Journal of General Internal Medicine

, Volume 34, Issue 4, pp 636–641 | Cite as

Health Care Providers’ Experiences with Implementing Medical Aid-in-Dying in Vermont: a Qualitative Study

  • Mara BuchbinderEmail author
  • Elizabeth R. Brassfield
  • Manisha Mishra
Health Policy



The evolving legal landscape for medical aid-in-dying (AID) in the USA raises clinical and public health challenges and concerns regarding how health care providers will accommodate AID while expanding access to high-quality end-of-life care.


To describe Vermont health care providers’ experiences practicing under the “Patient Choice and Control at End of Life” Act.


Qualitative semi-structured interviews analyzed using grounded theory.


The larger study included 144 health care providers, terminally ill patients, caregivers, policy stakeholders, and other Vermont residents working in 10 out of Vermont’s 14 counties. This article reports on a subset of 37 providers who had clinical experience with the law.

Main Measures

Themes from interviews.

Key Results

Physicians were roughly split between hospital and community-based practices. Most were women (68%) and the largest subgroup specialized in internal or family medicine (53%). Most of the nurses and social workers were women (89%) and most worked for hospice and home health agencies (61%). We identified five domains in which participants engaged with AID: (1) clinical communication and counseling; (2) the Act 39 protocol; (3) prescribing medication; (4) planning for death; and (5) professional education. How providers experienced these five domains of clinical practice depended on their practice setting and the supportive resources available.


Health care providers’ participation in AID involves clinical tasks outside of responding to patients’ requests and writing prescriptions. Research to identify best practices should focus on all domains of clinical practice in order to best prepare providers.


medical aid-in-dying end-of-life care ethics qualitative research health policy 



Lauren Brinkley-Rubinstein provided helpful comments on a draft of this manuscript.


This research was supported by a UNC Junior Faculty Development award, a Greenwall Faculty Scholars Award, and a research grant from the National Science Foundation (1630010).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4811_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21.5 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Mara Buchbinder
    • 1
    Email author
  • Elizabeth R. Brassfield
    • 2
  • Manisha Mishra
    • 3
    • 4
  1. 1.Department of Social Medicine, Center for Bioethics University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Philosophy and School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Center for Medicine, Health, and Society at Vanderbilt UniversityNashvilleUSA

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