Francine Milano, 61, got the news that her ovarian cancer had returned in 2023, after it had been dormant for over 20 years. Her doctors told her it was terminal.
Staring down the costs, side effects, travel and pain that she would have to deal with if she chose to treat her cancer with traditional therapy, she decided to opt for a different path: medical aid in dying.
So the Pennsylvania native looked to Vermont, one of only a handful of US states where physician assisted suicide is legal, and out-of-state residents can travel to be euthanized.
She’s started the process twice. The second time, which happened in June 2024, she met her doctor on a Zoom from a parking lot just over Vermont’s border.
Ms Milano lives in Lancaster, Pennsylvania. To get to Burlington, Vermont, where she met her doctor the first time she started the aid-in-dying process, she had to drive nine hours. To reach the border of the state, which she did the second time she started 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 apply to the program
Critics of medical aid in dying might be shocked to learn that though the laws stipulate a patient must be within state borders, if a doctor so chooses, they can conduct these interviews by telemedicine.
‘I want you to know that I’m not giving up hope, it’s just that I’m not willing to go down some of these traditional routes, because I’ve seen it,’ she said on her YouTube channel, explaining that she’d seen people with her kind of cancer go through intense treatment, and lose quality of life.
‘I want quality. I want quality over quantity at this point is more important to me,’ she said.
Mrs Milano isn’t the first person to come from out of state to seek assisted suicide in The Green Mountain State.
Roughly 26 people came to the state to die from May 2023 to June 2024, according to the Vermont Department of Health.
Since the first end-of-life program was authorized in 1994, 9,122 people in America have chosen to end their life with medical aid, according to the advocacy group Compassion and Choices.
There hasn’t been an effort to aggregate this national data per year, but that averages out to roughly 304 deaths per year.
In 2022, 278 people in Oregon used medical aid in dying. In the ten years since Vermont has allowed the practice, roughly 203 people had qualified for Medical aid in dying, the vast majority of whom sought out the program after a cancer diagnosis.
They estimate that 63 percent of people who go through with the process, and receive the prescription decide to follow through with the act.
Assisted suicide is currently legal in Oregon, Washington, Montana, Vermont, California, Colorado, Washington D.C., Hawai’i, New Jersey, Maine and New Mexico.
Eighteen more have aid-in-dying laws up for consideration this year, according to KFF Health News.
But Oregon and Vermont are the only states that allow individuals who don’t live in the state to travel for the procedure.
Still, the process to get approved to die in these states is rigorous, Dr Charles Blanke, an oncologist in Oregon who has a focus on end-of-life care and medical aid in dying, told CBS news.
‘The law is pretty strict about what has to be done,’ Dr Blanke said.
In order to get approved to die in Vermont, a patient has to be 18 years old, have six months left to live, be able to take the pills themselves and be capable of making their own informed health care decisions.
If they meet these criteria, then they have to make two requests, waiting at least two weeks in between the request, to the doctor who will write the prescription.
These requests can be made by telemedicine, if the doctor so chooses, but the law states that patients have to be in Vermont when they meet with doctors and take the pills.
In Ms Milano’s case, the first time she started the process in 2023, she drove nine hours to Burlington, VT to meet with a doctor.
She didn’t complete the process within six months, letting it lapse without getting the medication.
Ms Milano and her husband, pictured. She shared that she has been checking items off her bucket list since getting her diagnosis, including taking a visit to a local farm to hug a cow
But she started anew, driving back to Vermont in June 2024. This time, she drove six hours, meeting with the same doctor by Zoom from a parking lot just across state lines.
She said she did so because she ‘would have been afraid not to be honest’, about being within the state of Vermont when meeting with her doctor, as per the law.
After this step, a patient still has to make a written request to a doctor, get it signed by witnesses and visit a second doctor, to confirm the findings from the first doctor.
After that, the doctor will write a prescription, which is held for 15 days before being filled. Once the patient picks up the prescription, the process is in their hands.
Ms Milano has yet to follow through with these final steps.
Support for physician assisted suicide is not universal. Critics like Dr Jack Ende, the former president of the American College of Physicians, have said these efforts taking funding and focus away from efforts like improving hospice care.
‘The focus at the end of life should be on efforts to prevent or ease suffering and on the often unaddressed needs of patients and families. As a society, we need to work to improve hospice and palliative care, including awareness and access,’ Dr Ende said.
Religious groups, have said that these efforts overstep moral boundaries. Representatives for Catholic church have stated: ‘We don’t have the authority to take into our hands when life will end.’
Ms Milano, who herself is a reverend and pastor to the The Center for Spiritual Awareness in Pennsylvania, has remained publicly firm about her decision to explore physician assisted suicide through her social media channels.
She said that when she get the pills that she can take to end her life, she not sure that she’ll take them. About a third of people who fill their prescription never do.
Right now, she’s focusing on checking items off her bucket list. Recently, she shared she had fulfilled a life long dream of hugging a cow, sharing a video smiling alongside a docile, small dairy cow on Facebook.
Even while she lives, she said knowing she has a choice is comforting.
‘I’m afraid of dying, I’m not afraid of death,’ she said.
