BRATTLEBORO -- The Brattleboro Memorial Hospital Board of Directors has voted to enact the facility exemption rule that was included in the aid-in-dying law the Legislature passed this year.
The board's vote Tuesday means that doctors who work at the hospital will not be permitted to prescribe medication to hasten death for terminally ill patients who want to take that medicine on hospital grounds.
The board's vote does not preclude the doctors from prescribing medication to hasten death for patients who elect to take the medicine off of BMH property
The board's vote followed a recommendation from the medical staff, which met last week and voted to ask the hospital board to endorse the facility exemption rule. In the end there was overwhelming support to recommend to the board to invoke the facility exemption.
"The medical staff had a thoughtful and contentious discussion about the bill," said Dr. Kathleen McGraw, chief medical officer at BMH. "The staff thinks the hospital is a facility people come to for healing and the intent of the law is not to make the hospital a place where people come to die."
The new Vermont law establishes strict criteria for who can prescribe the medication, when and how patients can ask for it, and who can administer the drugs.
Under the law physicians are not required or prohibited from taking part in prescribing drugs to hasten death.
"By adopting this, the hospital is not voicing an opinion one way or the other on the law," McGraw said. "There is no judgment from the board on this. We are not judging the law. The number of patients who might want to do this at the hospital is very small and the staff feels like the hospital is not the right place."
Dane Rank, administrator at Thompson House, where some terminally ill BMH patients go, says his facility is also trying to work its way through the new law.
"Any time there is an abrupt legislative change this is what happens," Rank said. "It is left to the facilities to work it out and that is what you are seeing here."
Jill Olson, vice president of policy and legislative affairs at the Vermont Association of Hospitals and Health Systems, said she does not know if any other Vermont hospitals have yet voted on the new law.
After Gov. Peter Shumlin signed the bill into law Olson told hospitals to at least pass a temporary facility exemption to give the staff time to work on guidelines.
She said patients probably will very rarely seek to take the medicine at a hospital because most terminally ill patients go home or end up at an assisted care facility.
"There are still a lot of questions about implementation and we are focused on working with stakeholders to address the questions clinicians have about implementing and complying with the law," she said.
Lynne Dapice, executive director of the Vermont State Nurses Association said her group has also been working to clarify the law and give the nurses more guidelines.
She says nurses who are personally opposed to assisted suicide need to understand their own rights and responsibilities.
The association is going to look at the guidelines that nursing groups established in Oregon, where a similar law passed in 1994.
Under the Vermont law only the patient can administer the drug.
Dapice said nurses might be pressured into taking part in the administration and they need to clearly understand their rights and the expectations of families and patients.
"There are a lot of ethical questions with this and nurses need to understand their rights as individuals while not abandoning the care of their patients," said Dapice. "Any time a law is passed there are places where it can get hazy. There is a lot to think about with this one. We want to provide guidance and we are working on that, but we're not there yet. "
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