69 Coloradans seek physician-assisted suicide in first year of program
March 7, 2018
GRAND COUNTY — Coloradans recently got a first glimpse into how the controversial new physician-assisted suicide act played out in its first year as the Center for Health and Environmental Data released the 2017 data summary for the Colorado End-of-Life Options Act earlier this month.
Colorado voters approved an Access to Medical Aid in Dying proposition in 2016 which allows eligible terminally ill individuals with a prognosis of six months or less to live the option to request and self-administer life ending medication. The act also authorizes physicians to prescribe the medical aid-in-dying medication, and creates criminal penalties for tampering or coercing someone to request the medication.
In 2017, 69 patients received prescriptions for the medication — typically secobarbital or a combination of diazepam, digoxin, morphine sulfate and propranolol known as DDMP. Of those 69 individuals, the Colorado Department of Public Health and the Environment received reports that the medication had actually been dispensed to 50 individuals.
According to the report, CDPHE received death certificates for 56 patients through vital records registration, though not all of the deceased patients were necessarily dispensed the medication, bringing up some interesting nuances of the law.
The Colorado End-of-Life Options Act does not authorize CDPHE to follow up with physicians who prescribe the medication, patients or their families to obtain information about the use of the medication. The act also requires by law that the cause of death assigned on a patient's death certificate be the underlying terminal illness. In other words, the state doesn't know exactly how many people took the medication, only that 50 individuals could have.
"Other states have follow-up surveys they send out to physicians, but Colorado law doesn't authorize that," said Kirk Bol, manager at the registries and vital statistics branch of CDPHE. "It's very explicit in terms of what we're allowed to do in terms of information we can collect."
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Bol said the law doesn't allow, by intent or language, any authority or activities related to follow-up to find out if the patient actually took the medication, or any other types of information around that in terms of duration between taking it and death, complications, impressions or concerns.
"So we're not engaging in that presently on a count of a lack of authority to actually do it," he confirmed.
The most prominent diagnoses for individuals seeking out the treatment was cancer.
Forty-four individuals, or about 64 percent, who were prescribed medication had some type of cancer with lung cancer being the most prevalent. Seven individuals were diagnosed with amyotrophic lateral sclerosis, or ALS, seven had heart disease, six had chronic lower respiratory disease and five were listed as "other illnesses/conditions."
A large majority of patients came from the Denver metro area of Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas and Jefferson counties.
There were no patients from Grand County, according to Bol.
Of the individuals who died following prescription of aid-in-dying medication, though not necessarily from taking it, 54 percent were male, and the most common age range was from 75 to 84. The median age of those prescribed the medication was 75, with the youngest in their early 40s and oldest in their mid-90s.
Of those who died, most died in their residence, and almost all were under some form of hospice care.
Prescriptions were written by 37 different physicians, and dispensed by 19 different pharmacists. The average time to death for a patient after being prescribed the medication was 13 days, which does not represent how long it took the pills to become effective but rather the time from picking up the medication to the person's death.
To comply with the Colorado End-of-Life Act, physicians who prescribe the medication and health care providers who dispense such medication must submit documentation to CDPHE. But recordation appeared to be an issue in the inaugural year.
Of the 69 patients who received prescriptions for the medication, CDPHE only received 60 attending physician forms, 47 written requests from patients, one confirmation from a mental health provider and 27 consulting physicians written confirmation. With the exception of confirmation from a mental health provider, which is at the discretion of the attending physician, law requires all of these documents to be submitted to CDPHE, but every one is incomplete.
According to the report released by CDPHE, all attending physician forms they received contained physicians' signed attestations that all requirements of the act had been met, and that the required documentation is complete and contained in the patients' records.
CDPHE believes that the issues stem from the relative novelty of the system in its first year, noting that a similar phenomenon was seen in other states after similar laws were enacted.
Bol said that CDPHE does have the authority to request access to a patient's medical records, but noted that the department has little regulatory control over physicians and that, logistically, the process is difficult.
"We do have the authority to request access to a patient's medical records, but based on the paperwork we've gotten so far, there haven't been any red flags to suggest that's necessary," said Bol.