Frequently Asked Questions
Q: What is Vermont’s Act 39?
A: Act 39 allows a capable, terminally ill, adult patient who is a Vermont resident to request and obtain a prescription for medication to be self-administered for the purpose of hastening the patient’s death. Participation by patients and doctors is entirely voluntary.
Q: Do you have to be a Vermont resident? What qualifies as residency?
A: Yes, you must a Vermont resident. The prescribing doctor is the person who must confirm that you are a Vermont resident. Factors to be considered may include whether you own or lease a residence in Vermont, whether you have a Vermont driver's license, whether you filed a tax return in Vermont and whether you are registered to vote in Vermont.
Q: Does Act 39 allow physician assisted suicide or euthanasia?
A: No. Under Act 39, the patient must be able to self-administer the medication. Medical aid in dying is not suicide. Suicide refers to the death of patients who otherwise have a choice to keep living, which Act 39 patients do not.
Q: Are doctors required to participate? What if my doctor won’t help me?
A: There are many doctors in Vermont who are assisting patients with medical aid in dying. However, doctors are not required to participate. Health care facilities may not prohibit their doctors from participating except in the case of federally funded institutions which are prohibited by federal regulation from participating. We recommend reading “How to Talk to Your Doctor.” Doctors are required under Vermont’s Act 39 and Vermont’s Patient Bill of Rights to discuss all the patient’s options so that the patient can make informed decisions. If your doctor does not want to discuss Act 39, ask for a referral to another doctor. You may have to be persistent. Patient Choices Vermont is working with various institutions to encourage them to set up internal referral systems. Many Vermont patients are served by Dartmouth Hitchcock Medical Center in New Hampshire. DHMC doctors who are licensed in Vermont CAN assist Vermont patients with medical aid in dying under Act 39.
Q: How long does the Act 39 process take?
A: Once you have confirmed that your doctor will assist you through the Act 39 process, we still recommend that you allow two months because multiple appointments and a second opinion are required. We recommend confirming with your doctor well ahead of time that he or she will assist you, even if you are healthy. This will simplify the process down the road.
Q: What are the possible drugs that are prescribed? How long does it take to die? How much do the drugs cost? Is the cost covered by insurance?
A: Your doctor will prescribe the medication that is appropriate for your condition. Currently, the twoprimary drugs in use are Seconal and a drug combination called DDMP2. The patient must be able to swallow and absorb the medication. Instructions from your doctor should be carefully followed. Recent costs are $3,700 for Seconal and $750 for DDMP2. Insurance plans covering drugs for Medicare patients typically do not cover the cost. Other types of insurance do. Check your coverage.
Q: Can a patient change his or her mind? Does a doctor or nurse have to be present?
A: The patient is fully in charge of the decision-making and may change his or her mind at any time. There is no requirement for a medical professional to be present, but many families elect to have a hospice nurse with them when the patient takes the medication.
Q: What are the alternatives to medical aid in dying in case I don’t qualify?
A: This question can arise when a patient is severely debilitated but doesn’t have a terminal diagnosis, and therefore doesn’t qualify under Act 39. Patients always have the option to stop eating and drinking, which usually results in death in 2-3 weeks. Some patients receive palliative sedation, which may ease the way, especially if they are in pain.
Q: Can I use medical aid in dying if I am in hospice? What if I’m in a hospice facility or assisted living or a nursing home?
A: Many patients who use Act 39 are in hospice care, typically at home. Hospice support for the dying and for families is very helpful whether or not the patient is planning to use Act 39. Under Act 39, hospitals and nursing homes are permitted to adopt policies prohibiting patients from taking terminal medication in their facilities. Other residential facilities are not permitted to prevent residents from using medical aid in dying. In practice, most people using medical aid in dying want to die in their home or in the home of a family member.
Q: What is palliative care?
A: Palliative care is specialized medical care for people living with serious illness. The focus is on providing relief from the symptoms and stress that accompany illness. The goal is to improve quality of life for the patient and their family. Palliative care is provided by a multidisciplinary team including physicians, nurses, social workers, chaplains and others who provide an extra layer of support. Palliative care can be provided at any age and along with curative treatment.
Q: What is palliative sedation?
A: Palliative/terminal sedation is the continuous administration of medication to relieve severe, intractable symptoms that cannot be controlled while the person is conscious. This state is maintained until death occurs. While the intention is to relieve suffering and not specifically cause death, it is recognized that the level of pain medication required to control symptoms may hasten death. The death is attributed to the disease or complications of the disease, combined in some circumstances with the withdrawal of life-sustaining treatments such as intravenous liquids, nutrition and artificial respiration.
Q: Can the decision to use Act 39 be in my advance directives so that I can use medical aid in dying even if I’m not able to make the decision at the time?
A: No. In order to qualify under Act 39, the patient must be able to make his or her own decisions.