My Turn: End-of-life debate not for naught

By Dick Walters, Burlington Free Press, April 11, 2007

I am writing in response to The Burlington Free Press' editorial (March 23) that minimized the importance and value of the Legislature's work and debate on the Patient Choice and Control at the End of Life Act (H.44). The piece was implicitly dismissive of legislators and advocates who invested valuable time and energy in this important issue, and was insensitive to those who deeply believe in the right to retain choice and control at the end of life and those who would derive comfort from the bill's provisions.

The Vermont Legislature deserves our sincere thanks for allowing the conversation and debate to occur around the Patient Choice and Control at the End of Life Act. Special thanks and respect are due to members of the House Human Services and Judiciary Committees who patiently studied the issue and listened to testimony from the public and from experts on both sides of the issue and who ultimately voted in favor of bringing H.44 to the floor of the House. Lawmakers should be proud of the nonpolitical tone that characterized the deliberations on the floor.

This was a discussion that Vermonters were ready for and needed to have, and as a result, Vermonters are now better equipped to engage in the difficult deliberations related to end-of-life decisions. We accept that overcoming the inertia of the status quo is a tall order, and though H.44 did not pass, it brought end-of-life issues into the spotlight where they need to be.

From its earliest days when the patient choice and control movement started in our living room, it has grown to include thousands of Vermonters from every corner of the state and all walks of life. The vast majority of Vermonters are in favor of H.44. Our mission has been to improve all aspects of end-of-life care for terminally ill Vermonters. For example, three of the physicians on our board of directors were active in the development of the advance directive law. That mission will not change in the months and years to come. While continuing to advocate for reintroduction of legislation such as H.44 that will give Vermonters control and choice in their final days, we will also continue to advocate for improved pain management, palliative care and better hospice utilization.

There is much work to do. According to national studies, Vermont consistently appears in the bottom tier of hospice penetration (22 percent), which is much lower than the national average (36 percent), and we are improving that more slowly than most states. In addition, the Vermont attorney general's 2005 report on end-of-life care cited a real need for Vermont to improve pain and symptom management and remove barriers to hospice utilization and palliative care.

The report also noted that Vermont receive a "C" grade for pain management and palliative care programs, and a "D" grade for the strength of our pain programs and the number of hospitals with hospice programs. Obviously, we need considerable improvement in all aspects of end-of-life care.

While we are disappointed at the result of the floor vote on H.44, our collective efforts as a state are not for naught. The extensive discussion of H.44 has raised legislators' awareness of the need for even more improvements in palliative care, hospice availability and utilization, and treatment of the terminally ill.

I'm glad to hear that some representatives who championed H.44 are looking toward these areas and trying to figure out what can be done. We look forward to standing with them, looking into the future, and working hard to improve and expand end-of-life choices for all Vermonters.

Dick Walters of Shelburne is president of Death With Dignity Vermont.

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