Vermont governor signs end-of-life bill

Terri Hallenbeck | The Burlington (Vt.) Free Press

MONTPELIER, Vt. -- Bob Ullrich says he has no plans to use it, but he finds comfort in knowing that if he had a terminal illness and was in great pain, he could seek a lethal dose of medication to hasten his death.

Ullrich, of Charlotte, Vt., was standing beside Vermont Gov. Peter Shumlin on Monday as the governor signed the bill into law that makes it legal for doctors to prescribe such a medication to terminally ill patients who request it and can administer it themselves.

"It means peace of mind and comfort to a lot of people, including me, that I hope no one ever has to use the law, but to know every day of your life that it's there should such an occurrence happen," Ullrich said afterward.

A board member of the advocacy group Patient Choices Vermont, Ullrich is among those who have been pushing for the law for more than a decade. He received one of the three ceremonial pens Shumlin used to sign the bill.

The Patient Choice and Control at End of Life Act takes effect immediately, a fact that has doctors and hospitals scrambling to figure out whether they will take part in the law, and has state officials scurrying to prepare guidelines for doctors.

The law requires patients to wait 15 days after making an initial oral request before making a second request that must be written with a witness, and for doctors to wait 48 hours before issuing the medication, but it appears unlikely that any Vermont doctors would be ready to act immediately.

Shumlin signed the bill into law in his Statehouse office before a packed crowd that included many longtime supporters of the law, and a few opponents.

"We're here as witnesses," said opponent Carolyn McMurray of Arlington, Vt., part of a group called True Dignity Vermont that is starting a hotline and encouraging people to report abuses of the law. "We believe this bill was drafted hastily."

Shumlin noted that Monday also happened to be his father's 88th birthday and that his mother recently told him she supported the law because it would be a comfort to know the option was available if she were terminally ill and in pain.

Vermont becomes the first state to enact such a law legislatively. Oregon and Washington have laws passed by public vote. The Montana Supreme Court ruled in 2009 that physicians there may aid terminally ill patients in dying if they request it. In 2013, eight states introduced bills to allow physician-assisted death; two states introduced bills banning the practice, according to the Death with Dignity National Center, based in Portland, Ore.

Within the next 30 days, the Vermont Department of Health will prepare forms that doctors can use as a guideline, said Commissioner Dr. Harry Chen. Under the law, physicians are granted immunity from prosecution if they follow a list of requirements, including making sure the patient is acting voluntarily and is of sound mind. Those requirements, which are pared down from those required in Oregon, expire in three years with the idea that they will become a standard part of medical practice by then.

Dr. Diana Barnard, a palliative specialist who has worked in support of the legislation for a decade and attended the bill signing, said she has discussed the issue over the years with doctors who would be willing to participate, but at first expects it will be a small number, as it was in Oregon and Washington, when they enacted similar laws.

Barnard said the lethal medication that would be involved is a liquid that the patient must be able to self-administer. "It works very fast," she said.

Ullrich said he knows people who wanted the law who have since died. "I know people who took their own lives because this was unavailable," he said.

Former U.S. Rep. Richard Mallary, a longtime supporter of the legislation, would fit in that category. His widow, Jean Mallary, who attended the bill signing,shared her story with legislators while the bill was being composed. She said she found him dead at home with a note that indicated he hadn't wanted to put his family in the position of participating. The new law allows immunity to family and friends in such situations.

Supporters view the law as hastening death; akin to other medical measures such as removing feeding tubes or respirators. The law specifically says the action is not suicide and that the underlying illness would be listed as the cause of death. Opponents argue that it is suicide.

Carrie Handy of St. Albans, Vt., a member of True Dignity, said her group is looking to help anyone who feels they or someone they know is being coerced into hastening their own deaths. That was among the leading concerns of opponents of the law.

"We would have liked to defeat the legislation," said Handy. "Now that it's been enacted we feel our role needs to be for the time being serving as a watchdog organization. We do feel this legislation puts vulnerable people at risk."

Handy also said she sees the legislation as unnecessary. She said she watched her father-in-law and mother-in-law die and her mother is now in hospice care. In all of those situations, their pain was managed and the time they spent with family and friends at the end of life was relished, she said.