 Welcome back to the Vermont House Human Services Committee and we are continuing our testimony on S74 an act relating to modifications in Vermont's patient choice at end of life law. And we have with us two witnesses to respond to some more of the technical or other aspects of the bill. And let's start with Charity Clark who's Chief of Staff for the Attorney General's Office. Welcome. Thank you very much for having us today. I don't think I'll be very long but I just wanted to briefly say a couple of things. The first is that we support this bill as written. We did work with the committee on the Senate side on a suggested change that we'd like. So I wanted to point that out too so that you'll know the change that we had suggested. And it was for Section 5283A5A which is under the requirements getting the position determined that the patient and we had suggested that the language and a physician's physical examination of the patient be included. And we got that from our criminal division just so you know where it's coming from. The idea being that at some point in the journey of this patient and doctor or medical professional there was a physical examination. Not that NEC made it a certain time but that the diagnosis did involve some sort of physical examination. And I listened today to Dr. Maybe I'm moving at a very really insightful and often moving testimony that she gives. And she so articulately pointed out that she usually is making diagnoses based on using her eyes and her ears. And this is more to provide context and those things that just eyes and ears maybe aren't gonna be able to do on telemedicine. So we asked that to be added. We're happy the way that it looks now so we would ask that it remain there but happy to answer questions about that or if there's any concerns. I'm not sure if it's come up in the course of your testimony but one of the things that had come up was whether or not, was a legal question and whether or not and you started out your testimony saying that the AG's office supports this as long as we keep certain language which is already in that well and that's language on page two. Yes, four, sorry. Well, sorry, I have the official so I don't know what page it's on for you. Page two of ours where it says the physician determines that the patient and then suffering a terminal condition based on the physician's review of the patient's relevant medical records and a physician's physical examination of the patient. So at some point in time there has to be a physical examination. Patient is what I understand you wanted to have clarified. Yes. At this point I was trying to make about the column about both being telemedicine, both of them. Both of those could be there at some point in time whether it is the, I think before because, how's this? You come to me and I'm a doctor and I'm not, I choose not to participate in this and so I do not want to have the conversation with you about exercising. I've done the physical exam and there has been a physical exam. So I think that, so it, I believe it maintains one, that there is a physical exam at some point in this process and two, it respects the ability that we are not forcing anyone to participate who does not want to. It also is, the moment in time is a diagnosis. So the physician determined that the patient was suffering a terminal condition based on the review of the patient's relevant medical records and a physical exam. So that's the diagnosis portion. So yeah. So when I first read this, I'm like why is it crossing it out in one spot and putting it in another? And then on closer reading I think I understand what it says, but I think it's open to misinterpretation. How so? Well, it feels like it's open to misinterpretation that has to be a prescribing position of the medication. It seems, I mean, I know that that's not what your intent is. I think what I'm, we're envisioning and, you know, having heard the testimony that others have provided in this committee and across the whole way, if you will. I think the idea is say I have a, you know, a patient, I'm a doctor and I have a physician-patient relationship and I diagnosed my patient with terminal illness three years ago for the physical exam. And then we're in COVID and my imagination, we're in COVID and I don't physically see them although I'm treating them through telemedicine for years, but I was there, I had the context and I performed the physical exam and I'm, you know, I've checked that box. It doesn't need to happen, you know, the month before this person is going to, you know, reach a point when they wanna take the medicine, you know, it doesn't have to be at that point in time, it's just some point in time that that physical exam has occurred. And I'm presuming that there's ellipsis here so I know there's something that comes before it, but that it has to be related to the qualifying condition, the terminal illness. Well, I think that that's already in there. Yeah, it was suffering a terminal illness and then it goes on from there, the determination. There's, yeah, necessarily a relationship between illness and the next steps that are taken. I still have a question mark on my head, but thank you. Are there other, represent version? Just a question, pretty much a legal question, I guess. I mean, if somebody totally apart from this belt, if somebody commits suicide, doesn't get an insurance that the person may have, as to my knowledge, that's denied because the person took their own life, is that true or maybe that's changed over the course? Like life