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Follow VPR's statehouse coverage, featuring Pete Hirschfeld and Bob Kinzel in our Statehouse Bureau in Montpelier.

End-Of-Life Bill Signed, But Physicians Taking Cautious Approach In Implementation

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VPR/John Dillon
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A bill allowing terminally ill patients to get medication to end their lives became law on Monday with Gov. Peter Shumlin’s signature.

Although the law takes effect immediately, it may be some time before it’s used. Doctors and hospitals say they’re looking carefully at whether and how to participate.

The signing ceremony in the governor’s Statehouse office was both a celebration and a quiet remembrance for those who worked on the issue but didn’t live long enough to see it through.

As the governor signed the bill, Jean Mallary watched carefully over his shoulder. She’s the widow of the late Dick Mallary, a former speaker of the House and U.S. Congressman.

Mallary was in pain and suffered from terminal cancer when he chose to end his life over a year ago. Jean Mallary’s story about her husband’s choice – and that he had to die alone without his family at his side – was compelling personal testimony that pushed the bill forward.

She said she feels relief now that the bill she and her husband had worked for is law.

“I’m feeling that Dick is up there watching this and feeling very, very proud of his state,” she said. “And all the people, who not only felt this was possible from the beginning, but were then changed and were thoughtfully persuaded.”

Vermont is now the fourth state that allows dying patients to hasten their passing with a doctor’s help. But physicians and hospitals are proceeding cautiously before the first lethal prescription is written.

“There’s a lot of work to be done between essentially the bill that we’ve got now and getting physicians to that point,” said Dr. Phil Brown, vice president for medical affairs at the Central Vermont Medical Center in Berlin.

Brown said hospital officials will consult with lawyers and the hospital’s ethics committee before the institution decides how to proceed or even whether it will participate.

Brown gave one example of the legal issues that hospitals and physicians have to sort out. The bill “says that a person who requests the prescription has to be cleared, or understood to be a capable decision-maker, or a capable person. What does that mean?” Brown asked.

“What does that look like? Does there have to be a psychiatric evaluation involved in that case for every patient? I don’t know if we know the answer to that. That’s just one question we have to grapple with,” he said.

Brown said it will be late summer or early fall before all the issues are sorted out and the hospital makes a decision. Other Vermont hospitals are taking a similar approach. And at the Vermont Medical Society, physicians are being advised to wait until the state Health Department offers more guidance or rules on how the law will be implemented.

Paul Harrington, the group’s executive vice president, said the bill lays out a process physicians have to go through before prescribing the lethal medication.

“And it’s important that they know all 15 of these requirements because they way the bill is set up, it’s only if they comply with all of these requirements that they’ll have legal immunity from either a civil or criminal case or sanctions by their professional licensing board,” Harrington said.

The law’s supporters said such caution is to be expected. Michael Sirotkin, a lawyer and lobbyist for the group Patient Choices at End of Life, said he doesn’t believe health care providers are delaying implementation.

“These things take time. We waited 11 years; we can wait a few more months,” he said. “And I think it’s important that the Department of Health weigh in and give some guidance on the language.”

Sirotkin stressed that the law is completely voluntary, for patients and doctors. He said care for the dying will improve now that the law is on the books because the experience from Oregon and Washington shows that as physicians and hospitals learn more about end of life issues, they offer more hospice and pain management services.

“Everybody starts talking about the issue as a result of a bill like this and people are forced to become more educated. And we need attention on all fronts of end of life care,” he said.

Opponents will be paying attention as well. A group called True Dignity Vermont says it wants to track elder abuse and whether patients are coerced into killing themselves.

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