As Vermont continues to uphold its medical aid-in-dying law—one of the earliest such policies in the United States—it does so amid growing national and international debate over where the line should be drawn between personal autonomy and systemic pressure. While Vermont’s policy was once considered a bold step, the conversation around assisted death has shifted dramatically, with neighboring Canada now offering physician-assisted euthanasia to individuals far beyond the terminally ill.

So where does Vermont stand today? And how does it compare to other jurisdictions that have taken radically different approaches?

Vermont’s Law: Patient Choice, But Only By Your Own Hand

Vermont’s Act 39, passed in 2013, allows adults who are:

• Terminally ill (prognosis of six months or less),
• Mentally competent,
• Vermont residents, and
• Capable of self-administering the medication

to request and take a lethal prescription intended to hasten death. The law requires a specific process involving two oral requests, a written request signed in front of witnesses, and approval by two physicians. Once the prescription is filled, the patient must choose the time and setting—and must take the medication themselves, without assistance.

📄 State info: Vermont Department of Health – Patient Choice at End of Life

This structure is designed to safeguard consent and autonomy. But for some patients—especially those with degenerative diseases like ALS—self-administration becomes a barrier, not a protection.

The Quiet Realm of Palliative Care

Not all life-ending events in Vermont are captured under Act 39. Many patients nearing death instead enter hospice or palliative care, where powerful medications like morphine or midazolam are used to alleviate suffering. In some cases, this may hasten death. However, these deaths are not reportable under Act 39 and are not tracked as assisted death cases.

That distinction—between dying as a result of palliative care vs. medically assisted suicide—is both ethically and statistically significant. Critics argue it creates a gray zone of unreported, undocumented deaths.

💡 Ethics reference: Vermont Ethics Network – Palliative and End-of-Life Care

The same ethics network also acknowledges that patients may retain the right to refuse treatment—even when they lack full decision-making capacity.

🔍 Decision-making capacity: VT Ethics Network – Capacity & Refusals

Canada: Autonomy or Overreach?

In contrast to Vermont’s narrow, self-directed process, Canada’s Medical Assistance in Dying (MAiD) law has expanded dramatically since its passage in 2016. Initially limited to terminal illness, the program now includes:

• Non-terminal physical conditions,
• Chronic pain,
• Mental illness (eligible starting March 2027, following delays).

Canada reported over 13,000 MAiD deaths in 2022 alone. Cases have emerged in which:

• Veterans were offered assisted death instead of trauma support.
• Patients considered MAiD due to housing or economic insecurity.
• Individuals with disabilities or chronic illnesses pursued euthanasia not because of their condition—but due to social or financial despair.

While some view Canada’s policy as the pinnacle of bodily autonomy, others see a system that has normalized death as a solution to suffering—regardless of whether the suffering is physical, mental, or economic.

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The U.S. Landscape: A Consistent Barrier to Direct Physician Assistance

Despite the moral debates surrounding end-of-life care, no U.S. state currently allows direct physician-administered euthanasia. All jurisdictions with aid-in-dying laws—including Oregon, California, Maine, New Mexico, and Vermont—require the patient to self-administer the medication.

The most infamous figure to challenge that boundary was Dr. Jack Kevorkian, who directly assisted in over 130 deaths during the 1990s and was eventually convicted of second-degree murder. His actions were outside the bounds of legal, regulated medicine—but they raised enduring questions about how much help the dying should be allowed to receive.

Institutional Signals: A Cultural Shift?

In Vermont, programs surrounding death care are increasingly professionalized. The University of Vermont offers an End-of-Life Doula Certificate, an eight-week online course designed to train individuals to support others through the dying process. While marketed to adult learners, this program was previously advertised in high school settings—a decision that raised concerns about introducing death-work concepts too early.

Additional context:
📘 UVM Palliative Care Department
📘 Patient Choices Vermont – Advocacy Organization

Where Do We Go From Here?

Vermont’s law sits in the middle of a global spectrum. On one end: a highly restricted, self-service model that can feel isolating and inaccessible. On the other: a wide-open system like Canada’s, where autonomy is prioritized even when vulnerability clouds consent. Somewhere in between are the difficult, undocumented realities of palliative sedation—kindness administered without fanfare or oversight.

As end-of-life care continues to evolve, perhaps the most pressing question is not whether aid in dying should exist, but how it should be done, and under what conditions we as a society choose to help—or look away.

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Dave Soulia | FYIVT

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