insurance, I would have to, I would wanna look at the policy. A good lawyer would read the policy, I'm not, I did not come prepared to answer that question, I'm sorry. Sure, I see, I know, apparently in 39, we have a provision where somebody can't be denied their insurance as a result of participating in this program. It's my, I was just curious about somebody taking suicide at random, you know, whether my understanding was that it negated their, but I was just curious. I don't have the top of my head, it sounds like you're familiar with the statute, but. Yeah, thank you. I don't know if Legislative Council wants to comment, I believe in the underlying law, the first certificate does not, this is not death by suicide, this is the diagnosis is the medical condition. Right, the death certificate would state the underlying medical condition, but I think it sounds like representative or some question is not in the context of the bill so much as life insurance generally and whether suicide, death by suicide, just qualifies. Yeah, I was looking at the differentiation there, I mean, there's a whole body. Yeah, I think it depends on, it probably depends on the policy and you may want to hear from the Department of Financial Regulation, I can connect you with folks at the Department of Financial Regulation who would be familiar with life insurance policy terms. That'd be helpful. Thank you. There was one other area that I wanted to touch on, this more an observation that I wanted to make, I did make an understanding side, the change wasn't made, that's fine, but I just wanted to make the observation so that if you folks wanted to look at it, I would be remiss if I didn't mention it. There are a number of steps that the position has to do, it's like a checklist and if these things are done, then there's no liability. But the bill adds, in my reading of it, an extra step and the step is good faith. I'm sorry, good faith. Good faith is implicit. Now the bill introduces it as an explicit consideration and I wonder whether that is meant to, that was the legislature's intention. So for example, I'm in a position that I have my checklist, I've made the diagnosis, I've done this, the time has passed, check, check, check, check, check, and then there's good faith. Does that have to be proven somehow before I'm free of liability? Why did the legislature introduce the good faith language explicitly rather than just having it remain implicit? And I just, I don't know if it was intentional to add like an extra step that all these things were done and then next box, they were done in good faith. Does that need to be proven as the medical examiner looking at it? You know what I mean? Rather than it just being implicit. So if I get free, I don't know that it needs to be changed but it's just something that, you know, we noticed and I would be remiss if I didn't mention. Good question, I would agree 100%. And you brought this up and you started your, because not everyone was in the room when you started your initial testimony and what was your initial testimony? That we support the bill as written. And just for kicks, I did pull out my ancient copy of Black's Law Dictionary and I put a copy of Good Faith. So if you're curious, I just thought, well, I was here next to the photocopier which I am not always am because I'm at home usually when I testify, I thought I would just bring that over. So I'll leave it free if you're curious but I wanted to just flag it but yes, we support the bill. Thank you. We have a question from Representative McFawn. Thank you, Madam Chair. I could not, I do not understand what was just said. I couldn't understand what the witness said. To use some term that I couldn't hear. Right. The term is Good Faith. And where was that in the new version of S74? It's very close to the end under limitations on actions. Topper, you'll find that on page, on the bottom of page four and section three. That's the last sentence on page four. Okay. So for example, if it just said, blah, blah, blah, blah or professional disciplinary action for acting in compliance with the provisions of this chapter instead of in Good Faith Compliance. Good Faith, I would argue is implicit right now and just sort of introduces it as an explicit thing. It just made me wonder. How are you doing? The bill looks great as it is to go so far. Okay, thank you. And I think those are good, that's a good, sorry, Topper, continue. So that answers, there must be some legal meaning with Good Faith that I don't know. So. I could read this to you to give you a sense but I don't know that how clarifying it will be. Okay. Me too. Wait guys, I got old in the pandemic and now I wear glasses. Good Faith is an intangible and abstract quality with no technical meaning or statutory definition and it encompasses, among other things, an honest belief, the absence of malice and the absence of design to defraud or to seek an unconscionable advantage and on an individual's personal good faith is a concept of his own mind and inner spirit and therefore may not conclusively be determined by his protestations alone. And everyone wishes they went to law school so they could write flowery language like that but there you have it. Good Faith. And thank you and perhaps you could leave that with us so that we could scan it and put it on our webpage so that we know where it's from if we have further questions or want to make changes to that. Because I of course was gonna run and ask the doctors what that meant. There was something in terms of their process that