Hans Penner isn't ready to die just yet. The retired Dartmouth College religion professor has another book he wants to finish writing first. But, with the diagnosis of stage 4 inoperable lung cancer he got last fall, Penner knows it's coming. He just wants to be in control when it does.
"If I have the freedom to decide how I want to die, that is a very comforting thing," said Penner, a 77-year-old resident of Wake Robin, a retirement, assisted living and skilled nursing facility in Shelburne.
Dr. Joseph Nasca, a Milton pediatrician who's not involved in Penner's treatment, says he'd want no part of helping anyone die.
"It's not consistent with the practice of medicine as far as I'm concerned," said Nasca, a member of the executive committee of the Vermont Alliance for Ethical Health Care, "We don't go to medical school to give people prescriptions to go home and kill themselves."
The two represent opposite sides in a decades-old debate: Should a person be allowed to take his or her life with a doctor's help when it's no longer considered worth living?
Three states permit it, and the issue has now come to Vermont. Encouraged by the election of Gov. Peter Shumlin, who supports it, "death with dignity" advocates have introduced a bill that would make Vermont the fourth state to allow doctors to prescribe some terminally ill patients a lethal dose of drugs they could use to end their own lives.
It would allow doctors to prescribe for patients, who had requested it three times — once in writing — a lethal dose of pills that the patient would then administer to him- or herself.
Supporters say the measure would give patients a sense of control over a time of their lives that for too many is lost to the machinery and gowned and masked personnel of modern medicine.
Opponents say it could put society on a slippery slope toward euthanasia. They cite the continuing efforts by both private and government insurers to get spiraling health care costs under control.
National groups on both sides of the debate are watching Vermont closely to see whether it will follow Oregon and Washington, which enacted physician-assisted suicide laws by referendum, and Montana, where the state Supreme Court ruled at the end of 2009 that nothing in state law bars patients from seeking it.
Just after Thursday's announcement of the Vermont legislation, the Death With Dignity National Center, based in Oregon, posted to its blog a message saying it joined Patient Choices Vermont, the lead group supporting the effort in Vermont, in "applauding Representative Donna Sweaney" for introducing the bill, adding that it had a "strong and broad base of support," with 42 co-sponsors.
Rita Marker, executive director of the Ohio-based Patients Rights Council, which opposes such legislation, said of national supporters, "They're trying to gain a foothold in the Northeast."
Both sides are spending money in a bid to get their way. Two opposition groups have run television ads warning about the dangers of the legislation. The main group in support, Patient Choices at End of Life - Vermont, has raised more than $100,000 since November, said its president, Dick Walters. The Death With Dignity National Center pledged $100,000 to the Vermont group in November, though Walters said just a fraction of that money had been spent so far.
Vermont also looms as a battleground because Shumlin, a first-term Democrat, is a supporter of right-to-die legislation, unlike his predecessor, Republican Gov. Jim Douglas. House Speaker Shap Smith, whose fellow Democrats have firm control of the House, is as well. And while the Vermont House defeated a similar measure three years ago, the 82-63 margin was closer than has been the case in many other state legislatures.
But it's not clear the measure will come to a vote on the House floor this year. Smith, who took over as speaker in 2009, is a lawyer outside the legislative session who lives by the lawyer's rule of trying never to ask a question to which the answer isn't known. He's developed a reputation and record of declining to bring controversial matters to the House floor unless he has the votes to pass them.
"One of the things I have learned is that it's a good idea to have your ducks in a row," Smith said last week. "It gives people confidence you know what you're doing."
Supporters in Vermont include some physicians, citizens who say they want to expand personal choice and reduce government's say over people's lives, and some who have watched loved ones suffer slow and agonizing deaths.
Aaron Loomis of Burlington, who appeared with supporters of the legislation at the Statehouse on Thursday, told such a story about his father's death. "My father should not have to ask the government or the church or anyone to have control over his own destiny," he said.
Opponents include some religious groups, the Vermont Right to Life Committee and advocates for the disabled.
Ed Paquin, president of the Vermont Coalition for Disability Rights, said he objects to the term "death with dignity," saying that some of the people he represents, who need help with things as basic as eating and toileting, might be seen as leading "undignified lives."
Paquin said he worried about "the potential for people to be pressured, inadvertently or advertently, or even with their own feelings of personal responsibility to their survivors," so that a patient might feel compelled to choose assisted suicide.
Supporters say the bill contains several safeguards. The patient must be at least 18, must be of sound mind, must state a desire to die orally at least twice and at least two weeks apart and in writing, the written request witnessed by two people who are not a close relative, would not benefit financially from the person's death and is not affiliated with the facility where the person is receiving care. A second physician must give an opinion on the patient's prognosis and confirm that the patient has the capacity to make the decision and is acting voluntarily.
Penner said death is something that must be faced squarely and that he will be ready when the time comes. No one "can hope to come to grips with their own existential life until they come to grips with their own contingency," he said. "It could always be otherwise."