Box 1.

Case study: navigating the Act 39 protocol

Dr. Copeland* was a hospital-based primary care physician who was approached by a new patient with ALS, Jim, who had moved to Vermont with the hope of accessing Act 39. Dr. Copeland felt uncertain about prescribing but understood Jim’s reasons for pursuing AID and eventually agreed to participate. She had no experience with AID and the lack of infrastructure to support providers through the process meant that she had to spend significant time making phone calls to work out logistics. Dr. Copeland learned where to find the necessary forms for documentation, what type and dose of medication to prescribe, which pharmacy would fill the prescription, and who could assist, in what ways, with administering the drug. She also consulted with her legal department to determine who could be present for the death and what responsibility she would have for any complications that might arise. Because Jim had moved recently, Dr. Copeland also had to figure out whether he met the law’s residency requirement. Jim asked Dr. Copeland to be present for his death, but she ultimately decided against attending. After this experience, Dr. Copeland and several colleagues held a lecture to educate their institution about her experience with Act 39. *All names are pseudonyms.