they go through that there is something related to what I would say medical ethics and whether that is what is being referenced here. But thank you. And other questions for the Attorney General's office? The Attorney General's office. I think Theresa. Oh, you did. I'm sorry. I'm sorry. Okay. There was somebody to your left. Yeah. I'm not presenting for it. So in that same paragraph where we're referencing Good Faith. So would you, do you believe that the phrase no physician, nurse, pharmacist or other person licensed, certified or otherwise authorized to deliver law authorized by law to deliver healthcare services? That, that is a sufficient clause to capture nurse practitioners, advanced practice nurses, you know, essentially people who, I guess one of the questions that I have is that well, I guess they're bad. Sorry, I'm talking out loud. I'm asking questions in my head. They're also bound by their license in terms of what they're able to practice. So I think I've answered my own question. You're good. Okay. Yeah, I'm sorry. Yes. Legislative counsel. Let's take the conversation. Let's take the counsel again. So the existing statute that this one would be that this section would be amending is the 18th, the 17th, the 22nd, 85th and then subsection B of that section and already introduces this concept of good faith. So in existing law and healthcare facility or healthcare provider, shall not subject a physician, nurse, pharmacist or other person to discipline, suspension, laws of license, laws of privileges or other penalty for actions taken in good faith reliance on the provisions of this chapter or refusal to act under this chapter. So I think having the reason that this language is in here is it's consistent with what's already in this section. So it's reliance instead of compliance. It's good faith compliance in the bill and good faith reliance in the statute. So interesting, I didn't realize it was in there. Well, we'll look to like to say I actually didn't hear that. I'm having trouble with my hearing. Okay, yes, representative Wood. Jen, so since that's in this part of the statute already is there a reason to say it again? Subsection B is really about what somebody called employees. So I help care facility or healthcare provider not subjecting their employees to negative outcomes. The language that would be added is about civil or criminal liability or professional disciplinary action from a regulatory board. So I do think it's addressing something that is missing from the existing law. The language in subsection, new subsection C is talking about good faith compliance. So complying with the provisions as opposed to relying on the provisions is looking at it from a slightly different perspective because it's about liability as opposed to employment related provisions. But you could change the word compliance or to reliance or reliance to compliance if you want to be consistent. But I just wanted to flag that good faith was not a new concept in this statute. Thank you. Thank you. And are there other, this has been helpful. Thank you very much. Thank you. And Carl, I want to say you didn't say, you didn't do anything but I have just gotten, and if you want DFR to come in, they're happy to. And I will post to this email. It is from DFR and section five, two, eight, seven and five, two, nine, two. The Department of Finance. Department of Financial Regulation. Regulation. DFR. DFR, regulation, yes, R, regulation. And I say it was somewhat unrelated. In the bell, it's clear, okay. Or this procedure. Anyway, they would, if you would like them to come in, they're offering to come in. The language is an important protection and clarification on how the medical aid and dying law interacts with insurance underwriting practices. I will have this, I will post this, you know, cut from this. I don't know how other people feel. I mean, I was just curious about the question, but I, Well, we can try to answer your question. I said, we try to answer your questions, or at least. I know, I appreciate that. Yeah, so if you, do you want DFR to come in? If we have time, that'd be great, but I don't want to prolong the whole process here either, so. Okay, thank you. Our next, we have Theo Kennedy. Well, good morning, Madam Chairwoman and members of the committee. It's an honor to be here. I just have a brief contribution on behalf of the Vermont Retail Drugists on S74. And also in my capacity as a private attorney, during which time I represented Smiling Steve Pharmacies and drafted the agreement that's been used since the passage of Act 39 when the language in 5285, Limitations on Actions, was written as it currently is. So, I think you had requested that Smiling Steve be here in person. He regrets not being able to be here. What I, what he asked me to do was read his letter into the record and then maybe speak just briefly to our support. And I'm here on a very narrow part of this, specifically the Limitations on Actions on page four of five of your draft that we were just discussing. Does that sound all right? So I'll read a letter in and then refer briefly to why we support that language and then see if there are any questions. Does that sound proper, Madam Chairwoman? Mr. Kennedy, that sounds perfect. If we do not already have a copy of the letter, if you could forward that to the committee through Julie Tucker, that would be appreciative. Yes, thank you. I'd ask for it to be sent and I don't think it was sent yet. So I'll make sure it is. Thank you. Okay, so the letter reads as follows, dated