Beyond Legalization: Access, Equity, and the Implementation of Medical Aid in Dying in Vermont and its Lessons for Future Policy

Abstract

This thesis aims to examine Vermont's Medical Aid in Dying (MAiD) legislation, alternatively known as Act 39: An act relating to patient choice and control at end of life, and its recent amendments allowing access for those who are not Vermont residents and the use of telehealth. Medical Aid in Dying (MAiD) is a process allowing consenting adults to self-administer a liquid medication that will put them to sleep and then stop their heart. In order to qualify in the United States, patients must: 1) be at least 18 years old, 2) have a terminal illness with a prognosis of six months or less to live, 3) be able to make and communicate their health care decisions, 4) be able to make an informed and voluntary request to their physician, and 5) be able to self-administer the medication. MAiD remains a deeply controversial topic and has been for decades. Using MAiD in Vermont as a case study, over 10 years past its legalization, this thesis positions Vermont as a policy laboratory and uses patient/provider testimony as valuable data for future policy developments across the United States. This project engages these theories of policy diffusion by asking how, why, and under what conditions MAiD policies travel across states, and particularly, what lessons can be learned as MAiD continues to expand. Treating Vermont as an early adopter and an ongoing site of revision, this thesis uses original research to answer these questions. Conducted between May and October 2025, this work draws from a series of eleven 30 to 75-minute in-depth interviews and ethnographic research with those involved in Medical Aid in Dying in Vermont, giving accounts of five MAiD recipients, family members, medical professionals, and advocates to gain insight into the lived experience of MAiD. The project analyzes barriers to access, lived experiences of families, medical professionals, and patients, and evaluates the effectiveness of Vermont's approach, particularly after expanding access to non-residents, acting as a guide for other states considering MAiD or amendments. This work fills an important gap in academic literature by combining political, legal, and anthropological perspectives on end-of-life autonomy and challenging existing assumptions about how such policies should be implemented and regulated, and questioning how far the legal process can take us when it comes to healthcare equity.