Vermonters Deserve End-of-Life Options

By H. Carmer Van Buren, MD, Burlington Free Press, May 18, 2006

Opinion

Thousands of supporters of Death with Dignity legislation (H. 168) in Vermont, many of whom have watched a dear friend or relative suffer miserably at the end of life, are pleased that Vermont House Human Services Committee has taken a vote on this important legislation. Although the vote was tied, a seriously ill, absent Committee member stated he would have voted yes, had he been able to have advanced this crucial end-of-life issue to a full committee vote.

Legislative supporters plan to re-introduce this bill in January 2007 and we have high hopes for its passage in the next legislative session.

We know that Vermonters support Death with Dignity legislation by at least a two-to-one margin. Public opinion polls conducted by WCAX/Channel 3, Harris, Gallup, Doyle and Zogby International all show that the vast majority of Vermonters want this important end-of-life option. The Zogby International poll indicated that 78 percent of Vermonters are in favor of the legislation. Such support came from every part of the state and from people who classified themselves as liberal or conservative, Democrat, Republican, Progressive or independent. The strong favorable polling results were true in urban, suburban and rural communities and included all religious affiliations.

Provisions and safeguards in the bill include the following:

• Anyone using the law must be an adult Vermonter of sound mind and have fewer than six months to live;
• The dying patient must receive the same diagnosis and prognosis from two doctors;
• The dying patient may request a life-ending prescription and must be able to take it unaided;
• The patient must make at least three such requests -- two oral and one written -- at least 15 days apart;
• The patient may rescind the request at any time;
• If either doctor questions the mental competence of the patient, a psychological or psychiatric evaluation is mandatory.

No one other than the patient -- not a relative, not a doctor, not a guardian -- can initiate the process. Anyone who doesn't want to use the option simply won't use it. Therefore the small minority of those who oppose passage of the legislation should not be able to prevent the vast majority from having the choice. In Oregon, as it will be in Vermont, most people want the availability of the option although few will actually use it. By simply knowing that the option exists, should all else fail, most patients are empowered to live what life they have left to its fullest.

As Maria Walsh, a cancer patient from Londonderry, has told legislators, "I'm running out of time. Please pass this legislation."

Oregon's eight-year experience with their Death with Dignity law has proven that other end-of-life care improved substantially, subsequent to the passage of the law. For example, hospice use in Oregon was at about 20 percent before their law passed, yet today, an incredible 54 percent of all dying Oregonians are enrolled in hospice.

Unlike other legislation, we know how the Vermont law will function because Oregon has been the test laboratory where Department of Human Services reports have been issued annually since 1997. The Vermont law mirrors that of Oregon. We know it will work well for every Vermonter whether or not they choose to use it. We also know that myths and fears of opponents in Oregon (which are identical to those raised in Vermont) never materialized.

Competent, terminally ill, adult Vermonters deserve to know they have this option at the end of life, should their suffering become unbearable. All those seeking office this fall owe it to their constituents to familiarize themselves with the real facts behind this issue (www.deathwithdignityvermont.org). I'm confident that, having started the process, our Vermont legislators will keep Death with Dignity legislation high on their agenda and address it early in the session. Vermonters deserve nothing less.

H. Carmer Van Buren, M.D., lives in Shelburne.

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Web Master's Note: Dr. Van Buren, Associate Professor of Medicine, Emeritus at the University of Vermont College of Medicine, practiced for many years as an internist in both private practice and academic settings. He was also Medical Director and Vice President for Health Affairs of Blue Cross and Blue Shield of Vermont. He has been involved with numerous non-profit community organizations, and is currently a member of the Valley Health Care Coalition and the Board of the Vermont Chapter of the American Diabetes Association. Dr. Van Buren has a long-standing interest in medical ethics and is also Vice President of the Board of the Vermont Ethics Network.

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