Medical aid in dying waiting period would shorten from 15 days to 48 hours under Colorado bill

A bill in the Colorado legislature would shorten the mandatory waiting period for medical aid in dying from more than two weeks to two days, opening the option to more critically ill people, but raising concerns for some about rushed decisions.

Colorado legalized medical aid in dying in 2016, when voters passed Proposition 106. Under the law, two physicians must agree that an adult patient is mentally competent to make the decision to die and would have less than six months until natural death. If approved, the person would then give themselves a drug cocktail meant to cause death painlessly.

Under current Colorado law, a patient has to request medical aid in dying twice, at least 15 days apart, before they can get a prescription. Senate Bill 24-068 would shorten the timeline to 48 hours, and allow physicians to waive the waiting period if they believe the patient will die in less than two days.

It would also allow people who aren’t Colorado residents to end their lives under the state’s law, and let advanced practice registered nurses prescribe the drug cocktail. Colorado allows APRNs to prescribe most drugs, but limits medical aid in dying prescriptions to physicians.

Shelby Marcuse, of Colorado Springs, said that having more providers able to prescribe medical aid in dying would have made the process easier for her mother, Vyki Bishop.

Bishop was diagnosed with terminal bile duct cancer in April and made it clear from the beginning that she wanted the option to end her life on her terms, but Marcuse said the family couldn’t find a local doctor who would evaluate her and write the prescription. The closest doctor who could see her within a month was in Littleton, and fortunately offered telemedicine, since Bishop’s gastrointestinal symptoms would have made driving there a challenge, Marcuse said.

The waiting period was a smaller obstacle, though her mother worried during that period that something would go wrong and she’d no longer qualify, Marcuse said. Ultimately, Bishop chose to take the medication after her symptoms escalated in October, and she spent her last day calling family members and listening to her favorite music, her daughter said.

“Her anxiety decreased immensely because she had that choice” to die when she was ready, Marcuse said.

Julie Reiskin, co-executive director of the Colorado Cross-Disability Coalition, said she’s concerned that speeding up the timeline would result in people deciding to die while in despair over a diagnosis, before they’ve had time to process their options and adjust to a new life.

When she first became disabled, she thought she’d rather die than rely on a wheelchair, but with time found life was as fulfilling as ever, she said.

“That just feels way too fast,” she said.

Reiskin said she’s also concerned about allowing people who aren’t Colorado residents to come here to end their lives, because they won’t be working with a medical provider who knows their history and needs.

While some physicians in Colorado caused a stir by raising the possibility that some eating disorders and other mental health conditions could be considered terminal, state law doesn’t specifically address aid in dying for those patients. People with Alzheimer’s disease or other forms of dementia aren’t eligible.

The new bill clarifies that if providers aren’t sure if a patient is mentally capable of deciding to die, they should refer that person to a mental health provider for evaluation, and specifies that insurance companies may not attempt to persuade a terminally ill customer to die so they can avoid paying for care. It also removes a sentence from the request format that the person understands “the seriousness of this request” and expects to die if they take the medication.

Medical aid in dying is legal in nine other states and the District of Columbia, with some limiting their programs to residents and others allowing patients from elsewhere to receive life-ending prescriptions. Minnesota’s legislature is considering a bill to authorize the practice this year.

In 2022, 316 people were prescribed drugs under Colorado’s medical aid in dying law, according to the Colorado Department of Public Health and Environment. During the same year, 246 people opted to fill the prescriptions, and 243 died, though the state data doesn’t show how many took the medication and how many died naturally. (It’s possible some people who received a prescription in 2021 filled it or died in 2022, and that some people who got their prescription in 2022 died later.)

Those who died after receiving a prescription — whether they took it or not — were more likely than the general population to be white and to have a college degree. About four out of five were receiving hospice care at the time of their deaths.

Of the group that received a prescription, 184 had a form of cancer; 45 had progressive neurological conditions, such as amyotrophic lateral sclerosis (Lou Gehrig’s disease) or Parkinson’s disease; 25 had chronic lung conditions; and 24 had cardiovascular diseases.

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Reiskin said the state needs to do a better job documenting whether patients who seek medical aid in dying received adequate pain medication and home medical care. As is, no one knows if people were truly finished fighting their illnesses or were worried about burdening their families, she said.

“We need more information before we make it easier,” she said.

Mike Reagan, a death doula, said pain management isn’t perfect, however, and people nearing the end of their lives often want to exercise some control.

About six months ago, Reagan worked with a man who had been diagnosed with stage four pancreatic cancer and given one or two months to live. The man wanted to die before the pain required heavy medication, because he wanted to gather his loved ones and say goodbye at the end. As it happened, the man died during the 15-day waiting period, under the influence of painkillers and unable to communicate, he said.

“He got to a state he never wanted to get to,” Reagan said. “An elongated waiting period will rarely move someone to change their perspective” on dying.

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