What is the Colorado End-of-Life Options Act and how does it apply regarding medical aid in dying?
On November 8, 2016, Colorado voters passed Proposition 106, with 65% of voters in favor of this new legislation. Thus, the Colorado End-of-Life Options Act (EOLA) became effective on December 16, 2016. Currently only 7 other states have medical aid in dying (MAID) laws or other legal protections allowing terminally ill patients to end their lives.
The subject of aid in dying is a controversial one. The issue has been commonly known as “assisted suicide”; however, this is not a correct use of the terms. No one, including a physician or relative, is permitted to assist you in ending your life. Under the Colorado EOLA, a competent individual has the right, if he or she meets certain medical criteria, to end his or her own life and to obtain medications from a physician that will cause his or her life to end.
Specifically, EOLA allows an eligible terminally ill individual with a prognosis of living 6 months or less to request and self-administer MAID medication to voluntarily end his or her life. To request MAID medication in Colorado, the individual must:
– Be a Colorado resident who is at least 18 years old;
– Have a terminal illness with a prognosis of living 6 months or less; and
– Have mental capacity and voluntarily make the request.
Thus, the use of MAID medication is not suicide, assisted suicide, or euthanasia. Although both MAID medication and euthanasia are used to help induce a peaceful death, the main difference lies in who administers the medication. Euthanasia is administered by a person other than the dying person; in contrast, MAID laws require that the patient self-administer the medication and therefore, always remains in control.
Under the Colorado law, to receive a prescription for MAID medication, an individual must make two oral requests, with a minimum of 15 days separating each request. Additionally, the individual must make a valid request under the law to that person’s attending physician, which must be witnessed by at least two people. One of the witnesses cannot (1) be related to the requesting individual; (2) be entitled to any portion of the requesting individual’s estate; or (3) own, operate, or be employed at the healthcare facility where the individual is a resident or receives medical treatment. Further, neither the individual’s attending physician, nor a person authorized as the individual’s qualified power of attorney or durable medical power of attorney can serve as witness for the written request.
An individual who requests MAID medication may withdraw the request at any time. In practice, a physician cannot write a prescription for a MAID medication unless the physician offers the individual an opportunity to send the request.
Under the law, physicians and medical institutions may opt out of participating in the aid in dying law. An attending physician must make an initial determination whether the requesting individual has a terminal illness and must refer the individual to a consulting physician to confirm the patient’s diagnosis and prognosis and to determine whether the patient is mentally capable to make an informed decision and is acting voluntarily.
The death certificate of an individual who takes MAID medication is signed by the individual’s attending physician or hospice medical director. The cause of death is listed as the underlying terminal illness (such as cancer) and not the MAID medication. The manner of death must be marked as “natural” and a death that results from ingesting MAID medication, by law, is not grounds for post-mortem inquiry. These requirements insure that life insurance policies of those who use MAID medication are not affected. Further, insurers cannot deny or alter healthcare benefits available under policies to an individual who makes a request for MAID medication.
Selected information in this column has been taken with permission by Continuing Legal Education in Colorado, Inc., from the Colorado Senior Law Handbook, (Chapter 24: Medical Advance Directives, Michael A. Kirtland, Esq.), which is a copyrighted publication and may be accessed and downloaded for free at: www.cobar.org/For-the-Public/Senior-Law-Handbook.
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