How Vermont Passed Assisted Suicide (And Can We Go There To Die?)

Remember the physician-assisted-suicide referendum that came ever so close to passing last year in Massachusetts, failing in a 51-to-49 percent squeaker?

Well, where Massachusetts feared to tread, neighboring Vermont has now trodden, and the state is about to become the fourth to legalize physician-assisted suicide for terminally ill people, after Oregon, Washington and Montana. It is the first to do so through its lawmakers rather than a popular referendum or court.

The "end-of-life choices" bill rode a wild political roller-coaster before it was finally passed this Monday evening, and it's now on its way to a supportive Gov. Peter Shumlin and expected to be signed soon.

Vermont Public Radio's John Dillon has covered the bill all along the way, and I asked him for his insights into the political dynamics behind the action. But first, a brief note for us flatlanders: What will our neighbor to the north's decision mean for us? Will we be able to drive with our doctors up to Brattleboro or Burlington if we're fatally ill and want help taking control of our final days?

I sent a query to Patient Choices Vermont, the group that spearheaded the state's "end-of-life choices" bill, and heard back from Jessica Oski of Sirotkin & Necrason, a government relations firm that has represented Patient Choices Vermont for a decade. She writes:

1. To be qualified to use the assistance of the Vermont Patient Choice at End of Life Bill, a person must be "18 years of age or older, a resident of Vermont, and under the care of a physician." There is no specific guidance under the law as to who qualifies as a Vermont resident.

2. In order for a physician to benefit from the immunity under the law the physician must be "licensed to practice medicine under 26 V.S.A chapter 23 or 33." In other words, licensed in Vermont.

Now for the politics. The tale I heard from VPR's John Dillon suggests three possible lessons for the backers of physician-assisted suicide in Massachusetts: Stick with it. Compromise quickly when the right moment strikes. And you may fare better in a legislature than in a popular referendum.

The Vermont House had considered a "death with dignity" bill in 2007, John said, but it didn't pass. Last year, a similar measure failed to pass in the state Senate. This year was different.

The legislative action first heated up in February. The 30-member Senate narrowly voted down a bill that proposed an assisted-suicide model much like Oregon’s, with extensive reporting and protections aimed at preventing possible coercion. The measure appeared dead for this session.

But then, John said, proponents of the bill came up with an alternative measure “on the fly — they wrote it on the Senate floor, a bill that basically says that doctors can’t be prosecuted for murder if they prescribe drugs that patients then use to kill themselves. It was a three-paragraph piece of legislation and it passed. The proponents supported it just to get it to the House, and then rewrote it.”

That renewed bill’s passage was still far from assured, however. Earlier this month, the House sent its rewritten measure, now very Oregon-like again, back to the Senate.

It was then, John said, that the Senate came up with a pivotal compromise: a “hybrid” bill that included extensive, Oregon-style protections against coercion but also was scheduled to “sunset” in three years to assuage dissent.

That hybrid was the key to gaining the support of two swing senators, John said.

After three years of Oregon-style protections, he explained, the hybrid bill reverts to a version in which the terminally ill patients must still be mentally competent to request help with suicide, “but basically the government regulation goes away. And it was kind of ingenious. There were people who said, ‘We don’t want a government role in suicide at all. It should just be between patient and doctor.’ And other people said, ‘You really need all these protections, because you don’t want people to be coerced, be told they’re a drain on family resources, be nudged into it.’"

"So they kind of tried to bridge it by having these two versions with the sunset in the middle. And of course, a legislature can always elect not to sunset a bill. They can come back in two or three years and say, ‘That provision goes away, and we have an Oregon law,’ which is what the backers hope.”

In any case, the hybrid bill managed to pass in the Senate last week. Then it went back to the House, John said, for “a replay of arguments: ‘You’re going to kill Grandma!’ or ‘It makes sense for people to have the means to relieve their suffering.’ And everyone had to tell their story. It’s been the culmination of 10 years of this ‘end-of-life choices’ group in Vermont, Patient Choices Vermont, trying to get it done. They hired some really skilled lobbyists, and the real genius was this hybrid bill.”

It does seem easier to win a campaign in a legislature of a couple of hundred people than in a popular referendum, John said. Though the battle spilled beyond the State House: The sides bought Web and TV ads; those in favor of the bill showed “people staring into the camera saying ‘This is my story,’ including one really compelling one by the wife of a former house speaker, Richard Mallary. He killed himself a year ago December, and he was in favor of the bill, and his wife is on TV saying, ‘I wish I could have been there with my husband, Dick Mallary, but he had to die alone.’” (Read John’s 2012 report on Mallary’s suicide: Family Says Mallary Followed Convictions On Death With Dignity.)

This Monday night, the House took up the Senate version of the bill, and if it had passed any amendments, that would have killed the bill for the year, because the Senate would not have had time left to consider them, John said. But the measure passed unamended Monday evening.

Listening to John made me nostalgic for the days way back in 2000 when I covered the Vermont legislative debate around "civil unions" — so revolutionary at the time, so quaint now that gay marriage is legal in a dozen states. I admit to brazen bias in my admiration for Vermonters as leaders on social change, and mark my words, this Vermont move will likely find its reflection sometime soon in Massachusetts as well.

"As with same-sex marriage or other social issues, the passage of time changes attitudes," John observed. "The years also brought in a new generation of lawmakers, who were probably more open to this idea."

Readers, predictions?

Further reading:

Vermont Public Radio: House Approves End Of Life Bill

The New York Times: Vermont Passes 'Aid In Dying' Measure