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Start planning today! Vermont Advance Directive Week: April 13-19 | National Health Care Decisions Day: April 16
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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.
A patient must:
The patient must:
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:
Patient Choices Vermont (PCV), a non-profit organization focused on Medical Aid in Dying education, has many resources that can help:
No. In May of 2023, Vermont became the first state in the nation to pass legislation that permits medical-aid-in-dying services to be provided to qualifying patients regardless of the state in which they legally reside. Even though Vermont’s residency requirement has been removed, this does not guarantee access to Medical Aid in Dying for persons coming from another state. Patient Choices Vermont provides helpful guidelines and a checklist for those seeking additional information.
Participation is voluntary. Per section 5285 of 18 VSA Chapter 113, a physician, nurse, pharmacist, or other person shall not be under any duty, by law or contract, to participate in the provision of a lethal dose of medication to a patient. Further, a health care facility or health care provider shall not subject a physician, nurse, pharmacist, or other person to discipline, suspension loss of license, loss of privileges or other penalty for participation or refusal to participate in Vermont’s Patient Choice at the End-of-Life law.
A health care facility may prohibit a physician from writing a prescription for a lethal dose of medication when all 3 of the following conditions exist:
Prescribing Physician Process: A physician must:
Documentation: The physician must record and file the following in the patient’s medical record:
Reporting: After writing the prescription, promptly file a report with the Department of Health documenting completion of all of the requirements under this statute.
Other Statutory Obligations: Physicians have an obligation to inform patients of all available options related to terminal care pursuant to 18 V.S.A. § 1871. Patient Choice at the End of Life as outlined in 18 V.S.A. Chapter 113 is now an available option related to terminal care. In addition, pursuant to 12 V.S.A. §1909(d), a patient is entitled to a reasonable answer to any specific question about foreseeable risks and benefits of treatment.
Immunity: Physicians shall not be subjected to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and affirms by documenting in the patient’s medical record that the necessary steps were followed. (18 VSA Chapter 113 §5283 (a))
Limitations on Actions: No physician, nurse, pharmacist, or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter.
Participation in Act 39 is voluntary. Per § 5285 of 18 VSA Chapter 113, a physician, nurse, pharmacist, or other person shall not be under any duty, by law or contract, to participate in the provision of a lethal dose of medication to a patient. Further, a health care facility or health care provider may not penalize a physician, nurse, pharmacist, or other person based on their participation or refusal to participate in the law.
Act 39 does not alter the rights and duties existing under Vermont’s Patient’s Bill of Rights, 18 V.S.A. § 1871, or under 12 V.S.A. § 1909 regarding informed consent.
Legal References
18 V.S.A. § 5282 Right to Information:
“The rights of a patient under Section 1871 of this title to be informed of all available options related to terminal care and under 12 V.S.A. § 1909(d) to receive answers to any specific question about the foreseeable risks and benefits of medication without the physician’s withholding any requested information exist regardless of the purpose of the inquiry or the nature of the information. A physician who engages in discussions with a patient related to such risks and benefits in the circumstances described in this chapter shall not be construed to be assisting in or contributing to a patient’s independent decision to self-administer a lethal dose of medication….”
18 V.S.A. § 1871. Patient’s bill of rights for palliative care and pain management:
12 V.S.A. § 1909. Limitation of medical malpractice action based on lack of informed consent:
Participation in Act 39 is voluntary. Per §5285 of 18 VSA Chapter 113, a health care facility shall not subject a physician, nurse, pharmacist, or other person to discipline, suspension, loss of license, loss of privileges or other penalty for participating in or refusing to participate in Vermont’s Patient Choice at the End-of-Life law.
Definition: Health care facility is defined as all persons or institutions, including mobile facilities, whether public or private, proprietary or not for profit, which offer diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons, and the buildings in which those services are offered. The term shall not apply to any institution operated by religious groups relying solely on spiritual means through prayer for healing, but shall include but is not limited to:
Health Care Facility Exemption (§5286): Under the new law, a health care facility may prohibit a physician from writing a prescription for a lethal dose of medication when all 3 of the following conditions exist:
See the Vermont Department of Health’s FAQ list pertaining to Act 39, or visit Patient Choices Vermont for more frequently asked questions.
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