Francine Milano, 61, received the news that her ovarian cancer had returned in 2023, after being dormant for more than 20 years. Her doctors told her it was terminal.
Faced with the costs, side effects, travel and pain she would face if she decided to treat her cancer with traditional therapy, she decided to take a different path: medical aid in dying.
So the Pennsylvania native looked to Vermont, one of the few U.S. states where physician-assisted suicide is legal and out-of-state residents can travel to receive euthanasia.
She started the process twice. The second time, in June 2024, she met her doctor over Zoom from a parking lot just across the border in Vermont.
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 get to the state line, 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 for the program.
Critics of medical aid in dying might be surprised to learn that while laws stipulate that the patient must be within state lines, doctors can conduct these interviews via telemedicine if they so choose.
“I want you to know that I’m not giving up hope, I’m just not willing to follow some of these traditional paths, because I’ve seen it.” She said on his YouTube channel, explaining that he had seen people with his type of cancer go through intense treatment and lose quality of life.
“I want quality. Right now, for me, quality is more important than quantity,” he said.
Ms. Milano is not the first person to come from out of state to seek assisted suicide in The Green Mountain State.
According to the Vermont Department of Health, approximately 26 people arrived in the state to die between May 2023 and June 2024.
Since the first end-of-life program was authorized in 1994, 9,122 people in the United States have chosen to end their lives with medical assistance, according to the advocacy group. Compassion and Choices.
No effort has been made to aggregate this national data by year, but the average is approximately 304 deaths per year.
In 2022, 278 people in Oregon sought medical aid in dying. In the ten years since Vermont allowed the practice, approximately 203 people had qualified for medical aid in dying, the vast majority of whom sought the program after a cancer diagnosis.
They estimate that 63 percent of people who complete the procedure and receive the prescription decide to go ahead with the procedure.
Assisted suicide is currently legal in Oregon, Washington, Montana, Vermont, California, Colorado, Washington DC, Hawaii, New Jersey, Maine, and New Mexico.
Eighteen more have aid-in-dying laws being considered this year, according to KFF Health News.
But Oregon and Vermont are the only states that allow out-of-state residents to travel for the procedure.
Still, the process for getting approval to die in these states is rigorous, said Dr. Charles Blanke, an Oregon oncologist who specializes in end-of-life care and medical assistance in dying. He told CBS News.
“The law is pretty strict about what needs to be done,” Dr. Blanke said.
To be approved to die in Vermont, a patient must be 18 years old, have six months to live, be able to take pills on their own and be capable of making their own informed decisions about their medical care.
If they meet these criteria, then they have to make two requests, waiting at least two weeks between each request, to the doctor who will write the prescription.
These requests can be made via telemedicine, if the doctor 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, Vermont, to meet with a doctor.
He did not complete the process in six months, letting it pass without obtaining the medication.
Ms Milano and her husband, pictured. She shared that she has been ticking things off her bucket list since receiving her diagnosis, including a visit to 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 over Zoom from a parking lot across state lines.
She said she did so because she “would have been afraid of not being honest” about being within the state of Vermont when she met with her doctor, as required by law.
After this step, the patient still has to make a written request to a doctor, get it signed by witnesses, and visit a second doctor to confirm the first doctor’s findings.
After that, the doctor will write a prescription, which is kept for 15 days before being filled. Once the patient picks up the prescription, the process is in your hands.
Ms. Milano has not yet taken any final steps with these latest steps.
Support for physician-assisted suicide is not universal. Critics such as Dr. Jack Ende, The former president of the American College of Physicians has said these efforts are diverting funds and attention from efforts like improving palliative care.
“At the end of life, the focus must be on efforts to prevent or alleviate suffering and on the often neglected needs of patients and families. As a society, we must work to improve hospice and palliative care, including awareness and access,” said Dr. Ende.
Religious groups have said these efforts overstep moral boundaries. Representatives of the Catholic Church They have stated: “We have no authority to take into our own hands when life will end.”
Ms. Milano, who is a reverend and pastor of the Center for Spiritual Awareness in Pennsylvania, has publicly stood firm about her decision to explore physician-assisted suicide through her social media channels.
She said that when she receives the pills she can take to end her life, she is not sure if she will take them. About a third of people who fill her prescription never do.
Right now, she’s focusing on checking things off her bucket list. She recently shared that she’d fulfilled a lifelong dream of hugging a cow, sharing a video on Facebook in which she’s smiling alongside a small, docile dairy cow.
Even while living, he says knowing he has a choice is comforting.
“I’m afraid of dying, I’m not afraid of death.” She said.