Feature Assisted Dying

Assisted dying: what happens after Vermont?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f4041 (Published 24 June 2013) Cite this as: BMJ 2013;346:f4041
  1. Edward Davies, US news and feature editor
  1. 1New York, USA
  1. edavies{at}bmj.com

With a growing national movement to legalise assisted dying, last month Vermont became the third state in the union to actually do so. Edward Davies looks at the situation and implications for the rest of the US

Following in the footsteps of Washington and Oregon, Vermont law now allows physicians to prescribe lethal doses of drugs to terminally ill patients who request prescriptions.1

The legislation is closely modelled on Oregon’s 1994 Death with Dignity Act, under which “a mentally competent person diagnosed as having less than six months to live may request a prescription which, if taken, would hasten the dying process.”

It requires that the patient be diagnosed as terminally ill by both the prescribing physician and a consulting physician; that the request be voluntary and made orally and again in writing at least 14 days after the oral request; that the patient be informed of all feasible end-of-life services available—such as palliative care, comfort care, and pain control—or be enrolled in hospice care; and that the drug must be self administered.

However, in the Vermont legislation, many safeguards included in the Oregon law will expire in 2016, including the requirement for a consultation with a second physician and a waiting period, making the practice a private matter between the patient and a single physician, and so less restrictive. The practice in Vermont will then be governed by the professional standards that apply to all medical practices without additional government oversight.

The law also differs in the way it was passed: while Oregon and Washington adopted their legislation through voter referendums, Vermont is the first to pass it through a vote of a state legislature.

Popular ballot vs state legislation

This last point is an important one. State attempts to legalize assisted dying have not always come from popular votes, but the only …

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