​On Tuesday, October 9, 2018 delegates of the American Academy of Family Physicians (AAFP) approved a substitute resolution to adopt a position of "engaged neutrality" toward medical aid in dying as a personal end-of-life decision in the context of the physician-patient relationship.

AAFP President Michael Munger, M.D., of Overland Park, Kansas says, "The action taken today allows the AAFP to advocate for engaged neutrality on this subject at future AMA House of Delegates meetings. Through our ongoing and continuous relationship with our patients, family physicians are well-positioned to counsel patients on end-of-life care, and we are engaged in creating change in the best interest of our patients."

This stance puts them at odds with the American Medical Association (AMA) Code of Ethics which states: “Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.”

The substitute resolution also calls on the AAFP to reject use of the phrase "assisted suicide" or "physician-assisted suicide" in its own formal communications and to direct the Academy's delegation to the AMA to promote the same action in the House of Delegates.

"We have to understand the power of family physicians," he said. "We have an ethical, personal role in our patients' lives. We can't be opposed to something that some people think is valuable. I think we have to have a more neutral stake in this difficult area. We have to understand the power of family physicians," says Arnold Pallay, M.D., AAFP delegate from Montville, New Jersey.

The Vermont Medical Society (VMS) has already adopted a neutral position on medical aid in dying, in recognition that it is legal in Vermont and that many Vermont doctors and their patients have already participated in the Act 39 process. The VMS policy may be found at http://www.vtmd.org/sites/default/files/2017End-of-Life-Care.pdf.  

We understand that Vermont doctors participated in the AAFP meeting and urged adoption of the new policy.

“As prominent national organizations like AAFP recognize the legitimate and very personal nature of a decision to use medical aid in dying, we will increasingly solidify end-of-life choice and the comfort it provides, “ says Betsy Walkerman, President of Patient Choices Vermont.  “We are pleased that Vermont’s careful and measured approach to medical aid in dying is contributing positively to changes like this on the national level.”

Vermonters reflect on five-year anniversary of the state's Medical Aid in Dying law.

Tom Ozahowski, is shown walking on a wooded trail near his Thetford home. He made his career at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire where he worked with patients who often stared death in the face.

"People have cardiac arrests and have near death experiences that, it's not everybody, but some of them have had profound situations that have helped me," he said those situations have helped him find peace with his fate. 
"I was diagnosed in 2008," Ozahowski said regarding his prostate cancer, which has spread to his bones. "I have no idea exactly whats in store."h

The one thing he does know is how he plans on dying.
"My sons are totally in agreement that I can use Medical Aid in Dying and get a prescription to be self-administered," he said.
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"Most people that I talk to don't want to die. They want to live, but they are dying from their underlying illness and we cant stop that," Board Member Dr. Diana Barnard said.

In the past five years, the state's Department of Health said 52 people have qualified to utilize the law, but only 29 people have chosen to end their lives.

"The law itself was really carefully crafted and is working very well," said PCV President Betsy Walkerman, also featured in the story.

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In recognition of Legislators and Act 39 Supporters PCV hosted a reception at the Statehouse in Montpelier on May 16, the 5th Anniversary of the enactment of Vermont's End of Life Choice Law.

Five years ago, Vermont made history as the first state to adopt an end- of-life choice law through legislative action after more than a decade of research and debate. On May 16, 2018 the public was invited to the Statehouse in Montpelier to hear Lt. Governor David Zuckerman and other legislators and families with Act 39 experience speak in recognition of this important anniversary. Vermonters regularly express their gratitude for Vermont's Act 39, which provides mentally competent adults who face an impending death from terminal illness with the freedom to choose medical aid in dying. 

This reception provided an opportunity for families and friends who have had experiences with Act 39 to express their gratitude and tell their stories to the legislative and community leaders who made medical aid in dying possible in Vermont. 

A few weeks ago, just by chance, one of the doctors on the Patient Choices Vermont (PCV) Board of Directors discovered that the sole pharmacy in Vermont that had previously been filling prescriptions for medical aid in dying under Act 39, was directed by their new corporate owner to stop providing this service. ​

So, you may ask, why did they receive this directive?

The new corporate owner of the Marbleworks Pharmacy in Middlebury was just being cautious. Since laws like Act 39 are available only in a handful of states, they needed to understand the law. PCV contacted the corporate executives at the top level, and we were able to provide the information they needed. As a result, Marbleworks is now once again supplying the drug that has been the most used under Act 39.

I realized during these communications that no other organization or state agency had the responsibility or would have taken the initiative to reverse this situation. Patient Choices Vermont is the one organization that is making sure that Vermonters have practical access to medical aid in dying. We are proud and relieved to have averted what could have been a crisis for patients.

You may have heard that the drug that has been primarily used for medical aid in dying is very expensive. That's true. The Seconal prescription costs $3,700. This is because there is only one supplier worldwide and the demand is low, so there is no incentive for competitors to enter the market to help bring the price down. The good news is that a new drug formula, called DDMP2, has now been used extensively for medical aid in dying in California, which has a law similar to Act 39 and far more patients than we have in Vermont. DDMP2 costs $700. This drug requires a compounding pharmacy to dispense it, so we located a pharmacy in Vermont that will do so - the Rutland Pharmacy.
 
PCV has launched an intensive effort to increase the number of pharmacies who are able to fill prescriptions for both of these medications. We are calling both regular and compounding pharmacies, educating pharmacists about Act 39, and working to establish more locations that will be prepared to supply both drugs. 
 
If you or a friend are discussing medical aid in dying with a doctor, we would highly recommend that you ask the doctor to call us. We can put doctors in touch with experienced medical colleagues who can discuss clinical matters, dosages, instructions and what pharmacies to use. This is a relatively new part of medical practice, so it is important for doctors to check up on the most current information, even if they have prescribed before.

We really appreciate your interest in being part of the communication network on these issues. To be sure, medical aid in dying is just one option in a spectrum of choices that any given person might make toward the end of life. It's important, from PCV's perspective, that all Vermonters have the opportunity to learn about their medical options and their care options, and to choose what will be most self-affirming for them. ​

Vermont Edition's reporter Jane Lindholm and producer Matthew F. Smith say, "It's been four years since Vermont started allowing terminally ill patients to seek the help of a doctor to end their own lives. We're looking at how patient choice at the end of life is working in our state, and how Vermonters have used the program since it began in 2013.

Betsy Walkerman, president of Patients Choice Vermont, joins the program to discuss how Act 39 has been utilized in Vermont, and what she hears from people choosing this method of end-of-life care. And Ed Paquin with the Vermont Coalition on Disability Rights shares his concerns about the law, especially as it pertains to perceptions of people with disabilities.

Also joining the program is Dr. Robert Tortolani, a retired physician and a former president of the Vermont Medical Society, to discuss how physicians talk to their patients about this issue, and why the society dropped its formal opposition to the law in November.

We'll also hear from Vermont performer Rob Mermin, who shares his story of helping his friend Bill Morancy hasten the end of his life in 2015.

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