5 Things to Know About Colorado’s End-of-Life Options Act

Coloradans with terminal illnesses can now legally seek physician prescribed aid-in-dying. The End-of-Life Options Act, legislation approved by voters on November 8 via the citizen-initiated Proposition 106, went into effect December 16, when Governor John Hickenlooper certified the ballot measure. The legislation won a resounding victory with 65 percent of the vote.

The new law makes it legal for terminally ill, mentally capable adults to seek and self-administer life-ending medication; for health care providers to prescribe the medication; and for pharmacies to fill the prescriptions. However, physicians and pharmacies are not obligated to provide or partake in aid-in-dying. In fact, some doctors and hospitals across the state are already choosing to opt out.

Modeled after Oregon’s Death with Dignity law, passed in 1997, the new Colorado law mandates some specific qualifications to be eligible for a life-ending prescription. Here’s what you need to know:

Who is eligible to seek life-ending medication in Colorado?

Colorado residents over the age of 18, who have been diagnosed with a terminal illness, and who have been given a prognosis of less than six months to live can request a prescription for life-ending medication. A qualifying illness might be terminal cancer or advanced Amyotrophic Lateral Sclerosis (ALS). The patient’s attending physician and a second consulting physician must determine that the individual is mentally fit to make the decision and to self-administer the life-ending medication in a peaceful manner. If either physician has any doubt of the patient’s mental capacity, he or she must refer the patient to a licensed mental health professional to make the assessment.

What is the procedure for acquiring the medication?

The law has safeguards in place to keep a patient from requesting and obtaining life-ending medication in a short span of time (i.e., from making a rash decision) and to hedge against coercion or misunderstanding of one’s options. Because of those safeguards, the procedure for obtaining medication for aid-in-dying has several required steps:

• An eligible individual must make two verbal requests for life-ending medication. The requests must be separated by fifteen days. One request must be made to his or her attending physician (the doctor who regularly provides the patient’s health care) and one must be to another, consulting physician.
• Before writing the prescription, the patient’s attending physician is legally obligated to discuss the patient’s diagnosis and care options (for treatment, palliative care, and pain management) to ensure they are making an informed decision.
• In addition to two verbal requests, the patient must submit a written request to his or her attending physician. There must be two witnesses: At least one cannot be a family member, one cannot be entitled to any portion of the patient’s estate, and one cannot be an employee of the health care facility where the individual is receiving treatment or residing. Witnesses cannot be the patient’s physician or someone who has power of attorney for the patient. The witnesses must determine to the best of their ability that the patient is mentally capable and is not being coerced.
• The attending physician must also give the patient multiple opportunities to rescind his or her request.

Opponents to Proposition 106 cited a lack of appropriate safeguards. Read about one opponent’s thoughts here.

Not all doctors are willing to provide aid-in-dying. How do patients know if their doctors will partake in the Colorado End-of-Life Options Act?

They can simply ask. Kat West, national director of policy and programs for Compassion and Choices, a national nonprofit that organizes around end-of-life health care options (including medically assisted death), recommends that terminally ill patients considering this option have a conversation with their doctor early, well before one might want to seek life-ending medication. If the doctor is not willing, West says patients may want to find a new doctor as soon as possible. That way, she says, the full range of options will be available when (and if) they’re ready to seek aid-in-dying—without having to navigate finding a new attending physician close to the end of life.

What is the medication, and does health insurance cover it?

West says insurance plans vary, but some companies do cover the medication, which typically costs anywhere from $400 to $5,000. Compassion and Choices is reportedly advocating for more affordable medication after prices skyrocketed—from $1,500 to $3,000 for a common prescription—earlier this year. There isn’t one specific medication that can legally be prescribed; it’s up to the physician. Typically, patients receive a lethal dose of a sedative (a barbiturate like secobarbital) that puts them to sleep before slowing, and eventually stopping, their breath and heartbeat.

What are health care professionals saying about this?

Laird Cagan, M.D., a retired internist and member of the Boulder County Medical Society’s board of directors, says he voted to endorse the proposition and expects most physicians, save for religious practitioners (the Pope opposes physician-assisted termination of life), will support it. “I don’t anticipate that very many people [in Colorado] are going to take advantage of this, if I could phrase it that way,” Cagan says. In other words, there’s a very specific window of eligibility intended to spare suffering for a distinct set of individuals.

In Oregon, 218 people received prescriptions for life-ending medication in 2015, and 132 people died from ingesting said medication. In Washington, where a similar law was passed in 2009, 213 prescriptions were filled in 2015, and 166 died as a result.

“If it’s similar in Colorado, and there’s no reason to think it wouldn’t be,” Cagan says, “It’s going to be very rarely used.”