Is ‘Death Tourism’ on the Rise? Vermont Moving to Drop Residency Requirement for Assisted Suicide

Bill would provide East Coast ‘option’ for terminally ill out-of-state residents who want to end their lives legally with a lethal-drugs prescription.

The Church rejects suicide, as well as its modern companion, assisted suicide.
The Church rejects suicide, as well as its modern companion, assisted suicide. (photo: Unsplash)

Vermont legislators are considering dropping the state’s residency requirement for assisted suicide, which would allow doctors to prescribe life-ending drugs to anyone 18 or older with a qualifying terminal illness who comes to the Green Mountain State.

If the bill passes, Vermont would become the second of the 10 U.S. states that allow assisted suicide to also allow out-of-staters to get a prescription for it.

Oregon dropped its residency requirement in March 2022, after state officials decided not to contest a lawsuit challenging it. Vermont would provide an East Coast option.

“Remove the residency requirement on enough states that have assisted suicide laws, and you’ve pretty much got the whole United States,” said Mary Beerworth, executive director of Vermont Right to Life, in a telephone interview with the Register.


Clash of Terms

Assisted-suicide laws in the United States generally allow doctors to prescribe lethal drugs to a patient diagnosed with a terminal illness likely to kill the patient within six months with certain safeguards designed to ensure the patient is competent and the decision is voluntary.

Advocates on either side disagree not only on whether such a policy is a good idea, but also what to call it. Supporters call it “medical aid in dying.”

Whatever the terminology, accessing it has become easier in Vermont, where the original version of the statute required, among other things, two in-person visits to a doctor, two oral requests 15 days apart, a subsequent written request, and a waiting period of at least 48 hours between the final request and the prescription. In April 2022, the governor signed into law a bill allowing a telehealth option and eliminating the 48-hour waiting period.

The new bill, which observers expect to pass, would open the option to non-residents.

“We always said the slippery slope would keep widening. And it did,” Beerworth said.


Live and Let Die?

Supporters of allowing lethal prescriptions in terminal cases say they value patients’ ability to decide their own end on earth.

“Really the fundamental principle underlying medical aid in dying is respect for individual values and recognition that end of life is a deeply personal time, and if a person is suffering that they should have a right to have their own choices honored, based on their own individual choices and needs, and their own beliefs and values,” said Betsey Walkerman, executive director of Patient Choices Vermont, which supports the bill, in a telephone interview.

A Vermont palliative-care physician who prescribes lethal drugs to end-of-life patients told a legislative committee that her patients want to live, but knowing that they can’t live much longer, they want to control how they die.

“I see how comforted my patients are by having somebody listen to their suffering, by having options for how to manage their suffering,” Dr. Diana Barnard said Thursday, Feb. 9, during a hearing of the Committee on Human Services of the Vermont House of Representatives. “And many of them really are seeking and needing and wanting just a measure of control over what is happening at the end of their lives, when so much of it, unfortunately, feels out of their control. And for some of those people, control means considering a hastened death and the timing of their death.” 

Barnard is a plaintiff in a federal lawsuit challenging Vermont’s residency requirement filed in August 2022 by Compassion & Choices, a Denver-based nonprofit organization that “empowers everyone to chart their end-of-life journey.” Another plaintiff is Linda Bluestein, a 75-year-old woman with terminal cancer of the fallopian tubes who lives in Connecticut, where assisted suicide is illegal, and who wants the option of going to Vermont to get a lethal prescription.

Barnard told the legislative committee that the residency requirement limits her ability to treat her patients.

“Most of my patients live in Vermont. But I live along Lake Champlain, and I also care for residents of New York. And, you know, basically over time, as I’ve cared for more and more people with this law in effect, I’ve really come to see the injustice of not being able to offer the full spectrum of services that I have to my patients in New York that I am able to offer my patients in Vermont,” Barnard said.

The lawsuit complaint argues that Vermont’s residency requirement violates the U.S. Constitution’s guarantees of interstate travel, interstate commerce, and equal protection under the law.

Walkerman, in an interview, likened a lethal-drugs prescription for terminal patients to driving down to Boston from Vermont for cancer treatment

“No one’s saying you can’t come, can’t go across state lines for any other kind of medical service,” said Walkerman. “It’s a fundamental principle in our Constitution that people can freely travel from one state to another for any goods and services they seek.”


‘Death Tourism’

Opponents say ending a patient’s life on purpose undermines respect for human life generally and that ending Vermont’s residency requirement for it adds a harmful and ghoulish aspect to a state best known for skiing, fall foliage and maple syrup.

