Though the aid-in-dying proposition overwhelmingly passed in Colorado last fall, hospitals throughout Southwest Colorado have opted out of the program, leaving local residents with few options for care.
Recently, both Centura Health, which operates Mercy Regional Medical Center in Durango, and Southwest Health System in Cortez announced they would refuse to offer terminally ill patients the option of aid-in-dying medication, though Southwest officials said they will continue to amend the policy.
A spokesman for the Pagosa Springs Medical Center said the hospital’s board and staff are reviewing the law and have not come to a decision on the matter.
In the Nov. 8 election, Proposition 106 passed with 64.5 percent of the vote – more than 1.765 million residents – and was signed into law Dec. 16.
The act allows a terminally ill person with a prognosis of six months or less to live to request medical aid-in-dying medication, and voluntarily end his or her life by self-administering those medications. It allows physicians to prescribe such medication to terminally ill patients under certain conditions. However, since the legislation passed, nearly one-third of Colorado’s hospitals are deciding to opt-out, according to a report by STAT, a new national publication produced by Boston Globe Media.
And a major driver of that action is Centura Health, which is Colorado’s largest health system, operating 15 hospitals with more than 100 physician practices and clinics.
Centura Health is a Catholic health care group. According to STAT, faith-based hospital owners have long been a strong voice of opposition to aid-in dying legislation, with the Archdiocese in Denver spending $1.6 million to campaign against the proposition.
David Bruzzese, spokesman for Mercy, said Centura Health has “a long tradition of believing in the sanctity of life, extending compassionate care and relieving suffering,” evidenced by other services of care, such as palliative and hospice.
“As permitted by the statute, Centura Health has opted out of participating in the Colorado End-of-Life Options Act,” Bruzzese said. It is forbidding its doctors from prescribing life-ending medication.
And that’s where advocates for the legislation take issue.
Matt Whitaker with the national advocacy group Compassion & Choices said specific language was written in the legislation that allows health systems to restrict physicians from prescribing the medication to patients only when the patient wants to take the drug on premise.
However, the law does not give health systems the right to tell its physicians they cannot prescribe life-ending medication to patients who wish to take it home, which more than 90 percent of patients choose to do, Whitaker said.
“The law is clear, and the voters were clear,” Whitaker said. “And now health systems are imposing their own ideals into that patient-physician relationship, and that quite frankly is a pretty backwards thing to be doing right now.”
Bruzzese said Centura Health’s attorneys are confident they are in compliance with the law; Whitaker said he expects patients or physicians to eventually take legal action against hospitals that choose to opt-out.
Regardless, without participation of major hospitals in Southwest Colorado, an isolated area of the state, residents are left with few options.
In Durango, Proposition 106 outpaced the state totals, with nearly 75 percent (22,134 votes) in favor of the act. Betsy Norton, who led local campaign efforts, said it’s disappointing that the area’s largest health provider won’t offer a service with overwhelming community support.
“It’s frustrating that Mercy doesn’t want to do it, but we’ll find other doctors that do,” Norton said.
“And we really have to continue our efforts to educate the community here.”
Already in the area, private physicians – who according to the act do have discretion to prescribe the medication – are voicing support to offer medical assistance to those terminally ill patients seeking to end their lives.
“As part of compassionate care, I support the desire of patients to be able to make that choice,” said Jay Ciotti, a physician at Cottonwood Holistic Family Heath in Durango. “And it’s my understanding it has worked well in other states.”
Other states that have embraced aid-in-dying laws include California, Montana, Oregon, Washington and Vermont.
In those states, a provision allows health systems to bar doctors from prescribing the medication.
In Oregon, which passed the first Death with Dignity law in 1997, about 1,500 patients have been prescribed life-ending medication, and fewer than two-thirds of those people have ingested it.
The two-decade-old law still faces some of the same taboos and oppositions, said Holly Armstrong, with Compassion & Choices. She said there are places in Oregon where residents have to travel hundreds of miles to access care.
“With any aid-in-dying law that’s passed, there’s some growing pains involved, and we need to continue to get out there and educate,” Armstrong said.
“But the main point is: Health systems don’t write prescriptions, doctors do. And is it really a good idea to have health systems dictate how doctors practice medicine?”
jromeo@durangoherald.com
Aid-in-dying oversight
The Colorado Board of Health
approved new regulations at an emergency rule-making hearing Jan. 18, and a hearing for permanent adoption of the rules will be held April 19.
Proposition 106 requires the
Colorado Department of Public Health and Environment
to collect medical record information from physicians in aid-in-dying cases, according to CDPHE documents.
The rules the board of health recently approved require doctors to report a patient’s diagnosis, prognosis and mental capacity to CDPHE within 30 days of issuing a prescription for aid-in-dying medication. They also require doctors to report the dates of written and oral requests for medication.
CDPHE must annually review a sample of the records and release a public report with the findings, according to the law.
