Vermont has signed bill S.74, amending the law euphemistically referred to as the Patient Choice and Control at End of Life Act (Act 39), increasing the ease with which terminally ill patients can be provided the means to hasten the end of their lives. Act 39, enacted in 2013, previously required a multi-step process, in which a patient with a prognosis of 6 months to live or less would make two in-person visits to a prescribing physician and submit a request in writing for a life-ending prescription, which could be fulfilled after a 48-hour waiting period and a second opinion from a consulting physician. The newly-passed amendment will abolish the waiting period and allow patients to fulfill the required visits to a prescribing physician via telemedicine services. The amendment also immunizes any person “licensed, certified, or otherwise authorized by law to deliver health care services” in the state from “any civil or criminal liability or professional disciplinary action” arising from the prescription of life-ending drugs in accordance with the statute.
Euphemistic language is not uncommon to describe such measures, whose proponents love to frame them in such terms as Death With Dignity, Patient Choice, and perhaps most enduringly, Right to Death. Assisted suicide, much like abortion, is increasingly being pushed as a fundamental right inherent to the ordinary course of healthcare, and language is carefully chosen to avoid answering difficult questions about the ethical implications of such procedures. Our deepest intuitions about medical ethics are tested by the legalization of physician-assisted suicide: Is killing a valid use of medical science? Is patient consent a sufficient basis to grant the right to kill? Is any measure verboten in the pursuit of palliative care? The rights-based language utilized in legislation like Act 39 is calculated to foreclose these questions by reframing them entirely as questions of individual right.
This was clear even as the amendment was being discussed. Willem Jewett, formerly a giant of Vermont’s state legislature and a sufferer of terminal mucosal melanoma, argued vociferously for the amendment up to the day of his death at the hands of an Act 39 prescription, which he himself was instrumental in becoming law. Arguing that limitations like an in-person evaluation and a waiting period were “completely meaningless” and made access to assisted suicide too onerous, Jewett said of the amendment: “we all get to remain true to our guideposts at the end of our life.” His advocacy for the procedures that would eventually end his life makes his role all the more poignant; heroic, even, in the eyes of proponents.
Opposition to the “right” to assisted suicide has been easy to caricature as fear-based and reactionary, a response not to its actual exercise but to misguided fears as to its abuse. Stories like those of Jewett, a man so clearly lacking in malicious intent, who was able to take advantage of such procedures to end his intractable end-of-life suffering sometimes make such a charge hard to answer. But men like Willem Jewett, an able-bodied person who had access to a wide variety of cancer treatments and palliative care, are not the cause for concern. It is easy to frame his story as simply a patient making choices. This is not true of those whose suffering is the result of a lack of access to such care, whose “choice” is made for them due to the hopelessness of their condition and/or lack of social support.
The timing of S.74’s passage coincides with that of “Denise,” a Toronto woman whose request for assisted suicide under Canada’s far more permissive laws was sought not due to terminal illness, but due to the abject poverty she was forced to endure due to a failure of Canada’s housing system to accommodate her disabilities. Her requested death at the age of 31 is far harder to frame as the triumph of patient choice, especially in light of no effort being made to alleviate her suffering by other means.
It is perverse that, in a society marked by widespread healthcare inequity, S.74 would be presented as increasing access to end-of-life choice, when in fact what it represents is the erosion of safeguards designed to alleviate the supposedly baseless fears of a “slippery slope.” It is equally perverse that telemedicine, made a necessity during a time where remote health services are serving an essential role in the provision of medical communication, is being used as a tool to obviate one of such safeguards — physical examination of the requesting patient. While stories like Denise’s are not currently possible in the United States, the increasing push to have assisted suicide treated as simply another aspect of the rights of medical patients makes such a tipping point an inevitability.