Stephen Leffler M.D., the medical director of Fletcher Allen, writing on the hospital’s blog page, points out some of the many challenges the assisted suicide law presents to hospitals (http://fletcherallenblog.wordpress.com/2013/06/05/patient-choice-at-the-end-of-life-what-vermonts-new-law-means-for-fletcher-allen/).
There is, for example, the question of how the widely touted exemption from participating in assisted suicide will work. The law, now published on the Vermont legislative website as Act 39 (http://www.leg.state.vt.us/docs/2014/Acts/ACT039.pdf), states, “A health care facility may prohibit a physician from writing a prescription for a dose of medication intended to be lethal for a patient who is a resident in its facility and intends to use the medication on the facility’s premises, provided the facility has notified the physician in writing of its policy with regard to the prescriptions.” Fletcher Allen has chosen to avail itself of this exemption from the assisted suicide law on an interim basis while it decides what to do in the long term.
Noting that the exemption is applicable only for the hospital’s doctors and “for patients who are residents of the facility and intend to take the medication on site”, Dr. Leffler asks the obvious question, “What if a patient brings the medication from home and wishes to self-administer it here?”
The law offers no guidance on this or a number of other questions. For example, what if a doctor working in a non-participating facility writes a suicide prescription for a patient, then discharges him to take it at home or in a participating facility. Would the facility be able to discipline him?
Some of the questions Dr. Leffler asks are ethical ones any health care facility would have to ask itself in confronting any assisted suicide law. For example: Should the hospital participate? If it does not, should it refer patients to facilities that will?
Others are legal questions, ones that should have been answered by the law itself, simple questions like the one about the patient who brings the prescription, obtained from a non-hospital physician, from home or about the doctor who writes the prescription in the facility for use off its premises.
The fact that hospitals must now grapple with these unanswered legal questions is evidence of what a shoddily written piece of legislation this is. A legislature that ignored tons of reasonable and expert arguments to legalize the inherently dangerous and pressuring medical practice of prescribing suicide drugs should have at least given those affected a clear and unambiguous law. The VT legislature did not.