Vermont is the first state to enact a statute permitting doctor-assisted suicide for non-residents.
Gov. Phil Scott (R) signed Act 39 into law on May 2, making Vermont’s measure the most permissive in the United States, and opening the door to so-called “suicide tourism.” Vermont was the third state to enact doctor-assisted suicide, in 2013.
Oregon agreed to physician-assisted suicide for non-residents in March 2022, but that was done through a legal settlement between state administrators and a plaintiff, not legislative action.
Vermont Right to Life and True Dignity Vermont staunchly opposed the bill, saying it fails to provide immunity for nurses and pharmacists who don’t want to engage in the practice.
The groups also say there is no system in place to track lethal prescriptions, and there are no provisions to prevent abuse, such as requiring a disinterested witness be present at the time of ingestion of a lethal drug to ensure that the patient is capable of consent.
Safeguards Dismantled
Currently, 10 states and the District of Columbia permit medically assisted suicide.
After a state has legalized the practice, it is a simple matter for proponents to remove safeguards, says William Toffler, M.D., co-founder of Holy Family Clinic in Oregon and national director of Physicians for Compassionate Care Education Foundation.
“Every single society that has passed assisted suicide laws has expanded (them) to include those with mental illness, disabled people, and those who have more than six months to live,” said Toffler.
In Vermont, safeguards have been systematically removed since its assisted suicide law was first enacted. An amendment passed in 2022 removed the requirement of a face-to-face visit and physical examination before receiving life-ending drugs. The state also dropped its 48-hour waiting requirement.
“Parents can end a child’s life in the Netherlands [under certain circumstances],” said Toffler. “There’s no stopping it. Once you believe the solution to a medical problem is to kill yourself, you’ve already accepted that any life is not worth living.”
‘Family Members … Subtly Encourage’
When it comes to life and death decisions, there are many factors in play, says Marilyn Singleton, M.D., J.D., a visiting fellow at Do No Harm, which works to keep political ideology out of health care.
“The biggest fear of assisted suicide with doctors who do not know the family dynamic is being sure this is what the patient wants,” said Singleton. “In many cases, family members cannot be trusted to do what the patient really wants. As cruel as it sounds, some family members see the debilitated person as a burden and subtly or not so subtly encourage assisted suicide.”
‘Degrades Trust in Doctors’
In Oregon, about 300 of the more than 10,000 registered medical doctors in the state practice assisted suicide, which is not a widely accepted standard of patient care, says Toffler.
“This degrades trust in doctors when a doctor’s boundaries involve situational killing if someone is deemed terminal,” said Toffler. “In reality, we are all terminal. A doctor’s ability to make a determination of when someone will die is often horribly flawed, especially several months out. Doctors can easily kill [a person] prematurely.”
Allowing “interstate” practice further degrades local patient protections, says Toffler.
“We have state licensing boards for a reason,” said Toffler. “Doctors in a state are subject to the state board of medical examiners. Now, individuals are coming from out of state and next, they will likely [administer life-ending drugs] by telemedicine. It’s chaotic and breaks down the state board of medicine examiner system and control of doctors.”
‘Aid in Dying’ by Telemedicine
The fact that Vermont’s law requires patients to be “physically” in the state to receive the drugs is no assurance, says Singleton.
“We all know how things change,” said Singleton. “What if there is another lockdown for a new pandemic or some other public health emergency? Telemedicine would be deemed appropriate.”
Advocacy groups that promote doctor-assisted suicide refer to laws like Vermont’s with a euphemism, says Singleton.
“Let’s be clear, changing the name to ‘Medical Aid in Dying’ does not change the fact that the doctor is hastening someone’s death,” said Singleton. “Assisted suicide is for desperate people who would gladly go to another state, assuming they had the money to do so.”
Ashley Bateman (bateman.ae@googlemail.com) writes from Virginia.
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