By Diane Carman
Two Colorado legislators plan to introduce their Dying with Dignity bill this week, setting the stage for what likely will be one of the most intense and emotional debates of the session.
State Reps. Lois Court, D-Denver, and Joann Ginal, D-Fort Collins, are sponsoring the bill, which is modeled after the Oregon law that was passed by voters in 1994.
“We’ve been hearing from people all over the state,” Court said. “Hundreds of people have contacted us to express their support and only a handful to say they are opposed to the measure.”
A poll conducted last May by Strategies 360 for the advocacy group, Compassion & Choices, found that Colorado voters support the measure by a wide margin.
The poll asked, “Should mentally competent, terminally ill patients with less than six months to live be able to end their life using prescription medications they can self-administer?”
Sixty-two percent of respondents said they support the measure, 28 percent opposed and 9 percent were undecided.
Sen. Kevin Lundberg, R-Berthoud, who is chairman of the Senate Health and Human Services Committee, opposes the bill because it “fundamentally changes the relationship between a doctor and a patient.
“It’s a proactive action on the part of the physician and the pharmacist to provide a mechanism to intentionally kill the patient,” he said. “It’s a distinct change in our moral values.”
The one good thing about the bill, Lundberg said, is that it will spark a conversation about end-of-life issues.
“I believe most people haven’t considered the ramifications,” he said.
‘Civil rights issue of our time’
Court has been studying the issue for more than two years, meeting with advocates from Compassion & Choices and researching the situation in Oregon.
“I’ve met with people who believe that as the baby boomer population is aging, this will be the civil rights issue of our time,” Court said.
Modern medicine can keep people alive long after their quality of life is gone, she explained, and many people feel held hostage by a system over which they have no control.
Court had considered introducing a bill on aid in dying last year. Then last February, one of her constituents made the issue more urgent.
Charles Selsberg, a 77-year-old retired real estate agent, wrote a letter that was published in the Denver Post pleading for changes in the law to give people like him the chance to die on their own terms. He suffered from Lou Gehrig’s Disease, amyotrophic lateral sclerosis, and was in a Denver hospice.
The letter drew widespread attention to the issue across the state.
Selsberg died on March 6, 2014 after refusing all food and water for 13 days.
“Then the issue exploded last fall,” Court said, when 29-year-old Brittany Maynard, who was fatally ill with a malignant brain tumor, moved from California to Oregon so she could have the opportunity to manage her imminent death.
“When she made her story so public, it really escalated the conversation,” said Court.
Maynard ended her life on Nov. 1.
In part in response to Maynard’s appeal, 15 states are considering aid in dying legislation this year. Only one state, Vermont, has enacted such a measure through the legislative process. Oregon and Washington passed statutes through initiatives. Montana and New Mexico have aid in dying rights as a result of court decisions.
Court anticipates opposition to the bill from a variety of factions. Right-to-life advocates, disability groups and some in the hospice community have raised concerns about aid in dying, some saying that it could create a slippery slope toward euthanasia.
”I haven’t been lobbied,” Court said. “There has not been a lot of push-back.”
Lundberg anticipates opposition will grow when Coloradans become more familiar with the bill.
“There’s still a question in many people’s minds about whether it’s a truly independent decision (on the part of the patient) or not,” he said. “There are a lot of gray and murky areas.”
Court cites 16 years of documentation of the effectiveness of the law in Oregon as evidence that it has been successful.
“There have been zero problems in Oregon.” Demonstrating a complete lack of coercion, she said, “30 to 40 percent of people who ask for and receive the (life-ending) medications don’t use them.”
The Oregon Public Health Division has reported that since the law was enacted, 1,173 people have received prescriptions for life-ending medications and 752 have died from ingesting them.
Court speculated that merely having access to aid in dying apparently offers comfort for the terminally ill.
“It seems that the psychological comfort is at least as important as palliative care. If you know you have a fail safe option, either you’re no longer afraid of how bad it might be or having that option gives you the psychological comfort to go on.”
The bill, which is based on the Oregon law, requires:
- The patient must be determined to be mentally competent and diagnosed with an incurable illness that two doctors have determined likely will result in death within six months;
- If either doctor suspects that the patient is under duress or being coerced, is suffering from depression or may be unable to appreciate the action he is undertaking, the patient must be referred for psychological evaluation;
- The patient must request the medication twice and the requests must be separated by a minimum period of 15 days;
- The patient must be counseled on alternative treatment options, including pain management, hospice and palliative care;
- The patient must complete a written request for the medication, and it must be signed by two witnesses who can attest that the patient is fully informed and not being coerced;
- At least one of the witnesses cannot be related to the patient or be a beneficiary of the patient’s estate;
- The patient may rescind the request at any time;
- The patient must be capable of administering the medication without assistance;
- The measure would not permit euthanasia, mercy killing or assisting suicide, which will remain felonies under Colorado law;
- Death under the law would not invalidate a life insurance policy or annuity;
- Provided all of the procedures have been followed and documented, no doctor, pharmacist or health care provider can be held civilly or criminally liable; and
- Health care providers opposed to death with dignity are not required to participate.
Starkly different views
Among the supporters of the bill is Dr. Charles Hatchette, a retired physician in Fort Collins, who suffers from ALS. He recorded his testimony in support of the death with dignity law in a video in which, as he struggles to breathe, he says, “Compassion is the surest guide to making humane end-of-life decisions.”
Another was Gene Zumberge, an ALS patient from Englewood, who wept as he recorded his endorsement of the law. Then he refused all food and drink and died.
Lundberg maintains that there is a difference in his mind between allowing terminal patients to refuse food and drink, and providing them with lethal doses of drugs.
“It’s troubling to me when food and water are intentionally withheld,” he said, “but that’s one aspect of end-of-life decisions people can make. The water part in particular – hydration – is a difficult, difficult arena. But it’s qualitatively different to proactively provide drugs that will kill a person.”
Hearings on the bill have not yet been scheduled, but are expected to draw large crowds of advocates and opponents.
“I’m sure it will go on well into the night,” said Court, “and I expect it will be a highly emotional experience.”
As for the chances for success, Court declined to speculate.
“I’m reading Robert Caro’s five-part biography of LBJ,” she said. “I’m on the part about the controversy over the Civil Rights Act and the Voting Rights Act, and one thing I’ve learned is just because a bill is something the people want doesn’t mean it will pass.”