“And it opens up this idea of ‘death tourism’ — that you travel there as a place to be killed,” said Dwight Duncan, a professor of law at the University of Massachusetts School of Law, who opposes assisted suicide. “It’s one thing to travel to Vermont because they have great ski slopes. It’s another thing to travel there because they have great undertakers.”

Opponents see a negative effect on neighboring states.

“What interest does Vermont have in the suicide of residents of other states? Vermont should take care of its own citizens. It’s sort of intentionally undermining the protections for the citizens of other states,” said Andrew Beckwith, president of the Massachusetts Family Institute, in an interview. “It’s a cynical attempt by Vermont legislators to undermine the protections for life in neighboring states, like Massachusetts, at the same time offloading the consequences to other states while their doctors and pharmacies profit from it.”

Peter Wolfgang, executive director of the Family Institute of Connecticut, told the Register the incremental changes in Vermont’s law amount to bait-and-switch.

“Every state that does not have assisted suicide should take note. What the pro-assisted-suicide lobby calls ‘safeguards’ they will call ‘barriers’ once it is legalized in your state,” Wolfgang said by email. “Assisted suicide should not be legalized in the first place. If it is, attempts to expand it will happen next, as we are now seeing in Vermont and elsewhere.”


Church Teaching

The Church rejects suicide, as well as its modern companion, assisted suicide.

“It is God Who remains the sovereign Master of life,” the Catechism of the Catholic Church states. “We are obliged to preserve it for his honor and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.”

A July 2020 Vatican document called Samaritanus Bonus (The Good Samaritan) calls assisted suicide “an intrinsically evil act, in every situation or circumstance,” because it is, according to the document, “the deliberate and morally unacceptable killing of a human person.”

The document, which was approved by Pope Francis, also criticizes government officials who enable assisted suicide.

“Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful,” the document states.

A 2016 poll suggests a gap between Church teaching on assisted suicide and how most Catholics in the United States feel about it. The poll, conducted by Lifeway Research, an evangelical Protestant research firm, found that 70% of Catholics agreed with the following statement: “When a person is facing a painful terminal disease, it is morally acceptable to ask for a physician’s aid in taking his or her life.” More recent polls appear to confirm that finding.

The Church teaches that suffering is redemptive — “a participation in the saving work of Jesus,” according to the Catechism of the Catholic Church. 


Oregon the First

Legal physician-assisted suicide in the United States began in Oregon, where the state’s voters approved it in a 1994 referendum, by 51% to 49%.

Oregon’s statute, which became a template for other states, has a residency requirement. In October 2021, Compassion & Choices filed a federal lawsuit challenging the state’s residency requirement on behalf of a doctor there.

The docket for the case in U.S. District Court for the District of Oregon shows that the state attorney general did not contest the lawsuit, instead requesting three extensions to reply to the plaintiff’s complaint before settling the case in March 2022.

“Subsequent to the filing of the Lawsuit, the State decided … it would not apply or otherwise enforce the residency requirement under the Act …” states a settlement agreement filed jointly on March 28, 2022, by the theoretically opposing sides.

Asked why, a spokesman for the Oregon Attorney General’s Office did not respond to a request for comment.

The Oregon Medical Board, one of the defendants in the suit, responded to an inquiry by the Register by saying the board “does not have a comment on this case other than the information contained in the settlement agreement.”

The Oregon Health Authority, another defendant in the case, agreed in the settlement to support a future attempt in the state Legislature to remove the residency requirement. A bill to that effect filed earlier this year is pending.


Residency Requirements Elsewhere

The other states that have a statute that makes physician-assisted suicide legal — California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Vermont and Washington — have a residency requirement.

So does the District of Columbia.

Montana is in an unusual situation. The state doesn’t have a statute allowing assisted suicide, but a state Supreme Court decision in 2009 found that, in the absence of a statute prohibiting it, physicians could claim a defense against prosecution for it. A bill that would explicitly ban assisted suicide is pending before the state Senate’s Judiciary Committee, which held a hearing on it Feb. 1.

Jeff Laszloffy, president of the Montana Family Foundation, told the committee that terminally ill patients should seek palliative care to lessen their pain, not suicide.

“Doctors should not be killers,” Laszloffy said. “Doctors should be healers. And we should not turn that profession on its ear because there’s a few doctors that think that assisting in a suicide is okay.”