More Americans are making the difficult choice to travel to Vermont and Oregon for assisted dying options. This shift is highlighted by the recent cases of patients like Francine Milano, who, facing terminal illness, seek control over the end of their lives.
Milano's story is emblematic of this trend. Diagnosed with ovarian cancer for the second time, she traveled from Pennsylvania to Vermont not for the scenic views but to make arrangements to die.
“I really wanted to have control over how I left this world,” Milano reflected on her decision at age 61. After initially being informed of her terminal diagnosis, she realized her options were limited.
Previously, dying with medical assistance was not available to her without traveling abroad, typically to Switzerland, or to jurisdictions with favorable laws like the District of Columbia. This changed when Vermont lifted its residency requirements in May 2023, followed closely by Oregon.
These legal shifts have opened the door for terminally ill patients outside these states to seek assisted dying. For many, even with the procedures involved, the chance for agency at the end of life can feel like the ultimate farewell.
According to the Vermont Department of Health, about 26 out-of-state individuals traveled to Vermont to die within the first eight months of the new laws. This made up nearly 25% of the state's assisted deaths during this time frame.
Likewise, Oregon reported over 23 out-of-state residents who utilized medical assistance to end their lives last year, which accounts for 6% of their total assisted deaths.
Dr. Charles Blanke, who provides terminal care at his clinic in Portland, believes these figures are likely underreported. Over the past year, he has noticed two to four out-of-state patients per week, significantly impacting his practice.
The process of obtaining assisted dying, though, is strict and carefully regulated. Patients must be evaluated by two physicians and demonstrate they have less than six months to live, alongside cognitive stability to make such decisions.
This means not only physical travel but also enduring medical evaluations and the logistics of returning to these states multiple times, which can be taxing on severely ill patients. “The law is pretty strict about what has to be done,” Dr. Blanke emphasized.
Such measures, according to Peg Sandeen from Death With Dignity, are meant to protect patients. Still, many advocates argue these rules burden individuals already facing immense challenges, making transition care even more arduous.
Palliative care physician Diana Barnard echoes this sentiment, noting how some patients struggle to even travel for their appointments. “It’s asking people to use significant amounts of their energy to come here,” she commented.
Critics and opponents of assisted dying, including various religious groups, voice strong objections on moral grounds, fearing the impact of sanctioned life-ending decisions. They defend the notion of providing comfort rather than hastening death.
Researcher and anthropologist Anita Hannig, who explored these issues, suggests there won’t likely be any immediate federal redress to this complex issue. The Supreme Court ruled on euthanasia as a state's rights matter back in 1997, mirroring its stance on abortion debates.
During the recent legislative sessions, 19 states, including Pennsylvania, mulled over aid-in-dying legislation. So far, only Delaware has made significant progress, yet the governor has yet to act on it.
Sandeen is optimistic about future developments, noting how states often pass initially stringent regulations before recognizing their impracticality and amending them. “Many states started with burdensome laws only to repeal those as time goes on,” she stated.
Milano would have preferred to use the nearest option of New Jersey, which legalized assisted dying back in 2019. Still, residency stipulations rendered her plans impractical.
Traveling to Vermont was less physically taxing for Milano compared to other options. With her condition, every detail, including travel logistics, weighed heavily on her decisions.
On her first trip to Vermont, she was not at the point of needing to end her life. Instead, she intended to return when her health worsened.
Standard procedure involves a 15-day waiting period after making the request for medication. This is to provide what Barnard describes as “thoughtful time to contemplate the decision,” aiming to lessen impulsive choices.
For many patient families, this waiting time can be difficult. Although Oregon residents often celebrate their loved ones during the final moments with numerous family members, non-residents typically have only one accompanying person due to the costs and logistics of travel.
Navigational challenges increase for out-of-state patients, especially those who might be receiving care at their home facilities. This situation is compounded by hospitals and nursing homes who restrict assisted dying policies.
When Oregon's residency requirements changed, Blanke took to Craigslist to find rental properties willing to accommodate patients for their final moments. Nonprofits have also created databases for these listings, bridging the gap for desperate families seeking compassion.
Despite her travels, Milano has not yet reached the point where she needs to secure her final resting place. Encouragingly, she enjoyed relative health following her first trip, allowing her to let her medication approval lapse.
Yet, recognizing the timeline of cancer, Milano ventured back to Vermont to re-open her window of approval. This time she brought along her friend and camper van, taking breaks along the way for both their physical and mental well-being.
Today, Milano finds herself grappling with fears beyond logistics. What if she can’t make the trip when she reaches the point of needing assistance?
Despite her apprehensions, knowing she has the means to take charge of her death provides some assurance. Many individuals approved for euthanasia do not follow through, Dr. Blanke observed, often finding the control over their lives enough to provide peace.
Milano expressed gratitude for the option she has, lamenting, “I just wish more people had the same opportunity.” The conversations surrounding assisted dying are complex, intertwining humanity and legality as they touch on deep moral questions.
Patients like Milano symbolize the conflict between choice and regulation. Their stories spotlight the pressing need for dialogue on the values of autonomy and the rights of terminally ill individuals.
