By Guy Page
Critics of S74 say such an ‘update’ of Act 39 would increase the existing possibility of exploitation of adults at their most vulnerable stage of life. They also say the pandemic, with its unprecedented social isolation of the aged and reduced personal access to physicians, is a terrible time to eliminate safeguards meant to ensure a personal, informed patient choice.
Sen. Josh Terrenzini (R-Rutland) was the sole “no” vote. The bill now goes to the full Senate for a vote. If approved, it will then go to the House.
As passed in 2013, Act 39 provides Vermont residents with terminal diseases the option to be prescribed a dose of medication that will hasten the end of their life. An eligible person must be suffering from an incurable and irreversible disease that would, within reasonable medical judgment, result in death within six months. The patient must be capable of making a voluntary, informed health care decision, and can self-administer the prescribed dose.
As introduced last February, S74 would eliminate Act 39’s requirement that a patient ask the physician for the lethal drugs in person, and that a doctor conduct an in-person physical exam. Critics of Act 39 say these in-person requirements provide at least minimal safeguards against the central danger of legalized doctor-prescribed death: the intrusion of a third party seeking to make the lethal decision for the terminally-ill person. In-person exams and conversations give the doctor an opportunity to determine if the lethal drugs truly are the patient’s choice – or someone else’s.
Healthcare ethics professor Dr. Edward Mahoney testified that telemedicine is unsuited to end-of-life decisions.
“The current proposal detailed in S. 74 further exacerbates an already fraught situation, removing protections for vulnerable patients who may be seeking to end their lives not fully on their own accord. While one could agree that telemedicine has been helpful – especially during this pandemic – it has its limitations, as any one of us knows,” the St. Michaels College professor said. “The use of this medium is especially concerning in situations of life and death, or any other monumental decision facing a patient. Which one of us, for example, would be comfortable with a telemedicine appointment when facing spinal surgery, or navigating options regarding treatment for an initial diagnosis of cancer.”
The bill also removes a 48-hour waiting period between a patient’s request and the writing of the prescription.
“Is this year the right timing for isolated, depressed, elderly, sick and lonely Vermonters to have fewer safeguards?,” Mary Beerworth of Vermont Right to Life said in written testimony to Senate Health & Welfare Committee January 14. “Is a phone conversation with a physician enough to ascertain whether reduced financial and personal circumstances are impacting the decision to hasten the end of life – or to discover if family members are pressuring that request?
“Is shortening the time period required to think things over, especially during Covid, in the best interest of the patient making a request under Act 39? Patients are increasingly unable to access health care services without long delays for care – does that pressure people into decisions that they might not otherwise make – turning assisted suicide into an act of desperation rather that desire?”
Concern about vulnerable people being pressured is not merely hypothetical. Reports from Oregon show family members who are caregivers for high-needs adults at end of life also can unduly influence the patient’s “decision.”
During a two-year period, 29 Vermonters died after requesting prescriptions for legal drugs, according to a December, 2021 report by the Vermont Dept. of Health.