Francine Milano, 61, was diagnosed with ovarian cancer in 2023 after lying dormant for more than 20 years. Her doctors told her it was terminal.
Thinking about the costs, side effects, travel and pain she would endure if she treated her cancer with traditional therapy, she decided to take a different path: medically assisted suicide.
The Pennsylvania resident therefore turned to Vermont, one of the few states in the US where assisted suicide is legal and where out-of-state residents can travel to Vermont to be euthanized.
She has started the process twice. The second time, in June 2024, she met her doctor via Zoom from a parking lot just across the Vermont border.
Ms. Milano lives in Lancaster, Pennsylvania. To get to Burlington, Vermont, where she met her doctor when she first began the aid-in-dying process, she had to drive nine hours. To reach the state border, which she did the second time she began the aid-in-dying process, she had to drive six hours.
Ten states and the District of Columbia allow assisted suicide. Vermont and Oregon are the only two that allow out-of-state visitors to enroll in the program.
Critics of medically assisted suicide may be shocked to learn that while the law requires that a patient be within state lines, a doctor can also conduct these interviews via telemedicine if they choose.
“I want you to know that I’m not giving up hope, but I’m not willing to walk some of these traditional paths because I’ve seen it,” she said on her YouTube channel, where she explains that she has seen people with her form of cancer undergo tough treatment and that their quality of life has decreased as a result.
“I want quality. I want quality to be more important than quantity, right now that’s more important to me,” she said.
Ms. Milano is not the first person to come to the Green Mountain State from out of state to seek assisted suicide.
According to the Vermont Department of Health, about 26 people came to the state to die between May 2023 and June 2024.
Since the first end-of-life program was approved in 1994, 9,122 people in America have chosen to end their lives with medical assistance, according to the advocacy group Compassion and choices.
No attempt has been made to collect these national data by year, but on average we arrive at about 304 deaths per year.
In 2022, 278 people in Oregon used medical aid in dying. In the decade since Vermont allowed the practice, about 203 people were eligible for medical assistance in suicide. The vast majority of them sought the program after being diagnosed with cancer.
They estimate that 63 percent of people who go through the process and receive the prescription actually take action.
Assisted suicide is currently legal in Oregon, Washington, Montana, Vermont, California, Colorado, Washington DC, Hawaii, New Jersey, Maine, and New Mexico.
Eighteen other countries say assisted suicide laws will be considered this year KFF Health News.
Oregon and Vermont are the only states that allow out-of-state residents to travel for the procedure.
Still, the process for getting permission to die in these states is rigorous, says Dr. Charles Blanke, an oncologist in Oregon who focuses on terminal care and medical aid in dying, told CBS news.
“The law is quite strict about what needs to be done,” Dr. Blanke said.
To be eligible to die in Vermont, a patient must be 18 years old, have six months to live, be able to take their own pills and be able to make informed decisions about their own health care.
If they meet these criteria, they must submit two requests to the prescribing physician. The requests must be at least two weeks apart.
These requests can be made via telemedicine, if the doctor so chooses. However, the law requires patients to be in Vermont when they meet with a doctor and take the pills.
In Ms. Milano’s case, the first time she had the procedure in 2023, she drove nine hours to Burlington, Vermont, to meet with a doctor.
She did not complete the process within six months and allowed it to lapse without receiving the medication.
Ms. Milano and her husband, pictured. She said she has been checking off items from her bucket list since her diagnosis, including visiting a local farm to cuddle a cow
But she started over, driving back to Vermont in June 2024. This time, she drove six hours and met with the same doctor via Zoom, from a parking lot just across the state line.
She said she did so because she was “afraid of not being truthful” about being in the state of Vermont during a doctor’s appointment, as required by law.
After this step, a patient must still submit a written request to a doctor, have it signed by witnesses, and see a second doctor to confirm the first doctor’s findings.
The doctor then writes a prescription, which is held for 15 days before being filled. Once the patient picks up the prescription, the process is in their hands.
Mrs. Milano has not yet taken these final steps.
There is no universal support for assisted suicide. Critics such as Dr. Jack Ende, the former president of the American College of Physicians, have said that these efforts take away funding and distract from, for example, improving palliative care.
“The focus at the end of life should be on efforts to prevent or alleviate suffering and on the often unaddressed needs of patients and families. As a society, we must work to improve hospice and palliative care, including awareness and access,” Dr. Ende said.
Religious groups have said the efforts cross moral boundaries. Representatives of the Catholic Church have declared: ‘We do not have the authority to take control ourselves when life ends.’
Ms. Milano, who is herself a minister and pastor at the Center for Spiritual Awareness in Pennsylvania, has openly expressed her decision to explore euthanasia via her social media channels.
She said that if she were given the pills she could take to end her life, she would not be sure she would take them. About a third of people who fill their prescriptions never do.
Right now, she’s focused on checking off items on her bucket list. She recently shared that she fulfilled a lifelong dream of cuddling a cow, sharing a video of herself laughing next to a tame, small dairy cow on Facebook.
She says it is a comfort to know she has a choice, even though she is still alive.
“I’m afraid of dying, I’m not afraid of death,” she said.
