News from Vermont Public
More people want to come to Vermont for medical aid in dying than the system can handle
Vermont is one of nearly a dozen states where doctors can prescribe lethal medication to terminally ill patients who want to hasten their death. It's often called medical aid in dying. For the first decade, the law was on the books, only Vermont residents could use it. Then last year, lawmakers opened the program to out-of-staters. As Vermont Public's Michaela LaFrak reports, the change has brought an influx of interests to the small state. Ever since Vermont removed its residency requirement for medical aid in dying, Diana Barnard hasn't been able to keep up with the phone calls, from would-be patients. She's a palliative care physician at Porter Medical Center in Middlebury. "Yeah, give me a hard, I have like three calls sitting on my phone right now, but building capacity is important." Barnard is well known in this sphere of the medical world. She filed a lawsuit against Vermont with one of her patients, a Connecticut resident who wanted to use medical aid in dying here. This suit led Vermont to remove its residency requirement, and it led a lot of patients to Dr. Barnard. "There are a lot of people from many different states looking for access and calling, and right now the interest, or if you want to call it demand, definitely outpaces our ability to meet that demand." She hopes more local doctors will be willing to work with these patients. But it's a big ask. Patients have to be in Vermont for two required appointments and to take the medication. And most doctors here already have more Vermont-based patients than they can handle. "It's actually a big part of my work is trying to educate other physicians and in a way kind of inform other physicians about the importance of this practice, mentoring them through learning how to do it so that they can feel comfortable doing it on their own." Barnard was able to take on Rita Manibach of Florida. Barnard confirmed her patient had terminal lung disease and prescribed the drugs. During a recent phone call from a rented house in Burlington, Manibach described her plans for her last day alive. "On Thursday morning, we'll have a little program at 10 o'clock. There'll be a symbolic ceremony of letting go, me letting go of them, then letting go of me, and then I'll just cast in my swords that I say. May you be peaceful, may you be happy, that's kind of thing." She had no doubts about what she wanted to come next. "It's all about quality of life for me. It revolves in less suffering." Only Oregon and Vermont allow non-residents to use medical aid in dying. When Vermont opened up the program last year, it changed a lot for prescribing doctors and hospice workers. Every new patient requires significant paperwork, multiple medical consultations, and emotional support. "The floodgates opened, and suddenly we were receiving these calls." Tim Shafer is a physician at Grace Cottage Hospital in Townsend. "It has profoundly changed my life, our clinic function. We just had a lot to learn about how to pull this off logistically." Shafer feels a deep calling to help his patients who are suffering. He feels privileged to be a prescribing doctor. He's had to come to terms with not being able to help everyone. "It started surpassing what could be handled, and we finally agreed. We have to limit new consults to one per week." To help with logistics, Shafer and other doctors rely on a new network of volunteers called Wayfinders. It's made up of retired hospice nurses, social workers, and death doulas. We support families and patients navigating medical aid in dying. Suzanne Backstrasser is a Wayfinder in Brattleboro. For her, the biggest challenge is finding housing, where patients and their families can stay. "We want people to take the medicine in a safe place. We want people to know that nobody's going to come knocking on the door saying, 'What's happening?'" As Vermonters well know, the state faces a severe housing shortage. It's also a popular tourist destination, which makes short-term rentals even harder to come by than doctors. "We have had some Airbnb owners who have been supportive, and they've offered their places. But then when summer comes, everything gets rented." One family with an unused property has essentially donated it to the cause. And a local non-profit, Patient Choices Vermon, is trying to figure out a longer-term housing solution. If and when that happens, Backstrasser believes the increase in interest will turn into an increase in usage. "Because if patients knew there was a clear path, they would come. But right now, we don't have the structure to support that." With the help of the Wayfinders, Rita Manibach was able to find a place to stay for the weeks before her death. For years, volunteering as a hospice worker helped her feel ready for what was to come. "I am very comfortable with death, I'm 84, and I'm very under peace with the whole thing. I mean, to me, what happens after is totally unknown. I don't know what's going to happen, but I don't have any fear. So I feel perfectly at ease about the whole thing." Two days after our interview, she followed her plan. Rita Manibach of Florida died in Vermont. After she passed, her family made plans for her ashes to be shipped back to Florida. Then, they tidied up the rental, drove to the airport, and went home. For Vermont Public, I'm Michaela Lefrak.