The Vermont Study on Aid-in-Dying, 2016-2018

Résumé 0

Legislative support for physician aid-in-dying (PAD) in the US has risen steadily in recent years. In May 2013, Vermont became the fourth state to legalize PAD, through the "Patient Choice and Control at End of Life" Act (Act 39). The law authorized physicians to prescribe a lethal dose of medication to a mentally competent, terminally ill, adult patient for the purpose of ending the patient's life. With ongoing legislative activities in many other states, these laws are expected to spread nationally. This shifting legislative climate raises questions about how societies respond to changes in the sociocultural and biopolitical organization of death. While social scientists have examined the social and political forces that shape 'right to die' movements and counter-movements, sanctioning the right to die is only the first step in institutionalizing PAD as a new cultural and medical practice. What happens once these rights are legally authorized? The purpose of this study was to learn about how people in Vermont have been affected by Act 39. This 2-year ethnographic study (July 2016-June 2018) addressed the following overarching research questions: How do ordinary people understand, access, experience, and contest the 'right to die' through PAD once it has been granted?How do healthcare providers and policy stakeholders accommodate or resist PAD as a new end-of-life practice?How does PAD affect the cultural landscape of care for the dying in the US? Due to the recent enactment of Act 39, and Vermont's small size and the geographic proximity of key institutions, Vermont offered an ideal setting to explore these questions and document emergent responses to a new socio-legal phenomenon across multiple sites. By tracing the social life of Act 39 from the Vermont State House to the institutions, experts, and ordinary people responsible for managing death, this study yielded valuable information about the broad sociocultural consequences of legalizing PAD, including unintended consequences, that will be relevant to US policymakers, clinicians, patients, and families. This collection includes semi-structured interviews with seriously ill Vermont patients, survivors of people who have used Act 39, healthcare providers and administrators, activists, and legislators, as well as participant observation in settings in which PAD is likely to be discussed. Participants were asked about their personal and professional backgrounds, attitudes on death and the legalization of PAD, understandings of the physician's role and responsibilities regarding end-of-life care, and interactions between healthcare providers, patients, and caregivers about PAD. The age, gender, and race of the participants are also provided.