today, Dear Representative Pugh, on behalf of Vermont, and I'm gonna now read a several paragraph letter. On behalf of Vermont Smiling Steves Pharmacies, I am writing regarding Senate Bill 74 related to the immunity provision of Act 39. Together with my sons, Jason and Jeffrey Hochberg, our pharmacy has worked with the patients who choose to use Act 39 for over three years. We have witnessed the suffering of patients at the end of their lives and I've heard gratitude from patients and families only provide a means to end that suffering. We believe that Act 39 is helping to improve the quality of end of life care through personal choice. However, the anticipated end of life is difficult for an individual to bear and the Act 39 limitations add to that stressful situation. The current text of Act 39 limits participation by registered pharmacists, which necessitates that the prescribing physician must sign an indemnity agreement in all cases. The result is that fewer physicians are willing to prescribe aid in dying to their patients and fewer pharmacists are willing to be involved. When we receive an Act 39 call, we must have the physician and the patient sign an indemnity agreement before we can move forward. This delay adds a level of stress to an already stressed situation. When the pharmacy receives the indemnity agreement, we call the patient to discuss the details of the prescription and arrange for me to deliver their medication. I do this personally, I do not mail the medication. Instead, I travel the state to hand deliver the medication and meet with the family and the patients. I spend time with the patient and the family to thoroughly review the medication, the instructions and answer any questions. This duty requires knowledge, compassion, caring and support. Supporting an individual who chooses to utilize Act 39 requires a healthcare team approach between the doctor, nurses, pharmacists and families. All the participants in this healthcare team need to be protected and supported by the state of Vermont. Currently, only physicians enjoy that protection and support. Passing S74 will remove the need for the indemnity agreement. It would allow more healthcare professionals to serve their patient's end of life care needs. The focus should be on meeting the patient's needs at this time, and it is not the time to be concerned about personal liability. Thank you for your consideration and support of Senate Bill 74, including the correction to the immunity provision of Act 39, which supports Vermonters in the end of life care that they choose. If you have any questions, please do not hesitate to reach out to me. Sincerely, Steve Hockbird, RPH, smiling Steve Pharmacies, end quote. So that's his submission, and I'll make sure it gets to the committee, Madam Chairwoman, in briefer form, I'm here on their behalf, and as their attorney in this indemnity agreement process that's been underway for a few years to say we wholly support the new section C in 5285. Which clearly includes a pharmacist and protects other practitioners as well. Again, I'm here not selfishly, but on behalf of pharmacists, I'm not speaking for other healthcare providers, but we think it will be using the way he described it. It'll take a stress point out of the process. And pharmacists and perhaps other practitioners will I think be more, if they're inclined to provide these services, willing to do so. I just might add that over these few years, I've had conversations with the general counsel from various institutions that have suggested that the indemnity agreement wasn't necessary. In the end, we didn't concur and have required an indemnity agreement to date. So we support this change to the language. I don't have any other comments here today. We're thankful that you've taken this up and that I think that's it, unless there are any questions, Madam Chairman. Thank you. I am going to look around the room to see if there are any questions. So if I could just add and close. Oh, sorry. Was there something else? It's not necessarily for him. It's a general question. Probably an applicant. Okay, go ahead. Or reading of the bill that has to do with, of course, we're trying to help people here that are seeing no other way out of a situation that they're in. And yet my understanding is that the person himself has to inject this material. What do they do in the case of AMS or, you know, lateral sclerosis and all that? As far as I understand it, people become totally unable to move or do anything. They would not be able to. So what happens with people? They are not able to, they are not able to, given the law as written, they're not able to participate. Some, as I think the doctors said, this law is passed. It's a balancing act between providing access to those people who want to use medical aid in dying and to protect those who, and, one of the balancing acts that has been done is that the person needs to be able to take the medication themselves. And that protects, you know, it's a level of protection around. No, I understand that. I'm just surprised that because people are trying to increase access, that hasn't been one of the tasks that under some circumstances, somebody else could administer the drug. Okay, I'm just curious because it seems like it leads up a whole segment of people that are, in many cases, probably more likely to want to use this to end their life than others. So just a comment. And we could probably have a long discussion about that and about the balancing between. I'm not saying I'm for it. No, I know