By Chris Haring
New Hampshirites hoping to use Vermont’s new law permitting out-of-state residents access to medical aid in dying still face barriers and legal threats
When on May 2, 2023, Vermont became the first jurisdiction to permit out-of-state residents access to medical aid-in-dying services, it could have been expected that prospective patients and advocates in neighboring locations would feel optimistic.
However, as Rebecca Brown of the NH Alliance for End of Life Options told New Hampshire Public Radio’s Julia Furukawa in May, end-of-life travelers to Vermont should still proceed cautiously: Physician-assisted death remains illegal in their home state, with potentially-serious ramifications for patients’ loved ones.
“[T]heoretically, if you went to Vermont, qualified for medical aid in dying, got your prescription for your medication and brought it home with you to New Hampshire and used it, your family members could be implicated in your death,” Brown said.
Brown also spoke about the importance of appropriate terminology to distinguish between aid in dying and suicide from both legal and human perspectives. “In the ten states and the District of Columbia where aid in dying is legal, state law specifies that this is not suicide and it is not assisting suicide. So none of the people involved has any risk of legal ramifications,” she said, adding “[W]ith suicide, that is a life with potential that is cut short. Aid in dying is where the person has tried treatments and they’ve run out. Death has chosen them.” To refer to aid in dying as assisted suicide or likening it to suicide is technically and legally inaccurate.
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Vermont now allows people from other states to use its medical aid in dying law. What will that mean for NH?
Published May 12, 2023 at 3:52 PM EDT
Vermont recently became the first state in the country to allow people who live in other states to request medications to hasten their death.
While Vermont is the only state to waive its residency requirement, it’s not the only state that allows medical aid in dying. Maine also allows it, and policymakers in Massachusetts are considering doing the same. It remains illegal in New Hampshire.
Rebecca Brown is the director of New Hampshire Alliance for End of Life Options. NHPR’s Julia Furukawa spoke with Brown to understand where access to medical aid in dying stands in New Hampshire, and what Vermont’s new law could mean for local patients considering end of life options.
What is medical aid in dying?
Medical aid in dying is an option that some people might call “the right to die.” It means that for people with a terminal illness that have a prognosis of six months or less to live, that are over 18 years of age and are mentally sound, they may choose the time and place of their death through medication that is written by a physician. They often will self-administer at home in the presence of whoever they want to have with them, [typically] their loved ones. It’s meant to keep the quality of life as high as one can, as high as possible given their illness, right through to the end. And it is an individual choice, a very personal decision, and it is optional for all the people involved — starting with the patient who always has the choice to take the medication once it’s prescribed, or not. But the personal decision is also available for physicians. If you have reasons of conscience not to be involved as a physician, that is your right as well.
Rebecca, terminology around this, it differs and it’s sort of complicated. Your organization uses “medical aid in dying.” Some folks may also be familiar with “physician-assisted suicide.” What is the impact of language when it comes to this?
The term of art is “medical aid in dying” or “aid in dying.” Some people call it “physician-assisted dying.” It is actually inaccurate to call it “physician-assisted suicide.” In the 10 states and the District of Columbia, where aid in dying is legal, state law specifies that this is not suicide and it is not assisting suicide. So none of the people involved has any risk of legal ramifications. So that’s a legal difference. But there’s also the human side. Medical aid in dying is a very formal process that you have to request and you have to qualify for. There are many steps and there’s many people involved. Two physicians, a pharmacist, the person who’s the patient, of course, and usually their family or loved ones. And with suicide, that is a life with potential that is cut short. Aid in dying is where the person has tried treatments and they’ve run out. Death has chosen them.
Now that this law has been passed in Vermont, can residents of New Hampshire travel across the border to access this type of care?
So the residency requirement has been dropped, which means that people who are not residents of Vermont can go there and potentially qualify for medical aid in dying. So we applaud that. We think that more access to this right is better. But it is not an easy thing for people in New Hampshire. Medical aid in dying in the states where it is legal, the law specifies it is not assisting suicide. But medical aid in dying is not legal in New Hampshire and we have a strong criminal code that says assisting suicide is illegal, it’s a criminal act. So theoretically, if you went to Vermont, qualified for medical aid in dying, got your prescription for your medication and brought it home with you to New Hampshire and used it, your family members could be implicated in your death. Believe me, nobody wants that. You have to do every step, including dying, in the state of Vermont.
And when a person is terminally ill, that kind of travel and that kind of planning is not easy. Finding a physician is not necessarily going to be easy.
Rebecca, your organization, New Hampshire Alliance for End of Life Options, or NH Options, offers guidance and conversation for those who are thinking of end of life care. Since this legislation has passed in Vermont, what have you been hearing from people who’ve reached out to you?
People know that it’s legal in Vermont. They know that it’s legal in Maine. It’s also being worked on in Massachusetts. So it’s like, look to the left of us, look to the right of us, and what are we doing here in New Hampshire? So even before this Vermont change, we would get phone calls from people saying they or a loved one had a terminal illness where they knew what the end was going to be — and often not pretty. They said, “What can we do in New Hampshire when we don’t have medical aid in dying?” Physicians we talk to say more and more people are asking them about this, particularly now that Vermont has changed its residency requirement.
Where does this practice of medical aid in dying currently stand in New Hampshire? Are lawmakers considering it?
Medical aid in dying has been in the United States since the mid ‘90s, and there have been attempts in New Hampshire to raise this issue in the legislature since then. There have been a number of bills, many of them to study the issue, but none of them have been successful so far. The big difference between now and then, is that there was never a grassroots effort, an organized effort, in New Hampshire. That’s why we started New Hampshire Options. Because the people involved with starting the organization, we’ve all had experience with loved ones suffering at the end that we thought, ”We should have the option to take control of our lives and our deaths.” And many of us have served in the legislature, including myself. So we know this is not a top down issue. It’s really got to come from people. And that is what we are hearing from people saying, “I’ve been wondering about this. I’ve been concerned about this. I didn’t know where to turn. And then I found you guys.”