to a colleague who does. Even if your physician does not participate, they can still provide valuable information and support.
Contact Patient Choices Vermont: Patient Choices Vermont is a non-profit organization dedicated to providing information and support to individuals considering physician-assisted death in Vermont. They may be able to offer resources or referrals to physicians in your area. Their website (https://www.patientchoices.org/) is a valuable resource.
Consult the Vermont Department of Health: While the Department of Health does not provide direct referrals to specific doctors, their website (http://www.healthvermont.gov/) may offer general information and resources related to end-of-life care options in Vermont.
Seek Referrals from Hospices and Palliative Care Providers: Hospice and palliative care organizations are deeply involved in end-of-life care and may have connections with physicians who are willing to provide physician-assisted death.

It is important to begin this search as early as possible in your decision-making process to allow ample time for consultations and to fulfill the legal requirements of Vermont’s Patient Choice at End of Life law.

Conclusion

Vermont’s Patient Choice at End of Life law provides a legal framework for physician-assisted death, ensuring patient autonomy and access to this option while also protecting the rights and consciences of healthcare providers. Understanding the process, requirements, and available resources is essential for both patients considering this choice and for Vermont doctors who may be asked to provide this care. By prioritizing clear communication, comprehensive information, and adherence to legal guidelines, Vermont strives to ensure compassionate and lawful end-of-life care for all its residents.

Legal References:

18 V.S.A. § 5285
18 V.S.A. Chapter 113
18 V.S.A. § 1871
12 V.S.A. § 1909

Resources: