Monica Knorr, of Manchester, is on the board of directors of Patient Choices at End of Life Vermont. "This is the Vermont-based network of citizens urging our state leaders to enact the Patient Choice and Control at End of Life Act," she said in response to emailed questions.
"There are too many terminally ill Vermonters going through extreme pain and suffering, usually due to cancer, who lack adequate choice and control over when to end their suffering. The bill I support offers them choice and a law with over a dozen proven safeguards," Knorr said.
Dennis and Lani Candelora, of Pownal, and Gerald and Carolyn McMurray, of Arlington, are among the co-founders of True Dignity Vermont. Carolyn McMurray, also in response to emailed questions, said they started the group in January 2011 "when it became apparent that assisted suicide legislation would once again be pushed by lobbyists in Vermont."
She added, "Our group exists to fight the legalization of assisted suicide and to mobilize other Vermonters to fight assisted suicide."
"The particular safeguards in any law do not interest us much, because we do not believe it is possible to legislate away the inherently pressuring quality of legal assisted suicide," McMurray said. "Assisted suicide drugs cost about $200, while six months of good palliative care cost many thousands. There are also time and emotional
"An act relating to patient choice and control at end of life," Senate Bill 77, introduced in the Vermont Senate earlier this year, is just the latest attempt dating back decades to introduce to the Green Mountain State what one side calls "physician-assisted death" and the other calls "assisted suicide."
Oregon a model
If the legislature passes a bill and the governor signs it into law, Vermont will become the first state to adopt the practice by legislative action; the states of Washington and Oregon adopted it by voter referendum.
The original version of Senate Bill 77 was patterned on the Death With Dignity Act in Oregon. Information included in the bill notes that in the most recent year for which there are records, 2012, "115 prescriptions were written, and 66 patients died after ingesting the medication. An additional 11 patients died after taking medication pursuant to an earlier prescription, for a total of 77 deaths."
Vermont's population is about one-sixth that of Oregon.
"A patient-directed dying law has been in place in Oregon for 15 years," Knorr said. "The track record of the law there is really strong. We are lucky we can move forward as a state to enable this option here knowing that the safeguards built into this voluntary law work."
What would Knorr say to those who argue that what we need instead of assisted death is more palliative care, and psychiatric care for the terminally ill?
"It is a false choice. This is not about choosing between improving palliative and hospice care or patient directed dying," she said. "We are working to improve the full spectrum of end-of life-options that should be available to Vermonters. We have to room to improve on all of the above."
Knorr feels that Vermont can learn from the Oregon experience.
"After their law was enacted, they saw an incredible improvement in all aspects of the end of life care system," she said. "More people enrolled in hospice. Doctor training in pain management improved significantly and they report a more open and honest relationship with their terminally ill patients."
McMurray disagrees. "We do not agree that the Oregon model of assisted suicide contains adequate protections. Among the multitude other problems with that law is the lack of a requirement for witnesses at the time the overdose is taken. That is a recipe for abuse, including murder."
In Oregon "at least two residents, Barbara Wagner and Randy Stroup, got letters from Medicaid informing them that the treatment they wanted, and that their doctors believed they needed, would not be covered but that the drugs and doctors' visits required for them to commit suicide with a doctor's assistance would be," she said.
She added, "We show respect for each other by caring for and not harming each other. One way we care for each other is by offering companionship and the best possible medical care to the dying. Everybody should be able to count on that, and right now many cannot. Old and sick people often live alone and isolated. (Elder) adult abuse is huge problem. Vermont is one of the worst states in the country at substantiating abuse reports."
Vermont also ranks among the worst in the country in the utilization of the excellent hospice care that is available, McMurray said.
"Now, as our population ages and more are coming face to face with the reality of the illnesses of age and the certainty of death, and the costs associated with caring for the dying, some want to announce that suicide is a solution to these problems," McMurray said.
Knorr does not see it as being about suicide. "Suicide is a tragedy. It is an act by someone with impaired judgment who wants to die. Patient-directed dying is different," she said. "It is a choice to control the timing and manner of your imminent death being made by a person who is mentally competent but terminally ill.
"Most of the terminally ill patients interested in this law have cancer and experience extreme suffering," she said. "This is about enabling people to have more autonomy and control at their end of life. It is an individual choice that many will take comfort knowing they have and a few will use."
She added, "I don't believe politicians or religious leaders should be able to interfere with my right to have more choice and control at the end of my life."
Bill changed radically
At this point, however, the bill which has emerged from the Vermont Senate is radically different from the Oregon model, much-abbreviated from the original, and proponents say it lacks the safeguards against abuse that the original bill contains.
The original version of the bill contained a series of safeguards to ensure the patient had a sound mind and was not under any undue pressure when making the decision to take a lethal dose of medication. The patient had to make the request for the medication three times, once in writing. Two doctors had to agree on a prognosis of less than six months to live.
The version the Senate agreed to actually was an amended form aimed at limiting state involvement in the care of terminal patients, at the same time relieving those involved in managing such a patient's final days any threat of being prosecuted, sued or disciplined by regulators.
The bill that passed was reduced from 22 pages in length to one. Its key sections say a health professional "shall not be subject to criminal or civil liability or professional disciplinary action if the patient self-administers more than a prescribed dose of the medication and dies as a result."
The same protection would apply to anyone else present at the time of death.
The measure now moves to the House, which is expected to redraft it into a version much closer to the original bill. Gov. Peter Shumlin has said he would support that redrafting effort.
Ultimately, Knorr is "hopeful a final bill will be enacted that will enable a mentally competent, terminally ill patient to request and a doctor to legally prescribe medication a patient can self administer to control the timing of the final stage of their inevitable passing."
She said that many independent polls have shown the public supports assisted death.
A Feb. 20 Castleton State College Polling Institute polls shows that 68 percent of Vermont adults say that they would favor such legislation, while less than a quarter of all respondents (22 percent) oppose it; 9 percent say that they don't have an opinion on the matter," according to the Polling Institute website.
However, approval goes down to 54 percent approval among Vermonters 65 and over.
McMurray said True Dignity Vermont is optimistic. "We have been fighting this off and on in Vermont for at least 18 years," she said. "The people are telling their legislators to vote against it. We will not have an Oregon-style bill in Vermont."
She questioned the objectivity of polls on the issue, citing her experience and those of another woman of a telephone pollster asking questions skewed toward assisted suicide.
"We know that in Massachusetts a few weeks before the (2012) election a poll showed over 60 percent of people supported the ballot initiative to legalize assisted suicide, yet the initiative was defeated," McMurray said. "When people realize what this is, they don't want it."
Still, the vote on the 2012 binding initiative and referendum question in Massachusetts was close, with 51 percent voting against and 49 percent voting for it.
Material from the Associated Press was used in this article.
Contact Mark Rondeau at email@example.com, follow him on Twitter @Banner_Religion