that. I know that. I know that. But in terms of ensuring that this is of someone's own free will and that it is that they are doing it that way. Representative McFawn. Thank you, Madam Chair. I just want to reinforce what you just said. When this bill was passed originally, there was a lot of testimony around this subject. And this is- I'm sorry, I apologize. It's all from the wider list, Carol. Oh, my gosh. Sorry. That's okay. Let's go ahead, Tapper. Well, I was just gonna say that there was a lot of testimony around this particular subject of the individual being able to take it themselves. So this is where we ended up. I just want to reinforce what you said. Thank you, Tapper. Yeah. We have- Let me- Let's have a discussion, but let me first, before we have more of a discussion, check to see if we have any further questions for Theo Kennedy. Thank you, Madam Chair. And thank you, Mr. Kennedy, for being here. This question might be better suited to the- Mr. Steve, who you read the letter that he delivered, but just from a pharmacy's perspective, I'm just curious on a couple of these questions. The first one being, if you're able to answer just a little bit more about the pharmacology of this medication, if you can provide any information on that yourself. And second of all, I'm curious about, we've heard of some cases in which an individual chooses not to administer the medication and wondering about the follow-up of that. I mean, it was promising to hear that the pharmacist that you'd read the letter from was hand-delivering medication. It seemed like a very involved process with the patient and the family. But I think that's a question that, happy to hear that Mr. Steve gave his invitation for us to reach out with any questions, but I was wondering if you could speak to that as well as a representative. Well, thank you for that question, Representative. I most certainly am not. But I'm very happy to follow up and have Steve answer any more specific question, both on the pharmacological aspect and the question with regards to reluctance or choice not to at the point of administration. But those are important questions. And I apologize, that's not in my wheelhouse. I don't want to misspeak, but I'd be happy to follow up as quickly as reasonably possible. That would be very helpful. And if you could put those responses in writing, and so then we can share them in our discussion and post them. Thank you so much. And if it were possible just to write them, I think I took notes as I was hearing them, but we certainly will try to do that promptly, Madam Chair. I just wanted to add one thing that, because it came up in the conversation with the, this is an attorney general, that we very much want the word compliance in that section and not reliance. I do think as just an ordinary practitioner, good faith is implicit in the law, I agree with that comment. I don't mind its use here. It's really not my role to have a position on that. But I think it's important that compliance be the word in the new section C and not reliance. As legislative council, I think indicated it, there's a different section than the, what's currently five, two, eight, five B or remain five, two, eight, five B. Anyway, thank you for your time today. A lot of political courage to open this back up, but it's gonna make a big difference for pharmacists who choose to participate to have this new language. And thank you for your work. Well, thank you Theo and you're welcome to stay on as we have a discussion or if you have other things to do, we appreciate your time. Thank you and have a good day. I'll probably go to off video and listen in. Have a good afternoon, good morning, thank you. Thank you, thank you. Somehow I think I like interrupted a bunch of questions or perhaps, you know, or in the middle of a discussion and when I said, hey, let's wrap up with Theo first. And I've now lost the thread of what I interrupted. Well, I guess I brought up that issue of somebody other than the patient themselves rejecting the drop in the heart and talk for a few of the patients that there was a lot of discussion about this. I wasn't here at the time. Right, and that's why I- And after my talk, right? Yeah, it was in the middle of your talk, I mean, I think your questions are, I mean, it's very important. So are Dames that relate to the law as it was passed because you weren't here. And so how, you know, I think it's perfectly appropriate and helpful for those who were not here for whom this is not something, even for those of us who were here to understand what this is amending. And, you know, so I think that that's- Yeah, I just wanted to say thank you for enabling us to sort of think about the totality because the rest of the committee wasn't here. So it's helpful, although I do remember coming to the public hearing with my disability rights hat on and thinking about this was, you know, at the outset very much opposed by disability advocates. And for some of the reasons that sort of kind of like you were starting to get into, Karl, other people, the fear of other people being able to give the drug the fear about the rights of people with disabilities and ability to have substituted judgment about that. So I appreciate the way the law ended up being written and you'll see posted from the Vermont DD council that they have no concerns with the changes in the law as opposed amendments. And I feel like this is some relatively modest things that we can do to make things easier for people who are already making difficult decisions in their