On 20 May 2014 a community organisation, True Dignity Vermont, reported that since the law was enacted two clinical psychologists had cases of patients believing suicide was now a more acceptable option. Additionally, an 85 year old Korean war veteran from New Jersey suffering depression was seeking information on getting a lethal prescription in Vermont.
Assisted suicide laws tend to normalise suicide for everyone not just those who formally qualify under the law.
On 20 May 2013 the Governor of Vermont signed into law the Patient Choice and Control at End of Life Act. The Act permits Vermont physicians to prescribe lethal medication to terminally ill patients.
Suicide normalised
On 20 May 2014 a community organisation, True Dignity Vermont, reported that since the law was enacted two clinical psychologists had cases of patients believing suicide was now a more acceptable option. Additionally, an 85 year old Korean war veteran from New Jersey suffering depression was seeking information on getting a lethal prescription in Vermont.
These reports confirm the obvious: assisted suicide laws tend to normalise suicide for everyone not just those who formally qualify under the law.
Pressure to request assisted suicide
Beth Neill reports that her elderly mother, who was in a care facility for four months for rehabilitation after a fall, was continually reminded by staff of her right to request assisted suicide, even though legally she would not qualify.
Clinicians at the Berlin Health and Rehab Center informed her mother at regular intervals during her 4-month stay there that she had a “right” to request assisted suicide, and that, “She didn’t even have to discuss it with her family.” This act of repeatedly bringing up this possibility as a health care “option” that caused her mother to feel pressure. Neill said that her mother had made it clear she wanted nothing to do with assisted suicide and was disturbed that staff re-introduced the topic repeatedly.
Neill notes that her mother was, and is, in otherwise surprisingly good health for her age, and would not have qualified for Act 39, as the extended stay in Berlin Health and Rehab was strictly for help recovering from her fall.
Minimalist reporting
Four reports have been issued to date. The first covered 31 May 2013 to 30 June 2017, the second covered 1 July 2017 to 30 June 2019, the third covers 1 July 2019 to 30 June 2021, and the fourth covers 1 July 2021 to 30 June 2023.
All we can learn from these reports is that over this ten year period 203 prescriptions were issued under the Act for 153 cancer cases; 26 cases of neurodegenerative disease; 6 for end stage lung disease; and 5 for end stage heart disease. A further 12 cases were for one or more unspecified conditions.
In Oregon lethal prescriptions have been written for conditions not usually considered terminal such as diabetes and anorexia. It is not clear whether this is the case in Vermont given the limited reporting.
Of these 203 cases for which prescriptions for a lethal substance were written in 146 cases the “mechanism of death” is reported as having “died by Patient Choice” (Vermont newspeak for having ingested the lethal substance).
The phrase “mechanism of death” is a neologism to avoid referring accurately to the manner of death. The reports all state that “100% of the death certificates listed the appropriate cause (the underlying disease) and manner of death (natural), per Act 39 requirements.”
This is curious as Act 39, as passed, does not include the provision in the bill as introduced requiring the “manner of death” following ingestion of a lethal substance to be falsely recorded as “natural”.
Even more curious is how in those cases where the mechanism of death is reported as unknown or as from “other causes” the death certificate can still specify the manner of death as “natural”.
The data is not broken down further by age, sex or by year of death although this data is collected.
No information is collected in Vermont on the reasons for requesting assisted suicide (apart from the underlying condition); on complications; on the substance prescribed; on the length of time from prescription to ingestion, from ingestion to unconsciousness, or from ingestion to death; or on the duration of the patient-doctor relationship.
Death tourism
In May 2023, Act 10 (2023) was enacted, removing the requirement that only Vermont residents have access to the prescription of a lethal substance under the Patient Choice Act.
Conclusion
Vermont's experiment with assisted suicide has yielded no useful official data but anecdotal evidence points to suicide contagion and the fostering of a cavalier attitude among some clinicians towards the elderly, actively encouraging access to assisted suicide instead of promoting a culture of care.
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