I am writing in regard to House Bill H.44, which would allow a competent adult who is terminally ill with an expected prognosis of six months or less to live the right to request from their physician a prescription that would hasten death.

This legislation is very similar to a law in Oregon, which has been in effect for nine years. Numerous reports, including the independent Vermont Legislative Council report in the summer of 2005, have shown that this legislation has worked very well and without any of the fears of opponents coming to pass. I encourage everyone to read these factual reports for themselves. They can be accessed through the State of Vermont or the following Web site: www.deathwithdignityvermont.org.

H.44 is a piece of legislation which is completely voluntary and directed solely by the patient. Numerous safeguards are in place to be sure the law is used properly and without abuse. Physicians cannot ask a patient if they are interested in utilizing the bill or they would be in violation of the law. The patient must make three requests for a life ending prescription; two verbal requests separated by at least 15 days, and one written request witnessed by two individuals who cannot be beneficiaries or relatives of the patient. A second medical opinion is mandatory to assure that the patient is terminal, has a six-month prognosis and is mentally competent to make the decision. If either physician feels the individual's judgment is impaired, than a psychological evaluation is required. There are mandatory reporting requirements at several steps along the way to assure that each case is identified and documented.

This legislation is about choice and control for patients who are already dying. It is completely voluntary; no physician or patient who disagrees with the legislation needs to participate. The title of the legislation, "Patient Choice and Control at the End of Life", is meant to accurately reflect the process. Patients who use this legislation are not committing suicide. Suicide is an impulsive, tragic act done in secret, which ends a life that is yet to be fully lived. Suicide brings sadness and grief to families and loved ones. In contrast, patients who have used the law in Oregon have a terminal illness and face an unavoidable death despite a desire to live. When the very end of life brings unbearable suffering, dying can bring a peaceful end for both patients and their families. To call a hastened death under circumstances like this a suicide is an insult to the deceased and their families.

Death is a deeply personal experience. Many of us have strongly held religious and spiritual beliefs that will guide us at the end of our lives. None of us should presume to fully understand or to control the beliefs of others. And none of us should be able to dictate how much and what type of suffering someone else should have to tolerate at the end of life.

I have witnessed many deaths. Some have been blessedly peaceful. Many have been emotionally and physically difficult for patients. Aggressive palliative care can frequently make the last days tolerable for both patients and their families. But I have also witnessed very difficult deaths where patients face unbearable suffering that cannot be controlled despite the best efforts of family and medical personnel. During these emotionally trying times, which can last hours, days, or weeks, patients and loved ones often ask why death comes so slowly. These are the deaths that one cannot forget and some patients want desperately to avoid. These are the deaths which the Patient Choice and Control Law can do something about.

I am a strong believer in patient choice and control in all aspects of heath care, including end-of-life care. I am an enthusiastic supporter of advanced directives and of the best possible hospice and palliative care. In Oregon, the vast majority of individuals who utilize similar legislation are enrolled in hospice, which illustrates how this legislation will be used as a supplement to, not in place of, all the other best end-of-life care available. Only a small number of patients will utilize the legislation each year, but all Vermonters will benefit from having expanded choice and control at the end of their lives. I believe that passing this bill will allow many dying Vermonters to set aside their fears of a difficult death, and afford them the opportunity to live the rest of their life to the fullest extent possible which is, in the end, what we all want.

I respect those individuals who personally disagree with the use of H.44. I know that my patients have diverse opinions about whether or not they would want to utilize such legislation. Diversity of opinion should be expected and supported. I would like to see us engage in knowledgeable discourse based on facts and free of scare tactics. In the end, however, I believe that we should all have the freedom to decide for ourselves.
Diana Barnard. M.D. practices in Middlebury.