life and with their families and the people that surround them at that time of their life. So yeah, I mean, I would not personally be in favor of changing anything with regard to other people being able to assist. I wouldn't either. And I was here two years or whatever. I've been here since the beginning when it came to the floor more than once. But I think this at present time, this is an appropriate balance of three points of freedom and of free will and protection. Can I ask you a question? If anybody else reads it the way I do or not or the question I was asking about the position and the, let me see, for the one here. H2. And maybe it's just because it was in the context of seeing the cross out and then seeing the language, similar language reinserted. I think the same language. Yeah, it didn't seem to me to be clarifying. I don't know. I'm wondering if legislative counsel. Wait, wait just a second. There's multiple people talking and I'm just. Sorry, page two of the bell. We're talking about 5A here where it crosses out physical examinations. And then it adds in the patient in the same. And so what I have just called legislative counsel to the witness chair, because there's those three little dots, the ellipsics. So don't actually the ellipses don't matter in this particular instance because we're really looking at the leading language of the physician determined that the patient and then a is suffering a terminal condition and that is based on an existing law. It's based on the physician's physical examination of the patient and review of the patient's relevant medical records. The change would be that the physician determined that the patient was suffering a terminal condition based on the physician's review of the patients relevant medical records and a physician's physical examination of the patient. Doesn't have to be the prescribing physician, but it does have to be a physician's physical examination. as part of what the prescribing physician is relying on to determine that the patient was suffering a terminal condition. So this goes back to then Carl, your question to Dr. Barnard and she was saying that the two can be telemedicine, but there needs to have been at some point in time a physical examination. Separate from telemedicine or possibly, right? Correct. All right. Somebody has to have done a physical examination of the patient to determine that they are suffering a terminal condition. That's it. Yeah. I mean, I can read it. I can read what it says. If I'm the only one that has that like question mark then that it not being heard. I have the question mark there, but when you read the piece of that simple, as we know just one shift in language from the physician to a physician helps separate that piece of not having and have to be the same physician that there's a physician who determines the terminal illness. And then the prescribing physician can be a different provider. So that's clarified for me, I would just say. Yeah. Yeah. That's good. Carl. Can I just follow up on that? Absolutely. Is your concern that it is not, now it does not have to be the prescribing physician and the intimate relationship that there might be between the physician and the patient? I'm gonna say intimate, I mean it's not. I know what you meant. No, I don't have a concern. I don't have a concern about who the physician is who prescribes the medication. I just don't want physicians to not be clear that it is not they who have to have a physical presence with it. And everybody else seems to be clear about it. It only seems to be a question mark for me. I'm not at all concerned that it's that the prescribing physician that they're changing the requirements that the prescribing physician does not now need to physically see the person. I really believe that people will be practicing their medical ethics, right? When they're doing that. I mean, it was very clear to me, the people who specialize in end-of-life care are very in tune with evaluating people at that stage of their life. And so I don't have any problem with the change in that. I don't have any problem with the change in that. I was just wanting to ensure that other physicians who maybe have not been as in tune or who have been hesitant to participate in the program. And this is about actually increasing access to people by not having to hunt down a Dr. Barnard or another doctor who may be willing to do it that they would see this as a, I want to make sure they don't see it as a barrier. That's all. And that seems to be clear to everybody. So I'm good, Madam Chair. This will be important in close reading as to what is in, if we vote this out what is put on the calendar and make sure that there's the a and the the. Yes, in the proper place. Yes, yes. And somebody will ask you that question on the floor, Madam Chair. And they will say, well, you just struck it out and now you're putting it back in. They will ask you to email. I knew that that's not what was happening. If I could. Absolutely. My concern when I was first reading this was what I was trying to get out with. You're thinking you have the same concern I have is that there was that more intimate, our audience had a relationship of the doctor with the patient doing, he's doing the physical and he's really part of this process. Okay, and now you're separate, taking one level of separation away from that. He's not the one that's actually doing in all likelihood the physical exam. So I was just a concern of mine when I first read this. Yeah, yeah. But apparently that's not a