Stefan Hard / Staff Photo
Sen. Claire Ayer, D-Addison, introduces end-of-life bill S. 77 on Tuesday in the Senate Chamber of the Statehouse in Montpelier.
MONTPELIER — A bill that would allow doctors to hasten the deaths of terminally ill patients cleared a key hurdle in the Vermont Senate Tuesday. Supporters of the legislation, however, still have some political obstacles to sidestep before claiming victory in their decade-old push for “death with dignity.”
After nearly seven hours of debate on the Senate floor, lawmakers voted 17-13 to keep alive a bill that would permit physicians to prescribe lethal doses of medication to mentally competent people with a diagnosis of less than six months to live. While the vote augurs well for the bill’s fate in the next phase of the legislative process, it does not guarantee passage in the 30-member body.
At least two senators say their favorable vote on the bill Tuesday shouldn’t necessarily be confused with support for the underlying legislation. And without potentially significant alterations to the proposal, supporters could fall short of the 16 votes they’ll need.
Lt. Gov. Phil Scott, an opponent of the legislation, would cast the deciding vote against in the event of a tie.
Sen. Peter Galbraith, a Windham County Democrat, is at work on an amendment that would essentially replace the current legislation with language that “decriminalizes” the prescribing of lethal doses of medication to certain eligible patients.
“The opponents are primarily concerned about one main problem, and that is enacting a state-sponsored process of ending life,” Galbraith said.
Galbraith said his amendment will “absolutely enable choice” without establishing a “state-sponsored process.”
Sen. Bob Hartwell, a Bennington County Democrat, said he wants assurances, written into the law, that patients seeking a lethal dose of medication are required first to talk with members of their family. He said he also wants patients to have to consult with palliative care experts.
While those ideas may not have majority support in the body, Galbraith and Hartwell go into the negotiations carrying considerable sway. As Galbraith made clear to Senate Majority Leader Philip Baruth after the vote, “the issue is, are there 15 votes to pass this bill without Hartwell and me?”
“And the answer is ‘no,’” Galbraith said.
Two other senators who hadn’t yet announced their positions on the bill publicly indicated solid support for the measure Tuesday. That leaves Hartwell and Galbraith as the lone undecideds, and both their votes will be needed to hit the 16-vote mark.
Uncertainty swirling around Galbraith and Hartwell notwithstanding, Tuesday’s vote was a momentous victory for supporters of the legislation, namely Patient Choices at End of Life Vermont, a group that has funded a years-long lobbying effort in and out of the Statehouse.
Most recently, the group dropped about $5,000 on a poll of registered voters in Essex and Orleans counties. Sen. John Rodgers, a first-term Democrat representing those counties, credited the results, which arrived over the weekend, with winning his support.
The poll found that 60 percent of people favor “legislation to give a mentally competent adult dying of a terminal disease with a diagnosis of less than six months to live the right to request and take medication to peacefully hasten death.”
“The reason I chose to support this is because this is what my constituents asked me to do,” Rodgers said. “I think it’s our duty as senators to represent the people of our districts.”
The bill has spawned intense discussions this year about life, death and choice, and the impact of the legislation on disabled or infirm residents.
Sen. Dick Sears, a Bennington County Democrat, said that he worries about how the bill will affect terminally ill patients faced with the choice of pursuing life-extending, but very expensive, medical treatment. He told the story of a friend with cancer who was encouraged by his doctor to take a “very expensive” course of treatment.
“If he hadn’t had the money and this law is in effect, would he want to put that (financial) pressure on his family?” Sears said.
Sen. Peg Flory, a Rutland County Republican, said she worries about the legislation’s capacity to undermine the value of certain lives, including “people that are suffering, that might be incontinent, that might be in pain.”
Flory talked about sitting by her father’s bedside as he died of cancer.
“I can tell you his death was dignified, and he didn’t need drugs intended to specifically kill him to make my dad die a dignified death,” Flory said.
Sen. Ann Cummings, a Washington County Democrat, said she worries about threat for abuse by unscrupulous caregivers who might stand to gain financially from the patient’s expeditious death.
The job of defending the legislation against an hours-long barrage fell to Sen. Claire Ayer, an Addison County Democrat and chairwoman of the Senate Committee on Health and Welfare. She said the bill has been modeled after a 15-year-old law in Oregon, and includes safeguards designed to prevent many of the concerns raised by opponents Tuesday.
Ayer said that based on data from Oregon, Vermont would see only five to 10 people annually avail themselves of the new option. But she said the knowledge that the option exists will give countless other Vermonters peace of mind in the final stages of their lives.
“It allows them to opt for more autonomy and control in their final days. It allows them to participate in their own deaths on their own terms ... and take comfort their suffering will end quickly,” Ayer said. “And it ensures anyone who seeks this option does not have to die alone.”
Ayer said it’s true that people seeking to end their lives already have options. But those avenues — they include stopping eating or drinking, or being put in a pharmaceutical coma for the final days — can be unpleasant an unnecessarily drawn out.
Opponents of the bill have said that it will change societal views on suicide in a way that will cause more people to take their own lives. Ayer, however said statistics in Oregon, where suicide rates have been flat since passage of the law, don’t bear out that concern.
Ayer said the law has also has had the effect of improving end-of-life care in Oregon, where the rate of people getting treatment in hospice has more than doubled since the law was enacted. And the Oregonians taking advantage of the law, she said, are mostly affluent, insured and well-educated — evidence, Ayer said, that the law won’t pose any threat to disabled Vermonters or other marginalized populations.
Amendments on tap for today and Thursday will address a range of concerns, how to dispose of unused lethal medication (only about one-third of patients given lethal prescriptions in Oregon actually take it). Some lawmakers want assurances that the determination of a patient’s mental soundness will be made by a suitably credentialed professional. Other lawmakers want to revise the legislation so that “suicide” is listed as the cause of death on the death certificate, rather than the underlying terminal illness from which the person had been suffering.
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