MONTPELIER, Vt. -- After years of debate, Vermont became the fourth state in the country Monday to allow doctors to prescribe lethal doses of medicine to terminally ill patients seeking to end their lives.
Gov. Peter Shumlin signed the bill into law at a Statehouse ceremony even as opponents vowed to push for its repeal.
The End of Life Choices law was effective immediately, although it could be weeks before the state Health Department develops regulations in accordance with the new measure.
Vermont Health Commissioner Dr. Harry Chen said he expects doctors to write between 10 and 20 lethal prescriptions a year, with a smaller number of patients actually using the drugs.
He based his figures on the experience in Oregon, the first state to legalize assisted suicide in 1997. Washington state and Montana followed later, with Montana's coming by way of a court order.
"It's used by a very small number, but it brings comfort to a much greater number knowing it's there," Chen said.
During emotionally charged discussion of the bill, proponents said Vermonters of sound mind who are suffering from terminal conditions should be able to choose when to end their lives. But opponents said the law could be abused and vulnerable people, especially the elderly, could be forced to end their lives.
Shumlin offered reassurances before signing the bill.
"This bill does not compel anyone to do anything that they don't choose in sound mind to do," he said. "All it does is give those who are facing terminal illness, are facing excruciating pain, a choice in a very carefully regulated way."
Some critics of the law attended the bill-signing and promised to seek its repeal.
"We need to be more of a caring, compassionate society, not one that says `take a pill, go away,'" said Edward Alonzo of Burlington. "People don't have the best of intentions, always, with their family members," he said.
The Legislature passed the bill last week. A similar measure was defeated in 2007.
"I know from my many years of practice that there are many patients out there that want to have this option available to them, and because it's a new bill I anticipate that a lot of people are going to ask questions about it," said Dr. Diana Barnard, a family practice doctor in Burlington who is certified in hospice care.
"I do know there are providers who will be willing to provide the best possible medicine to their patients regardless of what that means, and that includes all aspects of palliative care," she said.
In its first three years, the Vermont law will resemble the Oregon model, which has built-in safeguards, including requirements that patients state three times – once in writing – that they wish to die. Other safeguards include a concurring opinion from a second doctor that a patient has less than six months to live and a finding that the patient is of sound mind.
In Oregon and Washington, patients who take advantage of the Death with Dignity law use the drug pentobarbital, a barbiturate, that is dissolved in liquid or semi-liquid, said George Eighmey, a board member of the Death with Dignity National Center in Portland, Ore.
The patient doesn't eat for four or five hours before taking an anti-nausea drug and the lethal drug about an hour after that. It takes about five minutes for the patient to fall into a coma. The average length of time until death is about two hours, said Eighmey.
After July 1, 2016, Vermont will move to a model pushed by some senators who complained of too much government intervention. The new model would require less monitoring and reporting by doctors. But many expect lawmakers may push to eliminate those changes and leave the original model in place.
The Health Department will receive reports of how many people were prescribed lethal drugs. Chen said he expects the process will be covered by health insurance.
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