Waukeshahealthinsurance.com-
KFF health news
–
Francine Milano has traveled from her home in Pennsylvania to Vermont twice in the 18 months since the ovarian cancer she thought she beat 20 years ago has returned. She went not to ski, hike, or rake leaves, but to prepare to die.
“I wanted to be in control of how I left this world,” said the 61-year-old, who lives in Lancaster. “I decided this was an option for me.”
Milano In early 2023, when he learned that her disease was terminal, medically assisted dying was not an option. At that point, she had to go to Switzerland – or live in the District of Columbia or something. 10 states where medical assistance in dying is legal.
But Vermont lifted its residency requirement in May 2023, followed by Oregon two months later. (Montana effectively allows assistance in dying In 2009, the court decisionBut this decision does not define the rules on residency. And although New York and California has recently been considered (No provision has been made to allow out-of-state persons to receive aid in death.)
Despite the limited options and challenges — like finding doctors in a new country, figuring out where to die and getting in a car, let alone getting to the next ward when they're too sick — dozens have made the trip to the two. States that have opened their doors to residents who are not seeking assisted dying.
At least 26 people traveled to Vermont to die, representing nearly 25% of all deaths in the state between May 2023 and June, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents died with medical assistance in 2023, just over 6% of the state total; Oregon Health Authority.
Charles Blanke, an end-of-life oncologist whose clinic in Portland is dedicated to end-of-life care, said he thinks Oregon's total may be an underestimate and expects the number to rise. Last year, he saw two to four out-of-state patients a week — about a quarter of his practice — and made calls all over the U.S., including New York, the Carolinas, Florida and “Ton. From Texas” But just because patients are willing to travel doesn't mean it's easy or they'll get the results they want.
“The law is very strict about what needs to be done,” Blanke said.
As do other states that some allow physician-assisted death or suicide, Oregon and Vermont require patients to be evaluated by two doctors. Patients must have less than six months to live, be mentally and cognitively healthy, and be able to physically take drugs to end their lives. Charts and records should be reviewed within the state; Failure to do so constitutes out-of-state treatment in violation of medical licensing requirements. For the same reason, patients must be in the state for the first examination, when they ask for the drugs and when they are administered.
The group's CEO, Peg Sandin, said state lawmakers impose those restrictions as safeguards — to balance the rights of patients who need help with the legislature's need to not enact laws that harm anyone. Death with honor. Like many assisted-dying advocates, however, she said such laws would place unnecessary burdens on people who are already suffering.
Diana Barnard, a Vermont palliative care physician, said some patients don't even make it to their appointments. “They ended up getting sick or didn't want to travel, so there was another appointment,” she says. “It's asking people to use a significant portion of their energy to come here when they have a choice closer to home.”
They include those who object to assistance in dying Religious groups They say that taking life is immoral, and Medical professionals Their job, they argue, is to make people feel comfortable at the end of life, not to end life itself.
Anthropologist Anita HannigIn the year In researching her book 2022, she interviewed dozens of terminally ill patients, “The Day I Die: The Untold Story of Assisted Dying in AmericaShe said she does not expect the federal law to resolve the issue soon. The Supreme Court in In 1997, it decided to make dying a state rights issue, as it did abortion in 2022.
In the 2023-24 legislative sessions, 19 states (including Milan's state of Pennsylvania) has considered subsidized legislation, according to the advocacy group. Empathy and choices. Delaware was the only state. to passBut the governor has not yet acted on it.
Sandin said many states initially pass restrictive laws — such as those requiring 21-day waiting periods and psychiatric evaluations — only to eventually repeal overly onerous provisions. That makes her hopeful that more states, like Vermont and Oregon, will follow suit, she said.
Milano preferred to travel to neighboring New Jersey. As of 2019, assisted dying is legal, but the residency requirement makes that a non-starter. And although Oregon has more suppliers than the mostly rural state of Vermont, Milano opted for the nine-hour drive to Burlington because it was physically and financially less expensive than a cross-country trip.
Logistics were key as Milano knew she had to return. When she traveled to Vermont with her husband and brother in May 2023, she was not close to death. The next time she was in Vermont, she thought, she would ask for the medicine. Then she has to wait 15 days to receive it.
Waiting times are standard to make sure someone has had “considerable time to think about the decision,” Barnard said, though many do so much earlier, she said. Some states have shortened the period or have the option to waive it, like Oregon.
That wait time can be difficult for patients, even more so than being away from their health care team, home and family. Blanke said he's seen as many as 25 relatives attend an Oregon death, but out-of-state usually only brings one person. And while finding a place to die can be a problem for Oregonians in nursing homes or hospitals that refuse aid in dying, it's especially challenging for nonresidents.
When Oregon lifted its residency requirement, Blanke advertised on Craigslist and used the results to compile a list of short-term accommodations, including Airbnbs, to allow patients to die there. Nonprofits in states with dying laws also maintain such lists, Sandin said.
Milano is not at the point where she needs to take medication and find a place to end her life. In fact, since she had a relatively healthy year after her first trip to Vermont, she let her six-month leave expire.
But in June, she went back to open another six-month window. This time she went with a girlfriend who had a camper van. They drove six hours to cross the state border. Stop at the playground and gift shop Instead of driving three hours to Burlington for an in-person meeting, Milano sat in the parking lot with her doctor for an ultrasound appointment.
Get Health's weekly newsletter
“I don't know if they do anything like GPS tracking or IP address, but I was afraid to tell the truth,” she said.
This is not the only thing that scares her. When she was ready to die, she was too sick to return to Vermont. And, even if she can get there, she wonders if she'll have the courage to take the medicine. About a third of people who are approved for assisted dying don't follow through, Blanke said. For them, it's often enough to know that they have the drug—the control—to take their lives when they need it.
Milano, for her part, said she is grateful that her health now gives her the strength to travel and enjoy life. “I wish more people had an option,” she said.
KFF health news It is a national newsroom that produces in-depth journalism on health issues and is one of the main operating programs. KFF – An independent source for health policy research, polling and journalism.