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Questions of Life and Death: Vt. Aid-in-Dying Law Examined in Norwich

  • Ninety-one-year-old Ned Coffin, of Strafford, makes a joke while asking a question about the aid-in dying law passed in Vermont last month during a discussion at Norwich Congregational Church in Norwich last night. (Valley News - Sarah Priestap)

    Ninety-one-year-old Ned Coffin, of Strafford, makes a joke while asking a question about the aid-in dying law passed in Vermont last month during a discussion at Norwich Congregational Church in Norwich last night. (Valley News - Sarah Priestap) Purchase photo reprints »

  • Dr. Dennis McCullough gives his opinion on the aid-in-dying law that was passed in Vermont last month during a panel discussion on the law at Norwich Congregational Church. (Valley News - Sarah Priestap)

    Dr. Dennis McCullough gives his opinion on the aid-in-dying law that was passed in Vermont last month during a panel discussion on the law at Norwich Congregational Church. (Valley News - Sarah Priestap) Purchase photo reprints »

  • Ninety-one-year-old Ned Coffin, of Strafford, makes a joke while asking a question about the aid-in dying law passed in Vermont last month during a discussion at Norwich Congregational Church in Norwich last night. (Valley News - Sarah Priestap)
  • Dr. Dennis McCullough gives his opinion on the aid-in-dying law that was passed in Vermont last month during a panel discussion on the law at Norwich Congregational Church. (Valley News - Sarah Priestap)

— The political wrangling over Vermont’s aid-in-dying law may be over for now, but the work of figuring out what it will mean for patients and their families has just begun.

A crowd of around 60 turned out for a forum last night in Norwich to explore some of the legal, practical, medical and even spiritual questions surrounding the law, commonly known as “physician-assisted suicide.”

Many of them are difficult questions that were argued over the past few months in Montpelier and will continue to be argued over as the law is implemented.

“It wasn’t an easy vote for the legislature,” said Rep. Margaret Cheney, D-Norwich, who voted in favor of the legislation. “The debate was prolonged and it was emotional.”

The aid-in-dying law went into effect as soon as Gov. Peter Shumlin signed it May 20, making Vermont just the fourth state to allow terminally ill people to end their own lives. But questions remain about what the potential impact will be, how many individuals will avail themselves of the option and how the process will be regulated.

State health officials are still figuring out how it will be enforced, and providers are deciding whether they will voluntarily participate. No doctor or hospital is required under the law to help a patient end his life. The law applies only to Vermont residents and doctors who are licensed to practice in Vermont, according to James Bernat, a Dartmouth-Hitchcock Medical Center neurologist who moderated last night’s panel.

The discussion touched on specific provisions in the law, how the process will work and what the potential impact would be.

On that last question, panelists said the experience in Oregon, where physician-assisted suicide has been legal for more than 15 years, suggests the impact could be quite small.

In the first year of the law’s implementation in Oregon, for example, 16 people went forward with their plans to end their lives using the provisions outlined in the law, said Dr. Dennis McCullough, a family physician and geriatrician at Dartmouth College. Oregon, which has nearly 4 million residents, is a much more populous state than Vermont. If Oregon’s experience could be extrapolated to Vermont, that means three people could be expected to end their lives under the aid-in-dying law this year.

“This may take some of the wind out of Vermont’s sails, in terms of feeling that this is a transformative kind of legislation,” McCullough said. “Maybe it’s going to be, but the Oregon experience wouldn’t suggest that.”

In its first three years, the Vermont law will look much like the Oregon model: Built-in safeguards require patients to state three times — twice orally and once in writing — that they would like to die. The patient must also be at least 18 years old, be of sound mind and have a terminal condition that leaves her with six months to live, a diagnosis that must be confirmed by a second doctor.

In 2016, Vermont will shift to a model that would require less monitoring and reporting by doctors, though lawmakers may eventually decide to leave the original plan in place, Cheney said.

“We believe ... in the three years between now and then, we’ll have had more experience and data and reflection and we’ll be able to keep the law going as it was passed for the first three years,” she said.

Earlier in the evening, the Rev. Mary Brownlow of the Norwich Congregational Church addressed some of the spiritual questions raised by the aid-in-dying law. Some have wondered whether this is “playing God,” she said, and whether giving someone the option to end his life is actually an act of mercy.

Brownlow did not provide answers for the audience, but rather posed a series of points for further contemplation.

“I don’t think I can tell anybody what to think,” she said, “but I’ll tell you some questions.”

The questions that Monte Clinton, of Etna, brought with him were largely practical ones.

“I was hoping there would be an opportunity to talk about what are the end-of-life decisions you have to make before this,” Clinton said.

Sybil Buell, of Norwich, said she wanted some clarity on what the legislation actually said. She said that she believes physician-assisted suicide should be available to the people who want it as an option, even if she did not think it was a route she’d take. She was encouraged to hear from the panelists about the rise in palliative and hospice care in Oregon after the law was passed.

Since then, the number of dying patients in hospice care has grown from 20 percent to 96 percent, Cheney told the audience.

“That to me is the better route,” Buell said. “I was encouraged to see that 96 percent (of patients) are in hospice.”

Whatever the actual number of people who end their lives under the law, a benefit of having it in place would be the opening of the conversation patients have with families and physicians about the end of life, Cheney said.

“One benefit will be that conversations and very full conversations with much more information are likely to take place,” she said.

Chris Fleisher can be reached at 603-727-3229 or cfleisher@vnews.com.