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, known as Act 39, which lets a capable adult with a terminal illness request medication from a Vermont-licensed physician to end their own life. Signed into law on May 20, 2013, the statute was the first medical aid-in-dying law passed by a state legislature rather than approved through a ballot measure.¹ Two later amendments matter for anyone using it today: a 2022 update that allowed telemedicine and cut a waiting period, and a 2023 change that removed the state residency requirement.

Who Qualifies

Every requirement in 18 V.S.A. § 5283 has to be met. You must be at least 18, have a terminal condition expected to result in death within six months, and be “capable” — meaning able to make and communicate health care decisions to a physician.² If your usual way of communicating involves someone familiar with you, that counts, so a speech impairment on its own does not disqualify you.

You do not need to live in Vermont. Governor Phil Scott signed the bill removing the residency requirement in May 2023, so you can now seek care in Vermont from any state, though you still need to work with a Vermont-licensed physician and complete the full evaluation.³

One boundary catches people off guard. You cannot request the medication through an advance directive, a health care proxy, or any other person acting on your behalf. Each request must come from you, in person, while you still have capacity. If capacity is lost partway through the process, the process stops. For anyone facing a progressive neurological condition, that turns timing into a real decision.

The Request Process

Two Oral Requests, 15 Days Apart

You make two separate oral requests to the physician who would write the prescription, and the requests must be at least 15 days apart.⁴ Since 2022, those visits can happen by telemedicine when the physician judges it clinically appropriate, so you do not have to be in the same room each time.⁵ At the second oral request, the physician has to offer you the chance to change your mind.

A Written Request With Two Witnesses

You also sign a written request. The Vermont Department of Health publishes a standard form titled “Patient’s Request for Medication for the Purpose of Hastening My Death,” but any written request containing the required elements works.⁶ Two witnesses, both at least 18, must watch you sign and then sign themselves, confirming you appeared to understand what you were doing and were not being pressured.

The 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’re receiving care.² Lining up two people who fit is worth thinking about early.

Medical Evaluations

Your prescribing physician confirms the terminal diagnosis, verifies that you are acting voluntarily, and makes sure you have been informed of the alternatives, including hospice care, palliative care, comfort care, and pain management.¹ A second, independent consulting physician reviews the records and separately confirms the diagnosis, the prognosis, and your capacity.

If either physician thinks your judgment may be impaired, by depression for example, they must refer you to a psychiatrist, psychologist, or licensed clinical social worker before anything else can happen.⁴ That evaluation has to confirm you are capable and not suffering from impaired judgment. A referral can add real time to the timeline.

Getting and Taking the Medication

Once the two oral requests, the written request, the consulting physician’s review, and any required mental health evaluation are complete, your physician can write the prescription. Under the statute, the prescription can be written after the latest 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 either to you or to someone you designate to pick it up. You can stop at any point. Nothing about filling or taking the medication is obligatory once the prescription exists.⁴

You Have to Take It Yourself

Vermont law requires self-administration. A physician, nurse, or family member cannot give you the medication. The statute uses the term “self-administered,” which means you need to be physically able to swallow the liquid or otherwise ingest the dose without help.¹ That’s why capacity and physical ability matter at the time you take the medication, not only at the time you requested it.

If the Medication Goes Unused

Some people obtain the prescription and never take it, finding comfort in having the option. Unused medication should be disposed of safely. The Vermont Department of Health operates free, anonymous drop-off kiosks and mail-back envelopes for prescription drugs across the state. You can remove your personal information from the container and either drop it at a kiosk or mail it in a prepaid envelope from any USPS location.⁷

What It Costs

The medication itself has recently run around $750. Medicare prescription drug plans generally do not cover it. Some private insurance plans do, so check your specific coverage before you fill the prescription.⁶ Separate from the medication, expect fees for the prescribing physician visits, the consulting physician’s evaluation, and any mental health assessment. Those may be billed and covered as ordinary medical appointments under your regular insurance.

Protections and Limits Worth Knowing

How the Death Is Recorded

Vermont treats 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 standard suicide exclusion clauses turn on the manner of death. Vermont’s statute does not spell out the insurance question as explicitly as some other states, so if a policy is a concern, review it directly with your insurer before you proceed.

Providers Can Decline

Physicians, nurses, pharmacists, and other licensed providers who take part in good faith are shielded from civil liability, criminal prosecution, and professional discipline. The same statute protects providers who refuse to take part: no employer or facility can punish a physician, nurse, or pharmacist for declining.⁸

Facilities Can Opt Out

Under 18 V.S.A. § 5286, a health care facility can prohibit a physician from writing the prescription for a patient who is a resident of the facility and plans to take the medication on the premises. The facility must give its physicians written notice of that policy.¹ Some hospitals, nursing homes, and residential care homes, particularly those with religious affiliations, do not allow aid in dying on-site. If you live in one of those facilities, you would need to arrange to receive and take the medication elsewhere.

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