Death With Dignity in Vermont: Eligibility, Requests, and Costs

Death with dignity in Vermont is governed by the Patient Choice and Control at End of Life Act, often called Act 39, which lets a terminally ill adult request a prescription for medication to end their own life. To qualify you must be at least 18, be able to make and communicate your own health care decisions, and have a terminal condition expected to cause death within six months. The request process requires two oral requests to your physician 15 days apart, a signed written request with two witnesses, and confirmation from a second consulting physician before the prescription can be written.¹

Who Qualifies

Eligibility sits in 18 V.S.A. § 5283. You must be 18 or older, have a terminal illness with a prognosis of six months or less, and be “capable,” which the statute defines as having the ability to make and communicate health care decisions to a physician.² Communication can be relayed by someone familiar with how you usually communicate, so a speech impairment on its own does not disqualify you.

You do not have to live in Vermont. The residency requirement was removed in May 2023 after a legal challenge, and you can now seek care in Vermont regardless of where you live.³ You still have to work with a Vermont-licensed physician and complete every step the law requires.

One boundary catches families off guard: you cannot request aid-in-dying medication through an advance directive, a health care proxy, or anyone acting on your behalf. The law requires you personally to make each request, orally and in writing, while you still have mental capacity. If you lose capacity between requests, the process stops. For a progressive neurological condition, that makes timing a real consideration.

The Request Process

Two Oral Requests, 15 Days Apart

You make two separate oral requests to the physician who will write the prescription, and they must be at least 15 days apart.⁴ Since 2022, these conversations can take place by telemedicine when the physician decides that is clinically appropriate, so you no longer need to be in the same room for every visit.⁵ At the second oral request, the physician must offer you a chance to rescind.

Written Request and Witnesses

You also sign a written request. The Vermont Department of Health publishes a standard form, “Patient’s Request for Medication for the Purpose of Hastening My Death,” but the statute does not require that exact form; any written request covering the required elements will work.⁶ Two adult witnesses must watch you sign and then sign themselves, affirming you appeared to understand what you were doing and were not under pressure.

Both witnesses must be disinterested. Neither can be your physician, a relative by blood, marriage, civil union, or adoption, someone who stands to inherit from you, or an employee of the facility where you are receiving care.² In a small-town hospital, finding two people who meet all those criteria takes some planning.

Medical and Mental Health Evaluation

Your prescribing physician must confirm your terminal diagnosis, verify that you are acting voluntarily, and make sure you have been told about every alternative, including hospice care, palliative care, comfort care, and pain management.¹ A second, independent consulting physician then reviews your records and separately confirms the diagnosis, the prognosis, and your mental capacity.

If either physician suspects your judgment may be impaired, by depression for example, the law requires a referral to a psychiatrist, psychologist, or licensed clinical social worker before anything else happens.⁴ That evaluation has to confirm you are capable and not suffering from impaired judgment. A mental health referral is the step most likely to slow things down.

Getting and Taking the Medication

Once you have completed both oral requests, the written request, the consulting physician’s review, and any required psychiatric evaluation, your physician can issue the prescription. The statute allows the prescription to be written after the last of three events: your written request, your second oral request, and the physician’s offer to let you rescind.¹

The prescription goes to a participating pharmacist, who dispenses the medication to you or to someone you designate to pick it up. You can stop the process at any point. Nothing obligates you to fill the prescription, and nothing obligates you to take it once filled.⁴

You Must Take It Yourself

Vermont law is firm on this. The medication must be self-administered. A physician, nurse, or anyone else cannot give it to you.¹ You need to be physically capable of swallowing the liquid or otherwise ingesting the dose without help. That is why capacity and physical ability matter not just at the time you request the medication but at the time you use it.

If You Do Not Use It

Some people obtain the prescription for the sense of control it provides and never take it. If the medication goes unused, dispose of it safely. The Vermont Department of Health operates free, anonymous drop-off kiosks and prepaid mail-back envelopes for unused prescription drugs; remove your personal information from the container first.⁷

What It Costs

The medication itself has recently cost around $750. Medicare prescription drug plans typically do not cover it. Some other plans do, so check your specific coverage before filling the prescription.⁶ Expect additional costs for the prescribing physician’s visits, the consulting physician’s evaluation, and any psychiatric assessment that gets triggered. Many of those visits may be covered under your regular health insurance as ordinary medical appointments.

Protections for You and Your Providers

How the Death Certificate Reads

Vermont treats medical aid in dying as distinct from suicide. The death certificate lists the underlying terminal disease as the cause of death and “natural” as the manner of death.³ That classification matters to families worried about life insurance; because the death is recorded as natural rather than suicide, standard suicide-exclusion clauses should not apply. The Vermont statute does not address life insurance as directly as some other states’ laws do, so if this is a concern, review your specific policy with your insurer before proceeding.

Immunity for Participating Providers

Physicians, nurses, pharmacists, and other licensed healthcare providers who participate in the process in good faith are shielded from civil liability, criminal prosecution, and professional discipline.⁸ The same statute protects providers who choose not to participate; no employer or facility can punish a physician, nurse, or pharmacist for declining.

When a Facility Opts Out

Individual clinicians are not the only ones who can decline. Under 18 V.S.A. § 5286, a healthcare facility may prohibit a physician from writing the prescription for a resident of that facility who plans to use the medication on the premises, as long as the facility gives written notice of the policy to its physicians.¹ Some hospitals, nursing homes, and residential care homes, particularly those with religious affiliations, do not allow aid in dying on-site. If that describes where you live or receive care, you will need to arrange to receive and take the medication somewhere else.

1
Vermont General Assembly. Vermont Code 18 – Chapter 113: Patient Choice at End of Life
2
Vermont General Assembly. Vermont Statutes 18 V.S.A. 5281 – Definitions
3
Vermont General Assembly. Report to the Vermont Legislature: Report Concerning Patient Choice at the End of Life
4
Vermont General Assembly. Vermont Statutes 18 V.S.A. 5283 – Requirements for Prescription and Documentation; Immunity
5
Vermont General Assembly. Vermont Act 97 – An Act Relating to Modifications to Vermont’s Patient Choice at End of Life Laws
6
Vermont Department of Health. Patient Choice at End of Life Frequently Asked Questions
7
Vermont Department of Health. Prescription Drug Disposal
8
Vermont General Assembly. Vermont Statutes 18 V.S.A. 5285 – Limitations on Actions