In the 18 months since she was diagnosed with ovarian cancer in her 20s, Francine Milano traveled twice from her Pennsylvania home to Vermont. She didn’t go hiking, she didn’t enjoy the countryside, she even planned her own death.
“I wanted to have control over how I left this world,” says the 61-year-old Lancaster resident. “I decided it was something I could choose.”
Seeking medical help to die was not an option when Milan, in early 2023, knew that his illness was incurable. At that moment, I wanted to travel to Switzerland, or live in the District of Columbia or one of its 10 States Where Assisted Dying Was Legal.
But Vermont eliminated its residency requirement in May 2023, followed by Oregon two months later. (Montana allows assisted death by virtue of a 2009 court decisionbut this failure does not establish any rules on residence. And yet New York and California (While recently legislation was passed that would allow out-of-state residents to access medical aid in dying, neither provision passed.)
Despite limited options and timeframes — such as meeting doctors in a new state, deciding where to die, and traveling when you’re too immobile to walk to your dorm or get into your car — witnesses have made the journey in person to both states that have opened their doors to terminally ill non-residents seeking help in dying.
Fewer than 26 people traveled to Vermont to die, which represents nearly 25% of the state’s recorded attended deaths from May 2023 to June 2024, according to the Vermont Department of Health. In Oregon, 23 out-of-state residents used medical care in 2023, about 6% of the state’s total, according to the Oregon Health Authority.
Oncologist Charles Blanke, whose Portland clinic specializes in end-of-life care, warned that all of Oregon is likely the result of inaccurate recall and hopes the numbers will increase. “In the past year, I said I’ve seen two out-of-state patients a week — about a quarter of your consultation — and I’ve gotten calls from all over the country, including New York, the Carolinas, Florida and the ‘toneladas’ of Texas.” But just because patients are willing to travel doesn’t mean it’s easy or that they’re getting the results they want.
“The law is very strict about what you can do,” Blanke stated.
As in other states that have allowed some llamas to die under the care of a doctor or to commit suicide, Oregon and Vermont require that patients be evaluated by two doctors.
Patients must be less than six months old, mentally and cognitively healthy, and physically capable of taking medications to end their lives. Historians must be reviewed in the state; failure to do so constitutes practicing medicine outside the state, which violates the requirements for obtaining a medical license.
For the same reason, patients must be in the state for the initial examination, when they solicit medications and when they take them.
State legislatures impose these restrictions as a safeguard, to balance the rights of patients seeking help in dying with the legislative imperative to not pass laws that could harm people, said Peg Sandeen, CEO of the group. Dying with dignity (Death with Dignity.) But like many advocates of assisted dying, Sandeen says these rules place too much of a burden on your friends.
Diana Barnard, a Vermont patient care physician, made sure that some patients or patients could not go on with their lives. “They end up sick or not want to travel, because you have to reschedule the quotes,” she explained. “If you’re giving patients that use a significant portion of their energy to come here when you’re really having the option closer to home.”
All those who are opposed to death are assisted religious groups that to say that leaving a life is immoral, and doctors who argue that your job is to make sure patients end their lives in the most comfortable way, fail to end their lives in the most comfortable way.
The anthropologist Anita Hannigwho interviewed terminally ill doctors during the investigation for his 2022 book, “The Day I Die: The Untold Story of Assisted Suicide in America” (“El día que muera: la historia no contada de la muerte asistida en Estados Unidos”), he stated that I did not expect the federal legislation to be ready for the issues. Just as with abortion in 2022, the Supreme Court in 1997 ruled that assisted death was a rightful issue for states.
During the 2023-24 legislative sessions, 19 states (including Pennsylvania, Milan’s home state) is considering enacting assisted dying laws, according to the organization Compassion and choices. Delaware was the only state that existed he approved itbut the governor still has no idea about it.
Sandeen noted that many states have initially had restrictions — requiring 21-day waits and mental health evaluations, for example — to get waivers that are very complex. So we are optimistic that other states will follow Vermont and Oregon’s lead.
Milano would have preferred to travel to nearby New Jersey, where euthanasia has been legal since 2019, but its residency requirement made it impossible. And while Oregon has more providers than rural Vermont, Milano opted to drive hours to Burlington because it was less physically and financially costly to travel across the country.
Logistics were key because Milano knew I would have to come back. When I traveled to Vermont in May 2023 with her husband and brother, I was not at the death line. I thought the next time I was in Vermont, the drugs would need to be shipped. So I would have to wait 15 days to receive it.
The waiting period is standard to ensure a person has what Barnard calls “time to think before they decide,” though he said the mayor had done so long before. Some states have cut off hope or, like Oregon, can apply for an exemption.
This waiting time can be tough on patients after they have wanted to take care of their doctor, their home, and their family. I didn’t say I saw up to 25 family members witness the death of an Oregonian, but those who lived outside of the state of Suelen were alone with one person.
And finding a place to die can be a problem for Oregon residents in nursing homes or hospitals that prohibit assisted dying, and it’s especially difficult for nonresidents.
When Oregon eliminated its residency requirement, Blanke posted an ad on Craigslist and used the results to copy a list of short-distance accommodations, including Airbnbs, that would allow patients to die instantly. Nonprofits in states with assisted-dying laws also maintain such lists, Sandeen says.
Milan has not reached the point where you need to find a place to get your medicine and end your life. In fact, as your relatively healthy year after your first trip to Vermont, I spent your six-month approval period.
In June, without embargo, I moved to open another place for six months. This time she was with a friend who keeps a house running. They drove six hours to cross the front of the estate, blocking it a children’s park and a box of gifts Before being held at a station where Milan had a Zoom city with his doctors at the place where he drove three hours more to Burlington to meet in person.
“I don’t know if they track GPS or IP directions, but I had to be honest,” he said.
He’s not the only one who worries about it. The worry is being too sick to return to Vermont when he’s listed to die. And even if you can get to everything, ask if you’ll have the courage to take the medicine. Nearly a third of the people who had witnessed the death had not, Blanke explained. For them, the menu is enough to know if you have the medicine – the control – to put them in your life when you want it.
Milano said she is happy to have the power now that she is still healthy enough to travel and enjoy life. “Ojalá más tuviera esa opción,” she stated.
