If you come down with a terminal illness in Colorado a new law gives you the right to have doctors end your life painlessly. The Colorado End of Life Options Act went into effect last Dec. 16. While the essence of the new law sounds simple, the realities of its usage can be complex. That’s why Region 10 recently sponsored a seminar about the law at the Holiday Inn Express, in Montrose.
More than eighty people from the medical, legal, and law enforcement communities came to be instructed about what the Act does, and doesn’t, allow and require.
The presentation was delivered by Jennifer Ballentine, an independent consultant with her own company, “The Iris Project”. “I’m located in California now, but have deep roots in Colorado, working with end of life issues,” she said.
Ballentine gave the Montrose Monitor a concise explanation of the End of Life Options Act.
“The brief description is that the law allows terminally ill adult Colorado residents to request from a physician a prescription for lethal medications to end their lives.
“There are a number of eligibility criteria, and qualification steps that the patient has to go through in order for that to happen,” she continued. “The law lays out what that process is. It’s a very complex piece of legislation, but at the end of the day, it basically allows terminally ill patients to end their lives.”
Ballentine explained to the Monitor that patients must be in full possession of their faculties, and that people who have the medical power of attorney can not initiate the process for them. “ Patients must be mentally capable, as defined in the law,” said Ballentine. “They have to make two oral requests directly to their attending physician, and one written and witnessed request.”
All three requests stress certain key points, according to Ballentine. “I am making this request on my own, and this is my choice. The physician is required to counsel the patient on a whole laundry list of issues to make sure they are making an informed decision. So this is not something that a power of attorney, or a guardian or a family member can request on behalf of a patient.”
Ballentine explained what the law would require if the patient were to slip into a coma after making the request, but before receiving the lethal medication. “Well,” she said, “if the person loses mental or physical capacity to take the drugs, it’s a de facto withdrawal of the request, because no one else can give them the drugs if they have lost their own capacity to take them.”
You might be wondering if anyone has actually used this law. “I have not heard of anyone using it yet,” Ballentine said. “It’s possible that people have, but have kept it private.”
Ballentine had done six of these seminars, in Front Range cities and Grand Junction, before coming to Montrose. “This is by far the most diverse crowd I’ve ever educated. We’ve had everyone from emergency services to coroners, hospice, hospital care, long-term care, home care, doctors, nurses, social workers, and mental health professionals. It potentially touches every aspect of health care.” Judges, attorneys, and law enforcement officials have also taken the training in Montrose.
We asked Ballentine to discuss some of the trickiest aspects of the new law. “I think one of the most challenging pieces of it for health care providers is that the law assumes that you are going to participate in medical aid in dying, unless you develop and publicize a written policy that says you’re not.” Individuals and medical facilities can choose to opt out, but that part of the law is “very, very narrowly crafted in one section, and in another section it’s very broadly defined,” she explained. “I think there’s a lot of confusion about what organizations can do to say ‘We don’t want this happening in our long-term care facility, or in our hospital.’”
So what do you do to clarify that confusion? “I can’t clarify it because it’s messy in the law,” she said with a hint of frustration in her voice. “Fortunately, this was passed as a ballot issue statute, not a constitutional amendment, so it can be amended and changed.”
However, Ballentine also emphasizes that the Colorado law is not all bad in her view. “I think there are some aspects of the Colorado law, as distinct from some of the other laws that are in effect in other states, that are innovative, interesting and good. It’s not all bad; it’s just complicated.”
“Oddly enough,” she said, regarding what she liked about the law, “I like the fact that policies must be publicized, that they must be written and given in advance to physicians and patients, because I think there’s a lot of confusion and discomfort with this process. And, there’s a lot of obscurity around it. As a patient, I would like to be able to go to a website and know what your policy is.” She hopes that hospitals will also provide patient information flyers.
Many of Colorado’s hospital systems have already announced policies that say they are opting out of the End of Life Options Act.
Montrose Memorial Hospital is one of them. “So has Delta Community Hospital, all of the SCL Health facilities, all of the Health One facilities, and all of the Centura Health facilities.”
However, hospitals are usually not where end of life drugs are administered, anyway. “The whole process takes about 45 days. People are not usually in the hospital that long,” Ballentine explained. “They don’t want to die in a hospital; if you have control over where you die, a hospital is not what you would pick.”
Individual physicians may also choose to opt out for religious, ethical, or other reasons. “The law is very clear that no one is to be sanctioned for either participating or not participating,” Ballentine said. Also, nurse practitioners do not have the authority to prescribe the drugs involved.
For more information, please visit www.irisproject.net.