Ever since Vermont removed its residency requirement for medical aid in dying last year, Dr. Diana Barnard hasn’t been able to keep up with the phone calls from would-be patients.

“It can be hard. I have, like, three calls sitting on my phone right now,” she said during a conversation at Porter Medical Center in Middlebury, where she works as a palliative care physician.

Vermont is one of nearly a dozen states where doctors can prescribe lethal medication to terminally ill patients who want to hasten their death. For the first decade the law was on the books, only Vermont residents could use it. Then, in 2023, lawmakers opened the program to out-of-staters. The change brought an influx of interest to the small state.

“The floodgates opened, and suddenly we were receiving these calls,” said Dr. Tim Schafer, a physician at Grace Cottage Hospital in Townshend. He prescribes for medical aid in dying, as do some of his colleagues. Because of their location in southern Vermont, they often get requests from Massachusetts, New Hampshire and other nearby states.

Barnard has also taken on a number of out-of-state patients, including Rita Mannebach of Florida. Earlier this year, Barnard confirmed Mannebach had terminal lung disease and prescribed the drugs. Mannebach and her family worked with a local death doula, Meg Tipper, to arrange housing in Vermont and manage other preparations, both logistical and emotional.

On a phone call from a rented house in Burlington, Mannebach described her plans for her last day alive.

“On Thursday morning, we’ll have a little program at 10 o’clock that we just put together ourselves,” she said. “There will be a symbolic ceremony of letting go — me letting go of [my family], them letting go of me. And then I’ll just have some last words that I say — may you be peaceful, may you be happy, that kind of thing.”

She had no doubts about what she wanted to come next. “It’s all about quality of life for me. It results in less suffering,” she said.

Building capacity

Barnard is well-known in this sphere of the medical world. She filed a lawsuit against the state with one of her patients, a Connecticut resident who wanted to use medical aid in dying in Vermont. The suit led Vermont to remove its residency requirement, and it led a lot of patients to Barnard — many more than she can responsibly take on.

“Building capacity is important,” she said. “A big part of my work is trying to educate other physicians, and, in a way, kind of inform other physicians about the importance of this practice, about mentoring them through learning how to do it, so that they can feel comfortable doing it on their own.”

For busy physicians, it can feel like a big ask. Most doctors here already have more Vermont-based patients than they can handle. Every new patient requires significant paperwork, multiple medical consultations and emotional support. Medical aid in dying patients have to be in Vermont for two required appointments and to take the medication.

Opening up the program to out-of-staters “has profoundly changed my life, our clinic function,” said Schafer at Grace Cottage. “We just had a lot to learn about how to pull this off logistically.”

Schafer feels a deep calling to help his patients who are suffering, and he’s had to come to terms with not being able to help everyone who reaches out.

“Our call center assures us that there’s a volume of calls coming in,” he said. “And finally, you know, it kind of started surpassing what could be handled. And we finally agreed — we have to limit new consults to one per week.”

To help with logistics, Schafer and other prescribing doctors rely on a new network of volunteers called Wayfinders. It was established earlier this year by Patient Choices Vermont, a nonprofit that educates the medical community and the public about medical aid in dying. It also advocated for the passage of the original law in 2014.

Wayfinders is made up of current and retired hospice nurses, social workers and death doulas who can support families and patients navigating medical aid in dying.

Suzanne Baxtresser, a retired hospice nurse, volunteers her services in the Brattleboro area. For her, the biggest challenge is finding housing where patients and their families can stay.

Finding a safe place

As Vermonters well know, the state faces a severe housing shortage. It’s also a popular tourist destination, which makes short-term rentals even harder to come by than doctors.

“We want people to take the medicine in a safe place,” Baxtresser said. “We want people to know that nobody’s going to come knocking on the door saying, ‘What’s happening?’”

While some Airbnb owners in the area are amenable to people using medical aid in dying on their property, they’re often booked up. “When summer comes, everything gets rented,” Baxtresser said.

One family with an unused property in southern Vermont has essentially donated it to the cause — physicians and Wayfinder volunteers call it “the safe house.” And a representative for Patient Choices Vermont said they are actively working on a longer-term housing solution.

If and when that happens, Baxtresser believes the increase in out-of-state interest will turn into an increase in out-of-state usage.

“If patients knew there was a clear path, they would come,” she said. “But right now we don’t have the support. We don’t have the structure to support that.”

With the help of the Wayfinders, Rita Mannebach was able to find a place to stay for the weeks before her death. Her years volunteering as a hospice worker helped her feel ready for what was to come.

“I’m very comfortable with death,” she said. “I’m 84, and I’m at peace with the whole thing. To me, what happens after is totally unknown. I don’t know what’s going to happen. But I don’t have any fear. So I feel perfectly at ease about the whole thing.”

Two days after our interview, she followed her plan. Rita Mannebach of Florida died in Vermont.

After she passed, her family made plans for her ashes to be shipped back to Florida. Then, they tidied up the rental, drove to the airport, and went home.

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