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More people want to come to Vermont to receive medical assistance in dying than the system can handle

Since Vermont lifted the residency requirement for physician-assisted suicide last year, Dr. Diana Barnard can no longer handle calls from potential patients.

“It can be tough. I have about three calls on my phone right now,” she said during an interview at Porter Medical Center in Middlebury, where she works as a palliative care physician.

Vermont is one of nearly a dozen states where doctors can prescribe lethal drugs to terminally ill patients who want to hasten their death. During the first decade the law was in effect, only Vermont residents could take advantage of it. Then, in 2023, lawmakers opened the program to people from other states. The change brought an influx of interest to the small state.

“The floodgates opened and all of a sudden we were getting these calls,” said Dr. Tim Shafer, a physician at Grace Cottage Hospital in Townshend. He prescribes aid-in-dying drugs, as do some of his colleagues. Because they are located in southern Vermont, they often receive requests from Massachusetts, New Hampshire and other nearby states.

Barnard has also taken in a number of patients from other states, including Rita Mannebach of Florida. Earlier this year, Barnard confirmed that Mannebach had a fatal lung disease and prescribed her the medication. Mannebach and her family worked with a local end-of-life care provider, Meg Tipper, to arrange housing in Vermont and make other logistical and emotional preparations.

Rita Mannebach worked for years as a hospice volunteer and advocated for physician-assisted dying in Florida before seeking it out in Vermont. (Courtesy of Mike Mannebach via Vermont Public)
Rita Mannebach worked as a hospice volunteer for years and advocated for physician-assisted dying in Florida before seeking it out in Vermont. (Courtesy of Mike Mannebach via Vermont Public)

In a telephone conversation from a rented house in Burlington, Mannebach described her plans for her final day of life.

“On Thursday morning at 10 a.m. we have a small program that we have put together ourselves,” she said. “There will be a symbolic ceremony of letting go – I let go [my family]that they let me go. And then I'll just say a few final words – may you find peace, may you be happy, things like that.”

She had no doubts about what should happen next. “For me, it's about quality of life. It leads to less suffering,” she said.

Capacity building

Barnard is well known in this area of ​​the medical world. She filed a lawsuit against the state with one of her patients, a Connecticut resident who wanted to seek assisted dying in Vermont. The lawsuit led to Vermont lifting its residency requirement, and it led to Barnard getting a lot of patients—far more than she can responsibly accommodate.

“Building capacity is important,” she said. “A big part of my job is to teach other physicians and in some ways educate them on the importance of this practice. I want to guide them and teach them how to do it so they feel confident doing it themselves.”

This can be a challenge for busy doctors. Most doctors here already have more patients from Vermont than they can handle. Each new patient requires a lot of paperwork, multiple office visits and emotional support. End-of-life medical aides must be in Vermont for two required appointments and take the medications.

The Porter Medical Center in Middlebury, where Dr. Diana Barnard treats patients. (Sophie Stephens/Vermont Public)
The Porter Medical Center in Middlebury, where Dr. Diana Barnard treats patients. (Sophie Stephens/Vermont Public)

Opening the program to people from other states “has fundamentally changed my life and the way our clinic operates,” said Shafer of Grace Cottage. “We just had to learn a lot about how to make it happen logistically.”

Shafer feels a deep calling to help his suffering patients, and he has had to accept that he cannot help everyone who comes to him.

“Our call center assures us that there are a lot of calls coming in,” he said. “And eventually it somehow exceeded what we could handle. And finally we agreed that we have to limit the number of new consultations to one per week.”

For logistical support, Shafer and other prescribers rely on a new network of volunteers called Wayfinders. It was created earlier this year by Patient Choices Vermont, a nonprofit that educates the medical community and the public about physician-assisted dying. It also lobbied for passage of the original law in 2014.

Wayfinders consists of active and former hospice nurses, social workers and end-of-life carers who can support families and patients in medically assisted dying.

Suzanne Baxtresser, a retired hospice nurse, volunteers in the Brattleboro area. The biggest challenge for her is finding housing to accommodate patients and their families.

Find a safe place

As Vermonters know all too well, the state has an acute housing shortage. Additionally, the state is a popular tourist destination, so finding short-term rentals is even more difficult than finding doctors.

“We want people to take the medication in a safe place,” Baxtresser said. “We want people to know that no one is going to knock on the door and ask, 'What's going on?'”

While some Airbnb owners in the area understand that people may seek euthanasia on their property, they are often fully booked. “When summer comes, everything is rented,” Baxtresser said.

A family that owns an unused property in southern Vermont has practically donated it to the cause — doctors and Wayfinder volunteers call it “the safe house.” And a representative from Patient Choices Vermont said they are actively working on a longer-term housing solution.

If and when that happens, Baxtresser said the increased interest from outside the state will translate into increased out-of-state usage.

“If patients knew there was a clear path, they would come,” she said. “But right now we don't have the support. We don't have the structure to make that possible.”

With the help of the Wayfinders, Rita Mannebach was able to find a place to stay for the weeks before her death. Her years of volunteer work as a hospice helper helped her feel prepared for what was to come.

“I'm very good at dealing with death,” she said. “I'm 84 and I've made my peace with the whole thing. What happens after that is completely unknown to me. I don't know what will happen. But I'm not afraid. That's why I feel completely comfortable with the whole thing.”

Two days after our interview, she put her plan into action. Rita Mannebach from Florida died in Vermont.

After her death, her family planned to transport her ashes to Florida. Then they cleaned up the rental apartment, drove to the airport and went home.

This story is a production of the New England News Collaborative. It was originally published by Vermont Public.

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