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Medical Aid In Dying

Act 39: Patient Choice and Control at the End of Life

In May of 2013, Vermont became the fourth state to legalize Medical Aid in Dying (MAID).  Vermont’s law (Act 39) permits a physician to prescribe to a terminally ill, capable, adult patient medication to be self-administered for the purpose of hastening their own death. In 2023, Vermont became the first state in the nation to pass legislation that permits MAID services to be provided to qualifying patients regardless of the state in which they legally reside.

While the Vermont Ethics Network (VEN) recognizes that Vermonters hold a diversity of views in regard to MAID, the practice is a legal end-of-life care option in this state. Act 39 outlines the process a physician must follow to be immune from any civil, criminal or professional disciplinary action for participation in medical aid in dying.  There are currently 10 states in the United States where MAID is permitted, in addition to the District of Columbia.

Participation in Act 39 is voluntary—for patients and health care providers.  Patients seeking this end-of-life option can change their mind at any time.  While many Vermont physicians, facilities and hospice organizations now have experience with Act 39, their participation is also voluntary. There is no public list of participating prescribers.

Qualifying Criteria for Medical Aid in Dying under Vermont’s Act 39

A patient must:

  • Be at least 18 year of age or older
  • Have a terminal illness with a prognosis of six months or less to live
  • Be capable of making their own health care decisions
  • Be able to make an informed and voluntary request to their physician
  • Be able to self-administer the medication

Process for Medical Aid in Dying under Vermont’s Act 39

The patient must:

  • Make two oral requests not less than 15 days apart to the physician who will be writing the prescription. Oral requests may be made in the physician’s physical presence or by telemedicine if the physician determines use of telemedicine is clinically appropriate.
  • Make a written request. The written request must be signed in the presence of two (2) witnesses who are at least 18 years of age and who sign and affirm that the patient appeared to understand the nature of the document and to be free from duress or undue influence at the time the request was signed.
  • Have a second physician confirm that the patient meets the required qualifying criteria.

The doctor will write the prescription, provide instructions on where the prescription will be filled and how to take the medication. Even after a prescription is filled, the patient can decide whether or not they wish to take it.  They can change their mind at any time.

Witnesses to the patient’s written request cannot be:

  • the patient’s physician;
  • a patient’s relative by blood, civil marriage, civil union or adoption;
  • a person who knows that s/he would be entitled, upon the patient’s death, to any portion of the estate or assets of the patient under any will or trust, by operation of law, or by contract; or
  • an owner, operator, or employee of a health care facility, nursing home, or residential care facility where the patient is receiving medical treatment or is a resident.

Patient Choices Vermont (PCV), a non-profit organization focused on Medical Aid in Dying education, has many resources that can help:

Legislative Reports