Up to 30 Colorado hospitals are opting out of the state’s new medical aid-in-dying law, either fully or in part, but whether that means the doctors they employ are banned from writing life-ending prescriptions is a controversy that could wind up in court.
At this point, terminally ill Coloradans who want to end their lives under the law will need to find out whether their physicians are allowed to participate.
Three major health systems with 30 hospitals among them — Centura Health and SCL Health System, both religiously affiliated, and HealthOne — have announced they will not participate in the law. What that means for doctors, though, varies by system.
Physicians at HealthOne’s eight hospitals, which include the Medical Center of Aurora, Presbyterian/St. Luke’s, Rose and Swedish, are allowed to talk to their patients about aid in dying and can write life-ending prescriptions in a hospital. But hospital pharmacies will not fill those prescriptions and patients are not allowed to take their own lives in the hospital, which health officials figure is an unlikely request anyway.
“We’re not saying as a system that our physicians can’t participate,” said Stephanie Sullivan, media relations director for HealthOne, only that doctors cannot dispense medication “within our hospital walls.”
But at SCL Health, the Sisters of Charity of Leavenworth, physicians will “continue to provide other requested end-of-life and palliative care services” but will not assist in helping patients end their lives. Hospital system spokesman Brian Newsome said employed physicians are subject to the policy “at all times.” Doctors with privileges to see patients in the hospital system but who are not employed by SCL Health must abide by the policy only when inside the hospital or working on behalf of the hospital, he said.
“We believe we can provide compassionate care and comfort to our patients so they can live with dignity until the time of natural death, and we have therefore opted out of participation,” says SCL Health’s online statement, adding that patients who want to use the law “will be offered an opportunity to transfer to another facility of the patient’s choice.”
SCL Health has seven hospitals in Colorado, including St. Mary’s Medical Center in Grand Junction and Good Samaritan in Lafayette.
Centura Health, with 15 hospitals in Colorado including Littleton Adventist, St. Francis Medical Center in Colorado Springs, St. Anthony and Porter Adventist in Denver, posted a vague statement saying it “has a long tradition of believing in the sanctity of life, extending compassionate care and relieving suffering.”
“As permitted by the statute, Centura Health has opted out of participating in the Colorado End-of-Life Options Act,” the statement says, offering no clarification on what that means for its employed doctors. Spokesman Eric Hubler said he could not answer questions this week about whether doctors employed by Centura could write prescriptions on or off premises.
Authors of Colorado’s medical aid-in-dying law, passed overwhelmingly by voters last November, say that although hospitals can prohibit patients from ending their lives at the hospital, they cannot bar doctors from writing prescriptions that patients would take later in their homes. It could take a patient filing a lawsuit to settle the matter.
“It’s quite frankly despicable that a hospital would hedge their bet on whether a terminally ill person wants to wage a legal battle in the last few months of their life,” said Matt Whitaker, multi-state implementation chairman for Compassion & Choices, the nation’s largest right-to-die advocacy group and author of the law.
The law says a hospital may prohibit an employed or contracted physician from writing a prescription for someone “who intends to use the aid-in-dying medication on the facility’s premises.” It also makes clear that a healthcare provider can choose whether to participate in medical aid in dying and that the provider must transfer the patient’s medical records to a new health care provider if requested.
It’s “absolutely permissible” to ban the use of the life-ending drug, often secobarbital, on hospital property, but barring physicians from prescribing it to terminally ill patients so they can end their life at home is out of bounds, Whitaker said. Voters intended the decision to take place within a doctor’s “individual conscience” and the “physician-patient relationship,” he said.
The Colorado Hospital Association, however, interprets the law as allowing hospitals to make decisions about whether their employed physicians can participate. Still, association policy analyst Amber Burkhart is urging health systems to consult their lawyers about “ambiguities” as they finalize policies.
“We are not encouraging in participating or not participating, we’re just focused on educating our members,” she said. “The law clearly states that hospitals have the ability to participate or not participate.”
The association, which represents more than 100 hospitals and health systems across Colorado, has not completed a statewide count regarding which are opting out.
University of Colorado Hospital, as well as UCHealth’s other hospitals and 100 clinics, will participate, as will Kaiser Permanente Colorado. Denver Health Medical Center has so far opted out, but its leadership is scheduled to discuss the issue further this week. Many hospitals still are in the process of establishing a policy, Burkhart said.
The law requires hospitals that opt out to make their policy visible to their patients and employees.
Kaiser, which participates in similar laws in Oregon, Washington and California, is developing a program for Colorado’s new law that will focus on Kaiser’s “commitment to support the physical, emotional and spiritual health” of its patients, said communications director Amy Whited. Kaiser doctors can choose whether to participate and Kaiser will “support all physicians whether they decide to opt in or opt out,” she said. “We realize there are strong emotions and opinions around medical aid in dying.”
In the first month of the new law, no one has ended their life but “several folks are in the process of getting prescriptions,” Whitaker said.
