Polemical and emotionally charged end-of-life legislation has been repeatedly proposed in Vermont.
This piece first appeared in The Vermont Standard.
During this upcoming winter or spring, State Representative Donna Sweaney of Windsor hopes that the Vermont General Assembly will be debating, and passing into law, legislation that many see as polemical and emotionally charged. Sweaney is the lead co-sponsor of and an ardent advocate for House Bill H.274, An Act Relating to Patient Choice and Control at End of Life.
The measure, which was introduced in the state House of Representatives last February and now awaits disposition by its Committee on Human Services, seeks to legalize physician-assisted suicide in Vermont, in particular circumstances. An identical bill is also before the Senate’s Judiciary Committee. The legislation’s backers see the bill as a means to provide relief to some who suffer with and would like to end the agonies of terminal illness; its opponents contend that, if allowed to become law, it would controvert the duty of government to protect human life. And while the House and Senate may both decline to act on the bill in the second half of the 2011-2012 biennium session, it is unlikely that its supporters will let the proposed legislation simply fade away.
As it is now written, H.274 allows an “attending physician” to prescribe or dispense self-administered medication to “hasten” the death of a terminally ill Vermont adult who has voluntarily requested it. To “qualify,” a patient’s diagnosis of “an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months,” must be confirmed by a second, “consulting physician.” A patient must make three separate appeals for the medication, including a written request that is verified by two disinterested witnesses. All patients must explore palliative care options, and those thought to be suffering from judgment-impairing mental illness or depression must be referred for counseling.
The measure is modeled after Oregon’s Death With Dignity Act. Usage rates in Oregon, if applied here, suggest that about 10 Vermonters a year might opt to hasten their deaths under the bill’s provisions.
Legislation to legalize physician-assisted suicide has been introduced in the Vermont Legislature in each of the last five biennium sessions. So far, only one of those iterations has progressed to a vote. In March 2007, the Vermont House declined to pass what was then H.0044 by a margin of 19, 82 nays to 63 yeas, with 3 not voting.
“I think there was tremendous opposition to it,” recalls former Representative Steven Adams of Hartland, who was among the “nay” voters, “it was not a partisan issue, it went across the spectrum of all legislators.” While Adams’ personal convictions were an important factor in his decision to vote against the bill, he also heard plenty from his district. On most issues, he says, constituents don’t feel the need to personally weigh in, they trust their elected representatives to do the right thing. The “fifty or sixty” emails, though, that the five term legislator received as a vote approached for the Patient Choice and Control at End of Life bill amounted to more than he’s gotten regarding any issue, other than when the state legally recognized same-sex civil marriages.
“A vast majority [of the emails] were opposed to the [Control at End of Life] bill for one reason or another,” Adams says.
Representative Sweaney says that recent polls in Vermont, although not scientific, indicate that there is support for the legislation. In a 2011 town meeting day survey by long-time Senator Bill Doyle, for example, about half of the 15,000 respondents from many communities across the state reportedly answered “yes” to the question “should Vermont legalize physician-assisted suicide?”; 37% answered “no” and 13% indicated that they were not sure. Sweaney feels 2007’s H.0044 was defeated because Vermont was not yet ready for it. “There hadn’t been enough education about the issue,” she says, “I think it has taken time for people to become comfortable and to understand what [the legislation] is and what it isn’t.” Over the years, she adds, the bill has evolved to “make sure that everybody’s concerns have been taken into consideration,” but she concedes that “still, it is kind of misunderstood.”
It is not clear that the current bill will emerge during 2012 from the legislative committees that are now charged with reviewing it. Ann Pugh, Chair of the House Committee on Human Services, is looking to the Senate to take the lead. “The House has taken the bill up, or similar pieces of legislation, several times,” she says, “and we would be more than willing and open to look at it when it comes over from the Senate.” Dick Sears, Chair of the Senate Committee on Judiciary, was unavailable for comment, but House co-sponsor Sweaney acknowledges that the Senate may not take up the bill either. “The concern [in the past] was that possibly there weren’t enough votes in the Senate, which is the same issue right now,” she says.
If the Legislature does pass An Act Relating to Patient Choice and Control at End of Life this spring, Vermont would become only the third state in the union with a law that explicitly permits physician-assisted suicide. In 1994, the voters of Oregon enacted its law via a ballot initiative, although implementation of their Death with Dignity Act was delayed until 1998 by court challenges and a repeal attempt. Washington state passed a similar measure, also in a grassroots vote, in late 2008. And while Montana laws do not specifically condone lethal prescriptions for the terminally ill, in 2009 the state’s Supreme Court ruled that “a terminally ill patient’s consent to physician aid in dying constitutes a statutory defense to a charge of homicide.”
Ninety-one year old Dr. Reggie Fitz acknowledges the ambiguity of his feelings about physician-assisted suicide. “It’s a very hard thing to be absolute about,” he says.
He and his wife Connie have lived in Woodstock since the early 1980s, when Fitz retired from his job as Senior Vice President at the Commonwealth Fund, a private Manhattan-based foundation that makes grants to improve health care practice and policy. After many years in their Linden Hill home, the couple has settled in at Woodstock Terrace, an assisted living retirement community. Fitz had an active work life that also included two long stints at medical schools in Colorado and New Mexico and a personal life filled with raising four children, sailing, and golfing. The routine at the Terrace is a bit of an adjustment. It’s “a little different kind of community that you kind of have to get used to,” he says, “I spend my time watching the box, or reading as best I can, or working on this little rascal,” he adds, pointing to an iPad, “it keeps me up to date, reading two or three newspapers.”
Fitz, through Commonwealth, was an early investor in hospice-based care; he continues to fervently support the philosophy of providing environments where the terminally ill can live out their lives as comfortably as possible without high technology or other protracting interventions. “I am very much in favor of not interfering with the process leading to death,” he says. But the difficulty comes, he adds, in wrestling with the difference between something that leads to death, as when a patient refuses treatment or food or liquids, from something that actually causes death, such as a lethal dose of medication. “I think you get into extremely dicey ground when you give somebody the capability of causing death the same as suicide,” he says, “I think that by the time people get to [the point to] make that kind of a decision they are likely to be not in a good position to make that kind of a decision. A true paradox and difficult to resolve.”
For those trying to sort through that paradox, both the supporters and opponents of Patient Choice and Control at End of Life offer statistics, anecdotal evidence, and arguments based on ethics.