MRH Board of Trustees maintains stance on Aid-in-Dying
February 22, 2019
An increasing number of Coloradans faced with terminal illness are making the decision to control how they die by opting to exercise their rights under Colorado’s End-of-Life Options Act, but to access the service, Moffat County patients must make costly trips away from home, as most area medical providers continue to opt out.
As a result, Memorial Regional Health medical providers brought forward a request for the board of trustees to consider changing its 2016 position from against to neutral.
“I am recommending that MRH take a ‘do not oppose or support’ position on medical aid-in-dying. This would allow MRH-employed physicians to participate in medical aid-in-dying for patients who wish to die at home,” said MRH physician Dr. Elise Sullivan during a dinner presentation to the board Thursday, Feb 21.
The act was approved by Colorado voters in 2016 by a two-to-one margin, and with its passage, Colorado joined California, Montana, Oregon, Vermont, Washington, Hawaii, and Washington, D.C. in allowing doctors to provide the service under strict regulations. All Western Slope counties favored the measure, and it passed in Moffat County with 3,562 in favor and 2,783 against.
In 2016, upon the advice of the Colorado Hospital Association and medical staff, MRH joined the majority of Colorado medical providers and all Western Slope hospitals in opting out when the board of trustees passed a resolution and created policies prohibiting the service by MRH employees and disallowing it in MRH facilities.
Compassion & Choices — a nonprofit group that “improves care, expands options and empowers everyone to chart their end-of-life journey” — indicated via its “Find Care Tool” that the closest facility to Craig providing the service is Rocky Mountain Cancer Center in Steamboat Springs.
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In 2017, 72 people received prescriptions for aid-in-dying medication, and this number increased by about 74 percent — to 125 patients — in 2018, according to data collected by the Center for Health and Environment, part of the Colorado Department of Public Health and Environment.
In 2017, 44 individuals — or about 64 percent of those who were prescribed the medication — had some type of cancer, with lung cancer 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,” according to Sullivan’s analysis of the 2017 data.
In 2018, the median age of patients prescribed aid-in-dying medication was 69, with some as young as mid-30s and some in their upper 90s, according to an analysis of the data by MRH Director of Hospice Kristine Cooper. She added that, in 2018, the most common illnesses patients suffered included malignant neoplasm (cancer), progressive neurodegenerative diseases, chronic lower respiratory diseases, and heart failure.
“The vast majority of people were in hospice care,” Sullivan said. She also noted the terminal illness, not the medication, is listed as the cause of death in each case.
As Sullivan asked the board to change its position, Alman Nicodemus, board secretary-treasurer and city representative, asked: “What has changed?”
Sullivan said MRH had added services, including Home Health and Hospice, behavioral health professionals, social workers, and case management professionals — services meant to provide aid and respite to patients in families who are dealing with difficult situations, including end-of-life decisions. Additionally, she said, there is greater understanding of the law.
Cooper added that at least one local patient has requested the service.
If the board were to take a position of neutrality, MRH Director of Risk and Compliance Gail Katz said the hospital’s risk would be minimal.
The risk is “a risk to our reputation” that could be mitigated or assumed, she said. “There sometimes is a difference of opinion in the community that would reflect back …”
She added that, under the law, “the policy is rigorous and strong.” As a result, MRH would face no more or less liability than any other service provided, in her opinion.
Sullivan said few providers had been sued for providing the medicine.
Proponents of the bill, including Compassion and Choices, suggest that future legal challenges to the bill may disallow health care systems to opt out as both patients and providers assert their right under the law.
At least two board members questioned the idea of neutrality after learning from Katz that, because all doctors in the system are employees, “we are responsible for what our employees do and don't do.”
City representative and retired rancher Don Myers said “Neutrality, is not neutral. Either allow it and support it, or don't. The end result is the same.”
He said he was struggling between his personal views and his role in deciding what was best for MRH, a sentiment shared by other board members.
“I sympathize with people in that position, but what concerns me more is what happens down the road,” Nicodemus said. “Right now, it's limited to what is said here and what is in the law. Once it becomes engrained, then I think it is easier to go a further step and a further step. … I think once you take this step, you won't be able to back up.”
Nicodemus prefaced his remarks with a personal story about friends struggling with end-of-life choices.
In response, board member Terry Carwile shared his own story of watching his mother — who had suffered from multiple strokes — die of thirst after she requested to be removed from life support. Carwile thinks his mother would have requested the medication to quicken her own passing and said he would have supported her.
“On the other hand, I would not oblige anyone on our staff to do something that would challenge there own personal sense of ethics,” he added.
He said his sense of compassion outweighed his discomfort with the “technical” part of the procedure. Carwile added, “We would do it for our four-legged family members; we wouldn't let them suffer.”
Board member and veterinarian Dr. Kelly Hepworth arrived after Carwile’s comments but also spoke about cases in his practice of euthanizing terminally ill pets belonging to terminally ill patients.
“I see it in their eyes: ‘Here I am, terminally ill. You can help my pet out and have them have a smooth transition, but I'm going to be bound to go through this the hard way.’ From my own ethical and religious beliefs, I struggle with it,” Hepworth said.
Also struggling with the issue was Board Chair Todd Jourgensen, who said: “I got on the board to make sure people had health care. … I think hospitals are a place to make people better. To do the opposite makes me uncomfortable.”
Following the dinner, the board held its regular monthly meeting. When the question of aid-in-dying arose, no one offered a motion for action.
“The Memorial Regional Health Board of Trustees opted to take no action on its policy regarding Colorado's Aid-In-Dying Act and will maintain its position not to participate in Colorado's End-of-Life Act. The Board of Trustees recognizes that end-of-life decisions are very personal and extremely difficult. The board also acknowledges that the organization's mission is to ‘improve the quality of life for the communities it serves,'” according to a news release from MRH provided after the meeting.
While this means medical staff will continue to be unable to assist patients, MRH will support patients to the extent allowed by the policy, available under the “Resources” button on the MRH webpage.
States the news release, “… the hospital and its providers will still provide all other requested end-of-life and palliative care and other services to patients and families … any patient wishing to request medical aid-in-dying while a patient at the hospital or undergoing care from one MRH's employed physicians will be assisted in transferring to another facility of the patient's choice.”
Contact Sasha Nelson at 970-875-1794 or snelson@CraigDailyPress.com.