Vermont Act 39: What the Medical Aid in Dying Law Actually Requires

Vermont Act 39 — formally the Patient Choice and Control at End of Life Act — has been part of Vermont law since May 20, 2013. It allows adults with a terminal illness and a prognosis of six months or less to request a prescription for life-ending medication that they can self-administer. Vermont was among the first states in the country to enact this law.

A decade later, in May 2023, Governor Phil Scott signed Act 10, which removed the residency requirement from Act 39. Vermont became the first state in the nation to explicitly allow non-residents to travel to Vermont to access medical aid in dying. That change made the law nationally significant — and brought a new category of family into the process.

This is a detailed breakdown of what Act 39 actually requires, who qualifies, and how the procedural timeline works.

Who Qualifies Under Act 39

The law applies to adults who meet all of the following conditions:

• Adult (18 or older) residing in or traveling to Vermont
• Diagnosed with a terminal illness — meaning an incurable, irreversible disease that will cause death
• Medical prognosis of six months or less to live — confirmed by two separate physicians
• Mentally capable of making and communicating health care decisions voluntarily and without coercion
• Physically able to self-administer the medication — administration by a physician, family member, or proxy is strictly prohibited under the statute

That last requirement is worth emphasizing. Unlike some countries with assisted dying frameworks, Vermont's Act 39 requires the patient to personally ingest the medication. A patient whose terminal illness has progressed to a point where they lack the physical capacity to self-administer is no longer eligible under the law, even if they were previously approved.

The Procedural Timeline

The process built into Act 39 is deliberately sequential and has mandatory waiting periods at each stage. It cannot be accelerated.

Step 1: First oral request. The patient makes an oral request to the prescribing physician. This can be done in person or via telemedicine if the physician determines that telemedicine is clinically appropriate for the required assessment.

Step 2: Mandatory 15-day waiting period. Vermont law requires a minimum 15-day interval between the first and second oral requests. This waiting period is fixed — it cannot be waived even if the patient's condition deteriorates rapidly.

Step 3: Second oral request. A second oral request is made to the same prescribing physician.

Step 4: Written request. Following the two oral requests, the patient submits a formal written request. The written request is a statutory form requirement.

Step 5: Second physician confirmation. Concurrently with the above steps, a second independent physician must examine the patient and the medical records to confirm three things: the terminal diagnosis, the six-month prognosis, and the patient's mental capability to make a voluntary, informed decision without coercion.

Step 6: Informed consent. The prescribing physician is required to ensure the patient is fully informed of all alternative options — palliative care, comfort care, and hospice — before issuing the prescription.

Step 7: Physician reporting. Once the prescription is dispensed, the prescribing physician files a Physician Reporting Form with the Vermont Department of Health. Filing this form confers legal immunity from professional, criminal, or civil liability upon all health care providers who participated in the process in good faith.

The 2023 Residency Change: What It Means

Before May 2023, Act 39 required patients to be Vermont residents. Act 10 eliminated that requirement. Vermont is now the only U.S. state with a statutory provision explicitly permitting non-residents to access medical aid in dying.

Practically, this means:

• A terminally ill patient from any state (or country) can travel to Vermont and legally request medication under Act 39
• They must still meet all eligibility criteria, including the two-physician confirmation and the 15-day waiting period
• Travel timing matters: the 15 days cannot be waived, so patients need to initiate the first oral request well before they anticipate needing the medication

For families outside Vermont considering this option, the logistics require planning. The patient must be well enough to travel, establish a treating relationship with a Vermont prescribing physician (telemedicine may apply for the oral requests), and arrange for a second Vermont physician to confirm the diagnosis. Hospice programs in Vermont have experience navigating these coordination questions.

Act 39 and Final Disposition Planning

One practical issue families often discover late: the timing of disposition planning relative to Act 39. If a patient has made Act 39 arrangements, all other end-of-life paperwork — including the designation of who controls funeral arrangements — should be completed before the process begins, not after.

Vermont law under 18 V.S.A. § 5207 establishes a default hierarchy for who has the legal right to control disposition: an appointed agent (if one is designated in writing), then a surviving spouse, then a majority of competent adult children, and so on down through next of kin. If the patient has preferences about the specific disposition method, the specific funeral provider, or the location of final remains, those wishes carry no legal weight unless documented in a written "Designation of Agent for After-Death Arrangements" or on page five of the Vermont Advance Directive.

Verbal instructions — even clear, specific ones made to family members — do not override the statutory default hierarchy if a dispute arises.

Act 39 and COLST Orders

Patients engaged with Act 39 are typically also working with Vermont's Clinician Orders for Life-Sustaining Treatment (COLST) framework. Vermont's COLST system is the state's version of what other states call POLST — it is a physician's order rather than a patient directive, and it governs immediate emergency medical interventions.

The critical operational difference: emergency medical responders in Vermont are legally required to provide life-saving treatment unless a valid, signed COLST order is physically present and clearly displayed when they arrive. A COLST order must be renewed annually or whenever the patient's medical condition changes significantly.

Patients using Act 39 typically have both:

1. A COLST order specifying no CPR, no intubation, and comfort-measures-only care
2. A Vermont Advance Directive naming a healthcare agent and documenting broader treatment goals

Neither document replaces the other. The COLST governs what EMS does in an acute emergency. The Advance Directive governs what a hospital or care facility does when the patient cannot communicate and no emergency is in progress.

What Families Need to Coordinate

If a family member is pursuing Act 39, the administrative steps that often get overlooked:

• Confirm the prescribing physician's telemedicine policy — many Act 39 consultations happen via video, but the physician must determine telemedicine is clinically appropriate
• Register the Advance Directive with the VADR — the Vermont Advance Directive Registry is a state-operated, free database that hospitals and emergency providers query during health crises; submitting your documents there ensures they are accessible regardless of where you are in Vermont
• Designate a disposition agent in writing — ensure the person who will manage funeral arrangements has legal authority to do so, rather than defaulting to the statutory next-of-kin hierarchy
• Consider timing relative to the 15-day waiting period — Act 39's mandatory waiting period means families cannot wait until the patient is days from death to initiate the request process

The Broader Legal Context

Act 39 exists within Vermont's larger framework of end-of-life autonomy. Vermont is one of a small number of states that also permits families to care for their own dead without a funeral director, conduct private property burials, and handle all the administrative paperwork of death registration themselves.

For families navigating both Act 39 and post-death administration, the Vermont Funeral Laws & Consumer Rights Guide covers the full disposition workflow: the Preliminary Report of Death timeline, how to procure a Burial/Transit Permit, home burial requirements, and the specific forms needed to ensure disposition wishes are legally enforceable. It also addresses how COLST and Advance Directives interact with the practical logistics of funeral planning in Vermont.

Act 39 is a carefully procedured law. Families who prepare the surrounding legal and logistical paperwork in advance — rather than managing it while in crisis — are in a substantially better position to honor a loved one's final wishes as they intended.

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