The number of Coloradans who received prescriptions to end their lives has increased each year since voters passed an aid-in-dying law in 2016, rising 18% in 2021.
Last year, 222 people obtained prescriptions for the lethal doses of medication, which they must ingest themselves after getting approval from two physicians who certify that they have a terminal illness and fewer than six months to live. That brings to 777 the five-year total prescriptions since the End-of-Life Options Act was passed, according to a recently completed report on the law by the Colorado Department of Public Health and Environment.
The department tracked how many of those 777 prescriptions were dispensed — 583 — but is not required to follow up with patients’ families or doctors to find how many of those patients actually took the medication. Also, under the law, the cause of death listed on patients’ death certificates is not suicide but their underlying terminal illness, so it’s unknown whether they took the dosage — a mixture of medications called DDMA and DDMP — to end their lives.
The median length of time between the date of a prescription last year and the patient’s death was 18 days.
The report also found that the 777 prescriptions written in the past five years came from 198 doctors.
Those numbers jibe with a study from Dr. Eric Campbell, a professor at the University of Colorado School of Medicine and a biomedical ethics researcher. The research, which included 300 physician surveys, found that many doctors are still wary of prescribing the medication.
Campbell found that 81% of Colorado doctors said they were willing to discuss medical aid in dying with their patients and 88% were willing to make a referral to a physician who would prescribe the medication. However, fewer than half of doctors, 46%, were willing to sign off as the consulting physician on an aid-in-dying prescription, and even fewer than that, 28%, were willing to serve as the attending, or primary, physician on such a prescription.
And even though more than 80% of doctors said they were willing to discuss medical aid in dying, not nearly as many were ready to do it or had actually done it, according to Campbell’s research. About 52% said they had discussed aid in dying with a patient.
“What that means is that people in general feel willing to do it, fewer are prepared, and even fewer have actually done it,” Campbell said.
Among physicians who had prescribed medical aid in dying, 75% said it was “emotionally fulfilling and professionally rewarding.” Almost 47% described it as “ethically challenging.”
The majority of patients who were prescribed aid-in-dying medication in the past five years had cancer or a neurological disease. Two doctors are required to sign off on the prescription, and if there is doubt that the patient is mentally capable of making the decision, the patient is supposed to have a mental health consultation with a psychologist or psychiatrist.
State data shows that in many cases, not all of the required paper was submitted as spelled out under the law. The state has a record of 667 attending physician forms for the 777 prescriptions written in the past five years, so 110 are missing.
Also, the state health department has a record of just 605 patient request forms, and 579 reports from consulting physicians.
In all five years, just five mental health provider confirmation forms were submitted. Those are required only when the patient’s mental capacity is in question, however.
The state health department report notes that the required documentation was incomplete, but says that the attending physician’s form attests that all requirements of the law have been met. The department is continuing to educate physicians about the requirements, the report says.
The average age of those seeking a prescription last year was 73, while the youngest age was mid-20s, according to the state health department. Medical-aid-in-dying patients are required to be at least 18 and live in Colorado, under the law passed by voters in 2016.
The lethal drugs, typically a powder, are often mixed into a drink — some aid-in-dying proponents suggest a strong liquor, warm water, juice or Gatorade — or a pudding, yogurt or applesauce. Most of the Coloradans who received prescriptions in the past five years died at home.