October 12, 2016
In our political discourse there is little that affects us as deeply or profoundly as death.
Political issues dealing with the immediacy of death are fairly rare and almost always extremely controversial, for good reason. This Nov. voters in Colorado will make their mark on an issue relating to death: Proposition 106: Access to Medical Aid-in-Dying Medication.
According to the Colorado Blue Book Prop 106 would, “allow a terminally ill individual with a prognosis of six months or less to live to request and self-administer medical aid-in-dying medication in order to voluntarily end his or her own life”. To facilitate such actions Prop 106 would also make it legal for physicians to prescribe medical aid-in-dying medication to terminally ill patients under certain conditions. Additionally Prop 106 would create criminal penalties for tampering with any person’s request for such medication or to knowingly coerce an individual with a terminal illness to request such medication.
Additional language within the proposed proposition outlines which individuals would be eligible to request aid-in-dying medication if Prop 106 is approved by voters. Anyone requesting aid-in-dying medication through the auspices of Prop 106 must be at least 18-years-old or older. They must be able to, “communicate an informed decision to health care providers”.
Anyone seeking aid-in-dying medication must also be terminally ill, meaning a person with a terminal illness with a prognosis of six-months or less to live. The prognosis must be confirmed by two physicians including the individual’s primary physician and a second consulting physician. Additionally to be eligible to request the medication individuals must be determined to be, “mentally capable” by two physicians who have, “concluded that the individual understands the consequences of his or her decision”.
All requests for aid-in-dying medication must be made voluntarily.
The Colorado Blue Book offers a few arguments for and against the ballot measure. Proponents of the measure claim Prop 106 will expand the options and supports available to terminally ill people allowing, “a mentally competent individual to peacefully end his or her life in the time, place, and environment of his or her choosing after voluntarily requesting and self-administering the medication.”
Those favoring Prop 106 argue the measure establishes safeguards against abuse by establishing criminal penalties for violations. The measure prohibits anyone other than the patient, including physicians, from making the formal decision to request aid-in-dying drugs.
Proponents also contend the measure will insure against, “suffering and the potential loss of dignity and autonomy”, and cite multiple states that have passed similar measures including: Ore., Wash., Vt., Mont. and Calif. According to those who favor the measure once the medication is requested it is up to the individual to decide when and if to take it.
Opponents of the measure contend that encouraging the use of lethal medication for terminally ill people may, “send the message that some lives are not worth living to their natural conclusion.” Opponents argue providing medical aid-in-dying medications to terminally ill patients may cause the patients to, “make drastic decisions based on concerns about the potential loss of autonomy and dignity, not realizing that modern palliative and hospice care may effectively address those concerns.”
Opponents of Prop 106 also worry about the potential that promoting aid-in-dying medication may lead to a reduced emphasis on treatment and development of new options for end-of-life care. Additionally opponents see the potential for abuse and fraud within the system created by Prop 106 arguing, “the protections in the measure do not go far enough to shield vulnerable people from family members and others who may benefit from their premature death.”
Other points of opposition include concerns about the storage of aid-in-dying drugs prescribed to terminally ill patients and the potential conflicts that may arise for physicians between medical ethics and requests to die from patients.
According to the Colorado Blue Book the fiscal impact of Prop 106 would result in an annual spending increase of about $45,000 for the Colorado Department of Public Health and Environment to collect information about health care provider compliance. The state may see some increases in revenue as a result of criminal fines for those who violate provisions of Prop 106.
Additionally, “to the extent that persons are tried and convicted of crimes created by the measure, workload and costs will also increase,” the Blue Book States. The Blue Book also states, “this measure may affect local governments as a result of prosecuting new criminal offenses under the measure. These impacts are anticipated to be minimal.”
The Proposition has several notable supporters and opponents.
Supporters of the measure include: Governor John Hickenlooper, the Boulder Medical Society, the Colorado Community Health Network and the Denver Medical Society among others.
Opponents of the measure include: Republican State Senator Larry Crowder, Focus on the Family, the Colorado Christian University, Archdiocese of Denver and the Roman Catholic Diocese of Colorado Springs.