When Francine Milano made her first trip from Pennsylvania to Vermont, she wasn’t chasing fall foliage or heading for a hiking trail. She was pursuing something far more personal: the right to choose how, when, and where she would die.
After her ovarian cancer returned two decades after initial treatment, Milano was told in early 2023 that her illness was terminal. What she sought wasn’t just palliative care—it was control. But her home state of Pennsylvania, like many others, offered no legal pathway to medically assisted death. So she took to the road.
Her journey represents a growing but quiet movement in American health care: medical tourism not for healing, but for dying.
A Legal Landscape in Motion
As of mid-2024, ten jurisdictions in the U.S.—nine states and the District of Columbia—explicitly allow medical aid in dying (MAID), sometimes called physician-assisted death. Montana’s Supreme Court decision allows it in principle, though with fewer formal guidelines. But only a few states have lifted residency requirements for those seeking this option, most notably Vermont in May 2023 and Oregon two months later.
Those changes have created a small but meaningful surge in end-of-life travelers. Since opening its doors, Vermont has reported that nearly 25% of its MAID cases have involved out-of-state residents. Oregon, a longer-standing MAID state, saw 23 nonresidents receive aid in dying in 2023—just over 6% of its total.
These numbers are modest, but they reflect something deeper: a rising tide of Americans willing to travel for their right to die with dignity, even while battling the physical and emotional toll of terminal illness.
The Challenge of Traveling to Die
For patients like Francine Milano, the journey isn’t just philosophical—it’s logistically daunting.
Two doctors must confirm the patient has less than six months to live and is mentally competent. The patient must travel to the state to request medication, undergo assessments, and return at a later date—often weeks later—to take the medication.
These requirements are intended to safeguard the process, ensuring it is thoughtful and deliberate. But for someone grappling with fatigue, pain, or nausea, making multiple long-distance trips can be more than difficult—it can be impossible.
Dr. Diana Barnard, a palliative care physician in Vermont, sees this firsthand. “Some patients are too ill to even make it to their appointments,” she says. “Yet they’re forced to use what little strength they have left just to claim an option that should be available closer to home.”
More States, More Barriers
While many state legislatures have considered MAID bills in recent years—including Pennsylvania—only Delaware passed such legislation in the 2023-24 session, and even that awaits executive action.
Opposition remains strong. Religious groups argue against the moral implications of choosing to die. Some medical professionals assert that their mission is to alleviate suffering—not hasten death. And federal-level legislation seems unlikely, especially after the Supreme Court’s 1997 ruling that left the issue to individual states, much as it did with abortion in 2022.
Still, progress continues in pockets. Peg Sandeen, CEO of Death With Dignity, notes that early adopter states often start with restrictive rules—long waiting periods, psychiatric evaluations—only to relax them later once systems and safeguards prove effective.
The Human Side of Choice
Control is the core theme that echoes through conversations with those seeking MAID. Anthropologist Anita Hannig, author of The Day I Die, spent years interviewing terminally ill individuals and found that the mere presence of choice—whether or not it’s ultimately used—provides profound comfort.
Milano echoes that sentiment. Though she hasn’t yet chosen the final step, the ability to access it provides her with peace. Her first approval window in Vermont expired while she continued to enjoy good health. But in June, she returned to the state—this time in a camper van with a close friend—to renew the process.
Her visit included a Zoom call from a Vermont parking lot, ensuring she complied with laws requiring in-state presence for medical consultations. “I don’t know if they track GPS or IP addresses,” she joked, “but I didn’t want to risk being dishonest.”
And she has real concerns. Will she still be strong enough to travel when the time comes? Will she be brave enough to take the medication? Studies show that about a third of approved patients never use the prescribed drugs. For many, just knowing the option exists is enough.
The Unseen Costs of Dying Far from Home
For out-of-state patients, even the setting of their final moments can be a challenge. Hospitals and care homes may prohibit MAID, forcing individuals to rent short-term housing—sometimes with the help of nonprofits or informal listings on platforms like Craigslist.
Dr. Charles Blanke, an oncologist in Oregon, has seen as many as 25 family members attend the death of a local patient. But for those who come from far away, the support system is often limited to a spouse or single friend. The emotional and logistical burden of dying away from home weighs heavily.
Still, for patients like Milano, the ability to choose outweighs the hardship. “I just wish more people had the option,” she says, reflecting on her second journey north. “I’m grateful to have the chance to decide how I leave this world.”
Toward a More Compassionate Future
The rise in MAID-related travel underscores a national dilemma: how to respect individual autonomy at the end of life while navigating deeply held ethical, religious, and political divides. For now, death with dignity is a privilege not yet granted to all Americans—but those who seek it are blazing a trail of compassion, resilience, and quiet courage.
Whether states follow Vermont and Oregon’s lead or continue to debate from the sidelines, one thing is clear: the conversation about dying—how and where it happens—is no longer just philosophical. It’s deeply personal. And for many, it’s worth the journey.
