The state is one of 10 and Washington DC that allow patients with a terminal illness to request help in dying from a healthcare provider, but had been the only one that didn't specifically allow that request to be made via a video visit.
Vermont’s governor has signed into law a bill amending the state’s assisted suicide statute to include telemedicine.
S.74, passed by the state House and Senate after an almost two-year process and signed by Gov. Phil Scott on April 27, amends the state’s medical aid in dying law, which was passed in 2013, allows a patient who meets specific criteria to request a prescription to aid in dying through telemedicine, eliminating the need for two in-person consults and a 48-hour waiting period. The bill also establishes legal immunity for licensed healthcare providers, including pharmacists.
The bill defines telemedicine for these purposes as an interactive audio-video platform that complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
The argument follows a familiar path around the use of telemedicine for controversial healthcare services, such as abortion. Supporters say patients should be able to use virtual care to access the services they need but can’t get to in person, because of physical, geographical, or social barriers or a lack of available providers. Opponents argue that some healthcare services shouldn’t be allowed through virtual channels because a patient should be in front of a care provider, in the same room, to talk through what may be a difficult decision.
The issue gained steam with the pandemic, which reduced many in-person services and led to emergency measures broadening the scope of telehealth services and coverage. In 2020, a committee formed by the American Clinicians Academy released recommendations supporting the use of telemedicine in aid-in-dying requests for the duration of the public health emergency.
Ten states and the District of Columbia currently allow medical aid in dying, also called assisted suicide and death with dignity, with all but Vermont including the use of telemedicine in their guidelines.
Vermont’s bill was hotly debated, and included the rejection of an amendment in the House that would have mandated at least one in-person meeting between the patient and a healthcare provider during the process. Adding to the emotion surrounding the issue, the bill was supported by former Vermont House Majority Leader Willem Jewett, who gave an interview with the VTDigger online news service just a few days before dying in January.
“It’s the fundamental authority of the individual over the most fundamental decision they’ll make in their life,” Jewett, 58, who died of mucosal melanoma, said in the interview. “It becomes simple if you accept that premise.”
The original law, which Jewett helped to pass, enables patients with a terminal illness and a prognosis of six months or less to make two in-person requests, at least 15 days apart, to a prescribing physician for drugs to assist in one’s death. That patient must also see another consulting physician in person and make a written request, and wait at least 48 hours after receiving the prescription to use it.
State Senator Dick McCormack, who sponsored S.74, and others, including Patient Choices Vermont, said that process can take months, sometimes longer than the time the patient have left, robbing those patients of their choice in the matter.
“These improvements will really help alleviate suffering toward the end of life, and make the process of medical aid in dying more compassionate,” Betsy Walkerman, president of Patient Choices Vermont, told VTDigger on April 27, following Governor Scott’s signature making the bill a law.
As amended by the bill, Vermont’s law allows patients to request medications to assist in dying from a healthcare provider, either in person or via telemedicine if the physician determines that a video visit is clinically appropriate. The patient must make the request twice, at least 15 days apart, and the clinician must determine that the patient is suffering from a terminal illness, is capable of making that decision and has been informed about the process to access and use those drugs. It allows the physicians to prescribe and the pharmacist to fulfill that prescription and eliminates the 48-hour period between when the patient receives the drugs and uses them.
Finally, it states that “no physician, nurse, pharmacist or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter.”
Eric Wicklund is the Innovation and Technology Editor for HealthLeaders.