Sixty-nine Colorado patients were prescribed aid-in-dying medication during 2017, the first year of the law approved by voters, and 50 of those patients filled the prescription, according to a report by the Colorado Department of Public Health and Environment released Thursday.
Although 56 of those 69 patients died, the data don’t reveal which ones died as a result of the drugs, or even if the deceased had filled their prescription.
But the CDPHE report does shed light on the characteristics of patients who pursued help through the law, and noted that Colorado’s data closely reflect that of other states that have medical aid-in-dying laws. Voters statewide approved the initiative, modeled after Oregon’s 22-year-old “Death with Dignity” law, in 2016 with a two-thirds majority. Two physicians must agree on a patient’s mental competence and that they have less than six months to live, and the patient must self-administer the drug.
Patients who were prescribed medication had a median age of 75, and men accounted for a majority, 54 percent. The primary diagnosis was cancer, at 64 percent, with amyotrophic lateral sclerosis, or ALS, and heart disease each accounting for 10 percent and respiratory diseases 9 percent.
Among those who died after a prescription, 93 percent used hospice care. Ninety-six percent of the patients were white. A majority, 63 percent, lived in the Denver area, and nearly three-fourths died at home.
Prescriptions were written by 37 physicians, and aid-in-dying medication was dispensed by 19 pharmacies. A combination of diazepam, digoxin, morphine sulfate and propranolol was most often obtained, at 56 percent, while 42 percent opted for the more expensive secobarbital.
The less-expensive alternative, sometimes called DDMP, costs about $500, while the secobarbital can cost more than $4,000 for the requisite dose.
Some who thought the law would provide a clear path to the aid-in-dying medication found that the process was beset by uncertainty on the part of physicians and pharmacists, as well as misunderstandings about how the law would work. Patients reported having trouble getting their doctors to sign off on the necessary paperwork, sometimes even when they had expressed support for the patient’s wishes.
One end-of-life planning and support organization noted that once the law went into effect, “We lived in chaos for the first couple of months.”
Finding two doctors to agree to assist with the prescription could be difficult. Some hospitals prohibit their physicians from participating, and anyone can opt out. And there were reports of patients having to travel hundreds of miles to obtain the required signatures — especially in rural areas. Only seven patients — 13 percent — who obtained a prescription for the medication lived outside the Front Range.
Fort Collins family physician Cory Carroll had six requests for aid in dying from his patients in the past year and was willing to help all of them. However, Carroll struggled to find consulting physicians who would agree that the patients met the requirements of the law, as required by the end-of-life options act. All six of the patients died before the prescriptions could be filled.
Carroll planned to attend the death of a patient Friday night who received a prescription under the law. The man became a patient of Carroll’s last year when he could not find another doctor who would “accommodate his wish,” Carroll said. “I anticipate he will take the (aid-in-dying) medications tomorrow to end his suffering in a peaceful, dignified and safe environment,” he said
“My hope is more physicians who are neutral or in support would be willing to learn the details of the law and help their patients rather than taking the easy way out and not participate,” he added. “For those physicians whose religious or moral beliefs are in opposition, I hope they respect their patient’s autonomy and help those that are dying find a supportive physician who will participate with the law.”
The health department data largely confirmed what proponents of aid-in-dying had expected.
“It mirrored what we’ve seen in other states that authorized medical aid in dying, so it’s unsurprising,” said Jessie Koerner, spokeswoman for Compassion & Choices, the national nonprofit that drove Colorado’s initiative, upon release of the data. “This is a good thing when we’re not surprised and caught off guard with what’s happening. It showed we don’t need to mandate further reporting requirements and also shows the law is working as voters intended and were promised.”
The new law has encountered a number of glitches as patients have attempted to put it into practice. Proponents say this reflects a “ramp-up” period in which patients and medical providers feel their way through the process, much as Aurora’s Herb Myers did while helping his wife procure and use the medication.
“We’ve seen from other cases, like Herb Myers, that just having (the medication) brings significant comfort to a patient,” Koerner said. “That’s all we ask for, that a patient gets to decide how to end their life. And if having the medication on hand is all it takes, that’s a patient’s decision.”