concern. Yeah, I'm sorry. Yeah, I think. I was thinking actually. You were thinking. I know you thought I was like right there with you. I'm sorry, Carl. But I think this actually may help to address your concern because I think this for the physician who has the personal relationship but who has been reluctant maybe in the past, I think this provides a more of an opening for that person. But you're still gonna have some physicians who they are not going to want to do this. But I hope that they avail themselves of the continuing education opportunities and the training that's available and out there because it's really kind of heartbreaking to hear stories that I think everybody's gotten emails and stuff about the people who live, their doctor said no, their doctor that they had that personal relationship and they thought that was the end of it. And they didn't get any further information and that was sad to me. Do we need legislative counsel in the, I'm seeing your feelings over here, Tapper. I'm wondering, Madam Chair, if we're at number five, if we said the prescribing physician determined that the patient was suffering a terminal condition based on that physician's review of the patient's relevant medical records and a physician's physical examination. It's not, they didn't have anything to do with the records and they didn't have anything to do with the physical examination, but they've reviewed all of that and they've determined that the person has a terminal condition. I see, I'm now gonna owe, I may have to consult people in the room or Jen, I don't think the prescribing, this is not necessarily referring to the prescribing physician, the prescribing physician. Well, it is the prescribing physician who's making a determination, but they refer to throughout this, I mean that the beginning of the section is that a physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to the patient and then it goes on and just the physician documents in the patient's medical record that all of the following occurred and then we're referring to this physician as the physician throughout. So I'd be concerned about starting to call them the prescribing physician without making that change throughout. I think if there's interest in making this language different or clearer, we can look at doing that, but I wouldn't wanna introduce new terminology yet one place. You see what she's talking about there, Topper. I thought we were talking about the prescribing physician. I didn't think we were talking about just any physician. We are in all cases except in this new language about who has done the physical examination of the patient that the physician who is doing the prescribing is basing their determination that the patient is suffering a terminal condition on. Yeah, I think the rely or the physician, actually the physician can rely on another doctor's physical. Exactly, that's exactly what this is saying. I guess I wanna sort of go back to what we're thinking of, what we have, but I have tentatively scheduled in terms of some more information, some more testimony would be next week, which is the first time they could come. Saren Toburg, who's the policy analyst from Vermont Right to Life, she's actually confirmed the Department of Health, David Englender and Sarah Teachout from the Medical Society. No, from Blue Cross Blue Shield, I'm sorry. Sarah Teachout from Blue Cross Blue Shield, Willem Jewett's wife as well as we are, because she, the family and then Mr. John Gelmore whose wife recently utilized the procedure and so that we could hear from, people said they wanted to hear from family members and that kind of thing. So I believe that is, I mean, that's right now who I have reached out to based on the information that people said they wanted to have, AG's office for the lawyer, that kind of thing. Topper. Kyle talked about the life insurance. Maybe we need a statement from financial regulation agency. I can try to, I have gotten an email statement that or an email response to a question that was asked and let me figure out whether a written statement or whether do you want her to come in? She's welcome to, she has offered to come in as well. Would you like her to come in, Topper? I don't know if she needs to come in, if it's a simple question is, if somebody does use this process, is their life insurance negated? That's all, that was the question Kyle asked. I don't think that's the question that they made. That's what's already addressed in the statute. The statute already says it has no impact on somebody's life insurance. I think the question I understood from Representative Rosa-Quist was, outside of the context of this, if a person dies by a suicide, what is the effect on their life insurance? Correct, that is the question. Which I understood that the insurance was still enforced if they used this procedure. We're just surprised to be quite frankly, but I mean, that's all. We have a question from James. Really a comment, which is an interesting question. I understand where it's coming from, but because it isn't related to this bill, it's not relevant to this bill. I don't, you shouldn't be talking about that. That's my opinion and I know events, but like it doesn't, this bill, the existing bill takes care of that issue in context of what's happening based on this bill. What happens outside of the context of this bill is not relevant at all to what's happening in this bill. Only in the context of what constitutes suicide. I guess that's what I am and how, why it's a different community. Okay, I mean, that's the way I would, that's really the basis of my question. I guess, and I hear that in the policy decision that was made back when the law first was passed that utilizing this process is not considered suicide. And that was a policy decision that the legislature made. Understood, and I'm not saying we're right or wrong. I'm just saying I just, and I think the rationale was they're already assumed to be at the end of life. So, it shouldn't really have any ultimate consequence on the payout of an insurance policy. I mean, that's the way I take it that it was rationalized. Okay. Anyway, I'd be happy with just a written comment on whether suicide by itself, that life insurance would pay out given. And I think we got a partial answer from the Attorney General's office because she said it all depends. I didn't realize I love pretty much. That was a no, no, and almost an insurance policy. I think it does all depend. And Carl, I'm gonna take this under advisement because two of the members of the committee have sort of said this is your question. Well, interesting, it's not related to what is before us. That's true. Can I work with Representative Rosalist and BFR to get an answer to this question? Absolutely. So you have sort of, I mean, I'm trying to let folks know where we are and hearing from who or what types of witnesses people wanna hear. And Carl, you had earlier asked if we were going to hear from any religious folks and I just wanna repeat. I appreciate that answer. And this is, we would have a laundry list of people coming in with different perspectives. And I think this is one of those decisions. If you are curious or wondering what your particular pastor or group that you are affiliated with, I would talk to them because there's going to be, even within certain denominations, there's not, there's going to be a different perspective. And yeah. I get obviously the big problem with me on this bill and the initial one, if I've been there to vote on is basically relative to your belief system. And many, many people believe life is a gift from God and that we shouldn't tamper with it. I guess the best thing to describe. Okay. So obviously I'm having a hard time on this. Absolutely. And this is something, I am not going to ask anyone to vote for this or to vote against it. I mean, this is something we have to decide for ourselves. The only thing that I would say, which may not be persuasive, is that this is making the existing, what is existing law? Right. And that's what I'm wrestling with too. In a way, it's- But I go with this because it's making the existing law for those people who have availed themselves of it better. Right. It's just the fact that I'm opposed to the concept. Exactly. Exactly. And so what I'm not hearing right now that folks want to hear from anybody else kind of thing. Other than who you have, right? Right. Right. Great lineup. Yeah. And there's some more, some individuals and what I have done and they're all posted, people have submitted some written comments or that they've wanted to and I've, you know, welcome to them all. And we post them and we also, we, Roy, Julie, or I, sends them out so that you get them individually. You don't have to, as a committee member, remember to go on the site. You will have gotten that on your email. So we have at this point, I received one or two people supporting it and a couple of people not supporting the changes based on the same sort of place that you are coming from. I'm just saying that's my... Yeah. Absolutely. That's my dilemma. Yeah. Absolutely. And the one factor probably apart from my belief system, but is discriminatory? Well, I mean, the initial law anyway, to not allowing somebody that is unable to inject themselves to not recover. Okay. So that to me is a, you know, a open question whether it could be seen as discriminatory because any of those people are in the worship or I would say the worship, but their desire to terminate their life might be greater than somebody suffering from a criminal cancer or something like that. Because they can't interact with the world at all. I mean, they're either, I would say, obviously they interact because they signed up for the process, but they can't do the final thing themselves. Can you just comment? Yeah. No, absolutely. We have to wrestle with these and with the choices and the balancing of rights versus responsibility versus personal and protection of people who are more vulnerable, more vulnerable perhaps to people more vulnerable to perhaps states of this is too hard. And so maybe not meeting the criteria ramp more vulnerable to people persuading them and perhaps more vulnerable for something happening that they don't, that was not their choice. So those are some of the things and good questions. Where are any thoughts right now or is, where are we? Okay. We are going to then break, we'll have lunch and other things and come back at 1.15 with a whole different subject. I do hope James you're gonna be here because it is an act relating to the interstate compact on the placement of children. Where else would I be? Well, I'm just saying because in case you hadn't gathered I really hope that you will be presenting this bill as an encore. I was picking up what you're putting down. And so that is I think where we are right now. Topper, do you wanna say anything before we leave? Okay. Thank you. Thank you all very much. I would just say one thing. Absolutely. Keep up the good work. Thank you, Topper. You're handling this very well. Thank you, Topper. I appreciate that.