Several terminally ill Coloradans have chosen to end their lives using legally prescribed drugs under the state’s fledgling medical aid-in-dying law, according the state director for the organization that was the main backer of the voter-approved measure.
Kat West, Compassion & Choices’ national director of policy and programs and acting state director for Colorado, told The Colorado Independent that the organization knows “several prescriptions have been written and several patients have self-administered” to end the suffering that comes with a prolonged or painful death. She declined to offer more specifics citing patients’ privacy.
Compassion & Choices on Friday hosted a webinar for doctors and other medical professionals to answer any questions they may have about the now two-and-a-half month old law. It’s the fourth such monthly educational seminar and West said many of the questions revolve around how to talk to terminally ill patients about the law the drugs recommended and the pharmacies that will dispense such drugs.
Most of Colorado’s major health care systems have adopted or are in the process of adopting policies in compliance with the law, she said during the webinar. The law does not offer hospitals the choice of opting out, but, West said, more than two dozen Catholic hospitals and facilities have invoked religious exemptions, saying they don’t have to comply.
Last November, Coloradans voted 2-to-1 in favor of the End-of-Life Options Act, which allows terminally ill, mentally capable adults to request a prescription from their physician for life-ending medication they can self-administer if they decide their suffering has become unbearable. The law went into effect in mid-December.
Under its provisions, no physician, medical professional or pharmacy is obligated to prescribe or dispense aid-in-dying medication. But neither does the law allow institutions to prohibit doctors or staff from participating if they choose, West said.
The one exception, West said, is that institutions can prohibit doctors from prescribing the aid-in-dying medication if the patient plans to take it on their facility’s premises.
Most terminally ill patients would rather die at home with their family and not in an intensive care unit, Dr. David Grube, Compassion & Choices national medical director and an Oregon physician with clinical experience in medical aid-in-dying, said during today’s webinar. Yet, he said, about 60 percent of U.S. terminally ill die in institutions.
Twenty years ago Oregon became the first state with a medical aid-in-dying law, and now there are six, including Colorado, Washington, Vermont, California and Montana, plus the District of Columbia.
“Legislation is pending in other states,” Grube said. “This is something that is advancing in our nation.”
He offered participating physicians a primer on the nuts and bolts of practicing under the law, which allows a patient with fewer than six months to live a life-ending option that does not legally constitute suicide, euthanasia or homicide.
In Oregon, about 75 percent of patients seeking aid-in-dying have a terminal malignancy, but about 10 percent are amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) patients, Grube said.
Simply having a prescription for medical aid-in-dying on hand is comforting to patients, whether they use it or not, and even talking with the doctor about end of life is palliative in and of itself, Grube said.
A patient must be seen by his or her physician and a second consulting physician. Either doctor can refer a patient for a mental evaluation if they believe the patient lacks capacity to freely make the decision.
“A mental evaluation is quite rare in Oregon, perhaps five out of 200 patients are evaluated,” Grube said.
Physicians are required to have patients provide them with two spoken requests two weeks apart and a written request signed by two witnesses, Grube said. Only one witness can be employed at a facility where the patient is being treated. The prescribing physician can’t serve as a witness. The documentation is then filed and finalized at the Colorado Department of Public Health and Environment. At the time of this posting, the department had not returned phone calls seeking comment on how it documents how many Coloradans have self-administered life-ending drugs under the new law.
The medication typically used is a short-acting barbiturate, such as secobarbital, a sleeping aid. “It’s generally a very calm and peaceful way of dying,” Grube said.
There is no duty to participate if a doctor or hospice nurse objects, Grube said. “There is no criminal or civil liability for any providers if they follow the law. In 20 years in Oregon, no physician has ever been disciplined for applying this law.”
Having the medication does not affect the patient’s health insurance status, he said. Many private insurances cover the medication.
The death certificate lists terminal illness as the cause of death, not the medication.
In this webinar as in previous ones, Grube was asked how to bring up the topic of medical aid-in-dying.
“Patients often initiate the conversation when it’s clear there is no longer a curative option,” Grube said. “Most want to be at home and in control. But sometimes the patient needs to hear about the option.”
The conversation must be handled “with a certain grace, a certain care, a certain style,” Grube said. He said he typically asks patients how they envision their final days and hours.
“It’s not easy sometimes.”
An earlier version of this story misspelled Dr. David Grube’s name. We regret the error.
Tina Griego contributed to this story. Photo by Jasleen Kaur via Flickr: Creative Commons.