KEY FEATURES OF THE LAW Act 39, Vermont’s Patient Choice at End of Life law, allows a capable, terminally ill, adult patient to request and obtain a prescription for medication to be self-administered for the purpose of hastening the patient’s death. Participation in the law is voluntary for patients, facilities and providers. A patient who obtains a prescription for the intended purpose of hastening death may change his or her mind at any time. Link to Text of Act 39.
Eligibility: For a physician to legally provide the requested medication, a patient must:
Be at least 18 years of age
Have a terminal condition with a life expectancy of 6 months or fewer
Be a resident of Vermont
Be under the care of a physician
Be capable of making an informed decision
Make a voluntary request to a physician for medication to be self-administered for the purpose of hastening his or her own death.
Process: A physician may prescribe medication to a terminally ill adult patient that will be self-administered for the purpose of hastening the patient’s death. In order to comply with the law, the physician must:
Determine that the patient is suffering from a terminal condition, with a life expectancy of 6 months or fewer, based on the physician’s physical examination of the patient and review of the patient’s relevant medical records.
Determine that the patient is capable of making a health care decision.
Determine that the patient is making an informed decision.
Determine that the patient is a Vermont resident.
Determine that the patient is making a voluntary request for medication to hasten his or her death.
Determine that the patient is able to self-administer the medication requested to hasten death.
Inform the patient in person, both verbally and in writing of the following:
The medical diagnosis.
The prognosis, including an acknowledgment that this is a prediction of life expectancy and an estimate based on the physician’s best medical judgment, that this is not a guarantee of the actual time remaining in the patient’s life and that the patient could live longer than the time predicted.
The range of treatment options appropriate for the patient’s diagnosis.
If the patient is not enrolled in hospice care, all feasible end-of-life services, including palliative care, comfort care, hospice care and pain control.
The range of possible results, including potential risks associated with taking the prescribed medication.
The probable result of taking the prescribed medication.
Refer the patient to a second physician for medical confirmation of the diagnosis, prognosis, and a determination that the patient is capable, is acting voluntarily, and is making an informed decision.
Either verify that the patient did not have impaired judgment, or refer the patient for an evaluation by a psychiatrist, psychologist, or clinical social worker licensed in Vermont for confirmation that the patient is capable and does not have impaired judgment.
Consult with the patient’s primary care physician, with the patient’s consent, if applicable.
Inform the patient of the right to rescind his or her request at the time that the second oral request is made (which can be no fewer than 15 days after the first oral request).
Ensure that all the required steps were carried out in accordance with the law and confirm, immediately prior to writing the prescription, that the patient was making an informed decision.
Write the prescription no fewer than 48 hours after the last of the following events:
The patient’s written request for medication to hasten death,
The patient’s second oral request (which can be no fewer than 15 days after the first oral request); or
The physician offering the patient an opportunity to rescind the request.
Dispense the medication directly (if the physician is licensed to dispense medication in Vermont); or contact a pharmacist (with the patient’s consent) and inform the pharmacist of the prescription, and deliver the written prescription personally, by mail or by fax to the pharmacist.
As described below, after writing the prescription, promptly file a report with the Department of Health documenting completion of all of the requirements under this statute.
Reporting: After writing the prescription, the physician must promptly file a report with the Department of Health documenting completion of all of the requirements under this statute. The following forms may be used: