- Courtesy of EVE Fox
- Maggie planting peas in her garden
Maggie Lake spent January 15 autographing copies of her artwork, signing over her car registration and talking quietly with family.
"Then at some point she just said, 'It's time,'" according to her oldest sister, Katy Lesser of Underhill.
After nine years of battling cancer — including two stem-cell transplants, chemotherapy and radiation — Lake had come to the end of her fight.
Lying in bed at her Putney home as day turned to evening, the 60-year-old took the lethal dose of drugs she'd been prescribed weeks earlier. She urged her family to coach her through it as she swallowed the combination of pills and liquids.
"We sat with her. We talked to her. We talked to each other. We reminisced. We laughed. We cried," Lesser said.
Within 10 minutes, Lake slipped into a coma. She lay quietly for eight hours before dying in the early morning of January 16.
"It was very, very peaceful," Lesser said. "It was pretty awesome."
Lake lived an amazing life, her sister recalled.
"She was really good at a lot of things," Lesser said. "She had two kids she adored, she was a gifted artist, a family nurse practitioner who treated hundreds of patients, a gardener, a cook and baker who grew all her own food. She kept bees, she raised meat and vegetables."
Just days before Lake died, her latest art exhibit opened in downtown Brattleboro.
Those are the things Lesser wants her sister to be remembered for.
But Lake also had a remarkable death.
She is believed to be the third terminally ill Vermonter to end her life with a lethal prescription since the state legalized the option in 2013, according to Compassion & Choices state director Linda Waite-Simpson, whose organization advocated for the law, helps families navigate it and has tracked its use. Lake's family is the first in Vermont to step forward to share its story.
- Courtesy of Katy Lesser
- Left to right: sisters Joanne, Maggie, Elizabeth and Katy Lesser in 1974
Twenty years ago, the people of Oregon voted for its seminal Death with Dignity Act. In the decades since, only Washington and Vermont have followed its lead — and only Vermont has done so legislatively. Courts in Montana and New Mexico have also protected the practice.
But the debate over Vermont's law is far from over. Advocates plan to seek changes this legislative session to ensure that state regulations surrounding its use remain in effect. They believe the measures guard against abuse, evidence of which would likely lead to the law's undoing. Some of the regulations, including a mandatory waiting period and second opinion, are due to expire in July because of a last-minute compromise struck to pass the bill two years ago.
"It's working exactly as we intended," said Sen. Claire Ayer (D-Addison), a leading advocate. "We have a responsibility to make sure it's under circumstances that give us some safeguards."
Opponents, meanwhile, hope to repeal the Patient Choice and Control at End of Life Act, which was approved by a narrow margin in 2013.
"We never should have passed it," said Sen. Peg Flory (R-Rutland). "I think it sends a horrible, horrible message to kids and the disability groups."
Many local medical professionals remain deeply uncomfortable with the idea of hastening death when their mission is to keep people alive. But since the Vermont law took effect May 20, 2013, doctors have prescribed lethal doses to five people, according to Vermont Department of Health spokesman Robert Stirewalt. Two of them didn't end up using the drugs, according to Waite-Simpson, a former state representative from Essex.
Doctors are required to inform the state each time they write such a prescription, affirming that they followed certain criteria, but the law does not require them to report whether a patient uses the drugs.
Waite-Simpson's group has collected that information from friends and family members of those who have sought to hasten their deaths, and from caregivers who have sought the organization's advice.
Jason Saltman, a 47-year-old Middlebury man with stomach cancer, was the first Vermonter to obtain a lethal prescription in November 2013. He died hours before he planned to pick up the drugs, according to his sister, Laura Saltman.
Waite-Simpson said others were unwilling to speak publicly.
Dying the Way She Lived
Lake was diagnosed with non-Hodgkin's mantle cell lymphoma in 2006. She enjoyed relatively good health for six of the next nine years, according to her sister. In the course of her treatment, she endured stem-cell transplants, radiation and numerous hospital visits.
- Poppies by Maggie Lake, 2014
Before she knew that a second transplant was possible, Lake started looking into obtaining a lethal prescription. That was before Vermont's law passed, her sister said. "No one wanted to help her, because it was illegal," Lesser said.
When the second transplant became a reality, about a year and a half ago, she turned her focus to getting better, her sister said. It worked — for a time.
"She seemed to be getting better for a while, and then she wasn't getting better," Lesser said.
Lake's health then quickly deteriorated.
"She started to see her whole selfhood disintegrate," Lesser said. "She was in pain all the time. She was having trouble breathing because the cancer spread to her lungs."
That's when Lake began thinking about the new legal option available to her. She talked about it freely with family, her sister said, but the conversations and the decision were difficult. They all would have preferred for her to get better and live, Lesser said, but they were all on board with her decision.
"For a long time she really felt there was always hope. Then she really felt like there was no hope," Lesser said. "In the end she wanted to die the way she lived: with those she loved, in her home, her wits about her, and with purpose and determination. And that is what she made happen."
Lake was the third of four girls in the family, six years younger than Lesser. "Maggie was a diminutive little girl, but she was a powerhouse," Lesser said. "She was one of the most alive people I've ever met."
Lesser said she appreciates that her sister took charge of her death, just as she took charge of her life. Without the law, the end might have looked different.
"She probably would've toughed it out and died a miserable, painful death that would have not included any of us because she would have just been out of her mind with pain, drugs, drowning in her own lungs," Lesser said. "We all have that memory of her going out the way she lived."
How the Law Works
The process of obtaining a life-ending prescription is detailed, which advocates of the law intended as a way of allaying fears that it could be abused.
In Lake's case, that process took time. According to her sister, she spent more than a month trying to find a doctor willing to write her a prescription.
Lesser said her sister's experience led her to believe the requirements are appropriate. "The longer she went through that process, the more doctors, the more meetings — she became more rooted in knowing she might want to do this," Lesser said.
Vermont's law requires a patient to:
Be a Vermont resident.
Have a terminal diagnosis with less than six months to live, corroborated by a second opinion.
Have the capacity to make a voluntary decision.
Make two oral requests for the prescription 15 or more days apart.
Make one written request for the prescription with two witnesses who affirm that the request is voluntary.
Waite-Simpson said that from what she knows, all three patients who have used the law to end their lives had different doctors.
Lesser declined to identify her sister's. Waite-Simpson also declined to name those whom she knows have written prescriptions. She doesn't want to send a message that only certain go-to doctors in Vermont will do it.
Waite-Simpson said physicians who've contacted her for advice have described a variety of experiences. One found his patient lacked the mental competence to make the decision, she said, and turned the patient down.
Some Vermont hospitals and other health care facilities have opted for exemptions that prevent patients from using the law within their facilities.
But supporters of the law say it is working. They never expected large numbers of people to exercise the right it gives them, and say they knew that some might seek prescriptions they would never use.
"I've received countless messages from all over the state from people grateful they have the choice," said Dick Walters of Shelburne, president of Patient Choices Vermont, who has spent more than a decade advocating for the law.
Diagnosed with lung cancer in April, Walters now finds the law personally reassuring. "There's tremendous peace of mind knowing that you're in control," he said.
The number of patients ending their lives has gradually risen in Oregon, where the practice has been legal since 1998. In 2013, 122 Oregon residents received a prescription and 71 used it, according to the Oregon Public Health Division. The Beaver State's population is more than six times Vermont's.
The Oregon law also requires much more detailed reporting of information on each patient. Records indicate that, in 2013, the median amount of time between ingestion and death was 15 minutes, with a range from five minutes to 5.6 hours. Since 1998, the longest time span reported between ingestion and death in Oregon was 104 hours.
No states have adopted similar laws since Vermont's passed in 2013, though some are considering it. One such bill was introduced last week in California.
Meanwhile, those who opposed passage of Vermont's law aren't giving up.
"It's a formula for abuse," said Lynne Cleveland Vitzthum, who represents the Vermont Center for Independent Living, an advocacy group for those with disabilities. "We will push for repeal."
Vitzthum, whose adult son has cerebral palsy and autism, said the law adds to existing pressures that those with disabilities endure over the value of their lives in the face of expensive health care needs. When her son was 8 and had pneumonia, she said, his doctor suggested she could consider letting him die.
"This helps a society that might not value us say, 'Here's a solution.' Our needs are expensive. Our care is expensive," Vitzthum said. "For some populations, it's not very difficult to socially engineer the will to die, where it looks like they're making the choice."
Vitzthum also argued that the law itself has numerous flaws, many of which came as a result of last-minute changes during the legislative process. Many of the regulations and reporting requirements, modeled on Oregon's law, were stripped away to win the votes of two senators, Peter Galbraith, a Windham Democrat, and Bob Hartwell, a Bennington Democrat. They insisted the few remaining regulations should sunset in 2016 because they were against any government involvement in the process.
Galbraith and Hartwell both retired from the legislature last year.
Ayer said she hopes to keep this year's vote focused solely on whether to reinstate the regulations, such as the waiting period and requirement for multiple requests, rather than revisiting the merits of the law itself.
Vitzthum argues that its regulations are too vague, including the definition of a Vermont resident, which is left up to a doctor. She also notes that while the law requires a patient to be capable of voluntarily requesting a prescription, there is no guarantee of a patient's ability to make decisions when it comes time to take the medicine.
Other groups plan to join Vitzthum in seeking repeal of the law, including the Vermont Alliance for Ethical Healthcare and the Vermont Right to Life Committee.
Ayer said she does not believe the law will be repealed.
"They don't have the votes," she said. "And the governor would veto it."
'Today's the Day'
Lake got her lethal prescription filled weeks before taking it, according to her sister. She was waiting until just the right time, without knowing for sure whether it would arrive, depending on what direction her health took.
"The day she died, she said, 'Yesterday was too soon. Tomorrow's too late. Today's the day,'" Lesser said.
Her two adult children, partner and three sisters were by her bedside as Lake took the drugs and went into a coma. Lesser said they started to worry as the hours passed. "We started thinking, 'My God, is the dose right?'" Lesser said.
In the end, her sister died peacefully. A celebration of her life is planned for June in an orchard in Putney.
"I can assure you there will be a thousand people," Lesser said.
Just before her death, Lake rallied to finish work for her last art show and traveled to Brattleboro, with the help of a wheelchair, to see the exhibit, of botanical prints, just before it opened at Mitchell Giddings Fine Arts.
On the gallery's website, Lake wrote about seeing the withering flora in late fall on one of her last hikes through the woods.
"What a metaphor for life, for my life, as I struggle with terminal cancer, birth, death and rebirth," she wrote.
Her show, called "Gone to Seed," runs through March 1.