It’s been a little over a year since it became legal in Vermont for physicians to help terminally ill patients hasten their death with medication.
But so far only two doctors have reported writing the lethal prescriptions, and it's not clear if they were used. So some advocates worry that patients are having trouble finding doctors willing to grant that final wish. Some doctors say the barrier is not just a moral dilemma—it’s a practical one.
The legislation allows doctors to avoid prosecution if they prescribe a lethal dose of a medication for a dying patient to use.
There are rules relating to how the terminal illness is diagnosed, how clear-minded the patient is to make the decision, and how near to death the prescription is written. But Rutland physician Seth Coombs says those are not the biggest barriers doctors face as they grapple with the new law.
“The regulations were very clear, the administrative paper trail that needed to be created, that was very clear, but actually how someone was going to do it remained a mystery,” he says.
Coombs himself has some questions about the doctor’s role at the end of life, but feels a professional responsibility to grant a patient’s wish to hasten that end when death is near and suffering is intense. He did have a patient like that. But he says it wasn’t easy to learn exactly what drug to prescribe. Nor was it easy to get that drug, because the law does not expressly give pharmacists the same immunity from prosecution granted to doctors. And the lethal dose, he says, is about $1,600.
“That’s a real obstacle for a lot of people,” Coombs says.
His patient died of disease, so Coombs did not have to write an end-of-life prescription. But Marnie Wood, a Vermonter who supports the physician-assisted-death law, wants to make sure that patients who do want to end their lives with medication have access to it. She says her sister, suffering from ALS, chose to die peacefully in her Oregon backyard surrounded by family. Oregon’s law was enacted in 1997.
“People we dealt with were just so honest and open and supporting of helping us through the particular procedure but just in general with the concept that our loved one was hastening the end of her life,” says Wood.
So Wood is helping a non-profit advocacy group called Compassion and Choices educate both patients and doctors about how the law works. Linda Waite-Simpson, a state representative from Essex, is the group’s Vermont director.
“We have had some cases where patients just have not been able to access the law because their physician said no,” Waite-Simpson says.
A doctor or nursing home is not required to help a patient die. But if they say no, Waite-Simpson says they should refer the patient to a doctor who is willing to use the new law. And she thinks even healthy people should think ahead, and talk with their families and doctors now about how they choose to end their lives, if suffering becomes too much to bear.
Note: Seth Coombs is married to VPR reporter Nina Keck.
