Vermont Medical Aid in Dying: How Act 39 Works

Vermont was the first state to legalize medical aid in dying through the legislative process rather than a citizen initiative. The law — officially the Patient Choice and Control at End of Life Act, enacted as Act 39 in 2013 and codified at 18 V.S.A. Chapter 113 — permits terminally ill, mentally capable adults to request a prescription for medication that will hasten death. In 2023, Vermont made a significant amendment: it removed the residency requirement, opening the law to non-Vermonters for the first time.

This post explains who qualifies, how the process works, what changed in 2023, and what family members and executors need to understand when someone dies under this law.

Who Qualifies Under Vermont's Aid in Dying Law

To be eligible, a patient must meet all of the following criteria:

Terminal diagnosis with a six-month prognosis. The patient must have an incurable, irreversible disease with a medical prognosis of six months or less to live. The treating physician and a consulting physician must both independently confirm this prognosis.

Mental capacity. The patient must be capable of making and communicating a voluntary, informed healthcare decision at the time of each request. A history of depression or mental illness does not automatically disqualify someone — the standard is whether the patient currently has decision-making capacity. If there is doubt, a mental health assessment is required before the prescription can be issued.

Physical ability to self-administer. Vermont law requires the patient to physically self-administer the medication. A physician cannot administer it, and no other person can administer it on the patient's behalf. If the patient's physical condition deteriorates to the point where they cannot self-administer, they lose access to the medication under this law.

Request process. The patient must make two separate oral requests to the attending physician, with at least a 15-day waiting period between requests. The patient must also submit one written request signed in the presence of two witnesses. Witnesses cannot be the patient's attending physician or another healthcare provider directly involved in care.

The 2023 Residency Change

Before 2023, Vermont's law restricted access to Vermont residents. Act 10, passed in 2023, eliminated this requirement. A terminally ill patient from any state — or any country — can now utilize Vermont's law, provided the physical acts required by the statute occur within Vermont's borders. This includes the physician consultations, the requests, and the act of self-administration.

The change has particular significance for patients in neighboring states where aid in dying is not legal. It has also raised insurance and estate questions that family members and executors need to understand.

What Participating Physicians Must File

Vermont's law imposes strict reporting requirements on physicians to ensure accountability and legal protection. The attending physician must submit four separate forms to the Vermont Department of Health: the Patient Request form, the Physician Reporting form, the Consulting Physician form, and the Prescribing Follow-up form. These filings are what grant physicians legal immunity under the statute.

This reporting trail is relevant to executors for one reason: it establishes a documented legal record of the death. The cause of death on the death certificate will reflect the underlying terminal illness, not the medication. Vermont law specifies this explicitly to prevent insurance companies from denying life insurance claims on grounds that death by aid in dying constitutes suicide. Vermont statute directly bars this practice.

Life Insurance and Executor Obligations

Family members often worry that a death under Act 39 will void a life insurance policy. Vermont law at 18 V.S.A. § 5293 explicitly provides that death resulting from the patient choice and control act does not constitute suicide for purposes of insurance policies. An insurer that attempts to deny a life insurance claim on these grounds is acting contrary to state law. If you encounter this as an executor, document the denial in writing and contact a Vermont insurance attorney.

From an estate administration standpoint, a death under Act 39 triggers the same probate obligations as any other death. You still need certified death certificates (the standard $10 per copy fee applies for in-person requests from a town clerk or the Department of Health), still need to petition the Probate Division if the estate requires formal probate, and still face the same 60-day inventory deadline and four-month creditor notice window.

What Executors Encounter Practically

If a loved one used Vermont's medical aid in dying law, you may find the following among their papers:

• A copy of the written request with witness signatures
• Documentation from the attending and consulting physicians
• An unfilled or partially filled prescription from a pharmacy

The unfilled prescription or leftover medication should be disposed of safely, typically through a medication take-back program or in accordance with instructions provided by the prescribing physician. Do not flush prescription medications. The Vermont Department of Health provides guidance on safe medication disposal.

The emotional dimension of settling the estate after an aid-in-dying death is often more complex than a sudden death. Families typically had advance notice, time to gather, and some degree of preparation. But the administrative obligations — death certificates, probate filings, creditor notices, asset inventory — remain identical regardless of the manner of death.

COLST, Advance Directives, and Act 39

Vermont has three separate end-of-life legal instruments that often coexist:

• The advance directive names a healthcare agent and documents general treatment preferences
• The COLST (Clinician Orders for Life-Sustaining Treatment) is a physician-signed medical order governing immediate emergency treatment
• Act 39 is the specific pathway for requesting life-ending medication

A person may have all three. The advance directive does not authorize aid in dying. The COLST does not authorize aid in dying. Only the formal request process under Chapter 113 — with two oral requests, a 15-day waiting period, a written request, two physician sign-offs, and the patient's ability to self-administer — leads to a valid prescription under Act 39.

Non-Vermont Residents: Practical Considerations

If you are coming to Vermont specifically to use the aid-in-dying law, you will need to:

• Establish a patient relationship with a Vermont physician willing to participate (not all physicians participate, and none are required to)
• Be physically present in Vermont for the physician consultations and the act of self-administration
• Understand that your home state's law governs your estate after death — Vermont probate would only apply if you owned real estate in Vermont

The practical reality is that access requires advance planning and sufficient time while still possessing mental capacity and physical ability to self-administer. The six-month terminal prognosis window is shorter than many people expect.

For executors settling a Vermont estate — whether or not aid in dying was involved — the Vermont Probate Process Guide covers the full administrative timeline, deadlines, and required forms from petition through final distribution.

See more Vermont guides →