Is Aid-in-Dying Medication Really a Compassionate Option?
In 2016, Proposition 106, also known as “Access to Medical Aid In Dying” passed in Colorado, allowing doctors to prescribe life ending medications to patients, in specific circumstances, upon request.
Before discussing the numbers, I want to clarify that I am aware this is a very personal and difficult issue to address. I respect that the specific details of each case should not be shared with the public unless the patient wishes to share. There are real people with real pain behind these statistics. I can’t begin to understand what it is like to receive a terminal diagnosis or know every person’s experience watching a loved one die. There is a lot of pain and suffering involved in these situations, despite our great advancements in medicine, and we are not ignoring this fact. I have seen people live with and eventually die from some of these diseases, including breast cancer, dementia, and ALS. It is understandable to want to avoid the pain, both mental and physical, that diseases like these bring. I am also aware that palliative care is not easy or simple, though we have wonderful people who work in that field. The administering of pain medication to a dying patient requires delicate balance by hospice and medical staff. However, palliative care is a separate, but related, issue to be addressed another time.
Our motivation behind opposing these “aid in dying” medications is to prevent abuse of those in vulnerable circumstances and to uphold the dignity and value of every human life.
The Disability Rights Education & Defense Fund describes why they opposed assisted suicide:
“Most people [choose assisted suicide] because they fear burdening their families or becoming disabled or dependent. But anyone dying in discomfort that is not otherwise relievable, may legally today, in all 50 states, receive palliative sedation, wherein the patient is sedated to the point where the discomfort is relieved while the dying process takes place. Thus, today there is a legal solution to any remaining painful and uncomfortable deaths; one that does not raise the very serious difficulties of legalizing assisted suicide.” [
https://dredf.org/public-policy/assisted-suicide/key-objections-to-the-legalization-of-assisted-suicide/
]
Review of the 2018 Data Summary, from the Colorado Department of Public Health and Environment site, found here, [ https://www.colorado.gov/pacific/cdphe/medical-aid-dying ] shows the following:
"The Colorado End-of-Life Options Act does not authorize or require the Colorado Department of Public Health and Environment to follow up with physicians who prescribe aid-in-dying medication, patients, or their families to obtain information about use of aid-dying medication. Additionally, the Colorado End-of-Life Options Act requires that the cause of death assigned on a patient’s death certificate be the underlying terminal illness." (from the CDPHE report)
- 125 patients received prescriptions for aid-in-dying medications which represents a 74% increase from 2017.
- 68.6% were prescribed DDMP (diazepam, digoxin, morphine, propranolol) and 31.4% were prescribed secobarbitol.
- The youngest recipient of these aid-in-dying prescriptions was in their mid-30s and the oldest in their upper 90s, with a median patient age of 69
- 48.1% of the recipients were female and 54.9% male. 94.2% were white (compared with 87% of all Coloradans), 4.8% Hispanic, and 1% other ethnicities
- 51% of recipients were married (compared with 55.7% nationally), 52.9% had college and/or advanced degrees (compared to ⅓ in the overall population)
- 84.6% of the recipients were enrolled in hospice
- 60% of the recipients had a malignant neoplasm (cancerous tumor), 20.8% had a progressive neurological disease, 5.6% had pulmonary disease, and 4.8% had cardiac disease. There were 8.8% who had “other illnesses”, including chronic kidney disease, stroke and other unspecified diseases
- The median time from date of prescription to time of death was 12 days, with a range from 0 days to 8 months
- There is no way to determine which patients prescribed the lethal overdose of medication actually took the medication . 104 patients died from either the overdose, the underlying terminal disease, or another cause
- 66 unique Colorado physicians provided aid-in-dying medications, but it is not known how many of these physicians also served as consulting physicians, meaning the doctor who confirms the terminal diagnosis. There is something called “doctor shopping”, where the patient will search until they find a physician willing to prescribe the life-ending prescription (example with reference provided below).
- 13% of attending physicians did not submit an attending physician prescribing form documenting compliance with the requirements of the End-Of-Life Options Acts
- For 28% of the recipients, no documentation of the patient’s written request for medical aid-in-dying medication was received, also a requirement [see C.R.S. 25-48-104]
- There were no confirmations of mental capacity from a licensed mental health professional.
- 32.8% of the consulting physician’s reports were missing.
“Although intractable pain has been emphasized as the primary reason for enacting assisted suicide laws, the top five reasons Oregon doctors actually report for issuing lethal prescriptions are the “loss of autonomy” (89.9%), “less able to engage in activities” (87.4%), “loss of dignity” (83.8%), “loss of control of bodily functions” (58.7%) and “feelings of being a burden” (38.3%).” (Death With Dignity Act Annual Reports) [ http://www.notdeadyetcolorado.org/ ]
Note: the Death with Dignity Act was approved by voters in Oregon in 1994 by only a 51% majority, but did not go into effect until 1997.
Learn more from Not Dead Yet http://notdeadyet.org/disability-rights-toolkit-for-advocacy-against-legalization-of-assisted-suicide
I also encourage you to learn about Colorado lawyer and disability rights advocate Carrie Ann Lucas , who passed away in February of this year. This remarkable women was the adoptive mother of 4 children with multiple disabilities and the founder of Disabled Parents Rights. She worked with Not Dead Yet Colorado and in 2016 wrote a legal analysis on the End of Life Options Act, which you can find here: http://www.notdeadyetcolorado.org/wp-content/uploads/2016/02/PAS-bill-analysis-updated-1.pdfRead more about her here:
https://www.coloradoindependent.com/2019/02/28/remembering-disability-rights-carrie-ann-lucas/
National Suicide Prevention Lifeline (1-800-273-8255)
Specific cases
Doctor Shopping
“Kate Cheney, 85, died by assisted suicide under Oregon’s law even though she had early
dementia. Her physician had declined to provide the lethal prescription. Her managed care
provider then found another physician to prescribe the lethal dose. The second physician
ordered a psychiatric evaluation, which found that Cheney lacked “the very high level of
capacity required to weigh options about assisted suicide.” Cheney’s request was denied, and
her daughter “became angry.” Another evaluation took place, this time with a psychologist who
insisted on meeting Cheney alone. Disturbingly, the psychologist deemed Cheney competent
while still noting that her “choices may be influenced by her family’s wishes and her daughter,
Erika, may be somewhat coercive.” Cheney soon took the drugs and died, but only after
spending a week in a nursing home.” The referenced document includes other cases, including the next one.
https://dredf.org/wp-content/uploads/2012/08/revised-OR-WA-abuses.pdf
Insurance Prefers to Pay for Physician-Assisted Suicide
“Barbara Wagner & Randy Stroup: What happened to these patients underscores the danger
of legalizing assisted suicide in the context of our broken U.S. health care system. Wagner, a
64-year-old great-grandmother, had recurring lung cancer. Her physician prescribed Tarceva to
extend her life. Studies show the drug provides a 30 percent increased survival rate for patients
with advanced lung cancer, and patients’ one-year survival rate increased by more than 45
percent. But the Oregon Health Plan sent Wagner a letter saying the Plan would not cover the
beneficial chemotherapy treatment “but … it would cover … [among other things,] physician assisted suicide.”
Stroup was prescribed Mitoxantrone as chemotherapy for his prostate
cancer. His oncologist said the medication’s benefit has been shown to be “not huge, but
measurable”; while the drug may not extend a patient’s life by very long, it helps make those last
months more bearable by decreasing pain. Yet Stroup also received a letter saying that the
state would not cover his treatment, but would pay for the cost of, among other things, his
physician-assisted suicide”.