Colorado may become the third state to allow out-of-state residents to receive medical aid in dying through a bill that would also shorten the mandatory waiting period for people seeking to end their lives.
Senate Bill 68, which was introduced in the legislature on Jan. 22, would shrink the waiting period to 48 hours from 15 days and also let advanced practice registered nurses, in addition to doctors, prescribe aid-in-dying medication.
The bill comes eight years after Colorado voters overwhelmingly approved Proposition 106, which legalized aid in dying in the state for terminally ill adults given less than six months to live and who get the approval of two doctors.
Proponents of the bill say it would remove barriers that the ballot measure unintentionally put in place.
“There are more people who are utilizing this option for end of life,” said Sen. Joann Ginal, a Fort Collins Democrat and one of the lead sponsors of the legislation. “We just want to make sure that those people are getting the care and the medication in the best way possible so that their lives will end in a more peaceful manner in the way they want at the time they want.”
Colorado is among just 10 states that currently allow medical aid in dying. Washington, D.C., does, too.
Oregon was the first to drop its residency requirement, in 2022. Vermont followed in May.
There are sure to be concerns raised about so-called aid-in-dying tourism in Colorado if the measure passes. But because the changes in Oregon and Vermont are so recent, there’s a dearth of data on whether removing the residency requirement affected the use of the aid-in-dying option in those states.
Kim Callinan, the CEO of Compassion and Choices, a group that advocates for medical aid-in-dying legislation across the country, said fears that terminally ill patients would suddenly flood to Colorado if Senate Bill 68 passes are overstated.
“A person who is terminally ill and at the very end of their life — it takes a considerable amount of effort to get up and move to another state,” she said.
Most states where medical aid in dying is legal have a waiting period of at least 15 days between when someone asks a medical professional to sign off on the end-of-life option and when they can get the medication.
But California lowered its waiting period to 48 hours from 15 days in 2022. New Mexico, whose law went into effect in 2021, also has a 48-hour waiting period between when an aid-in-dying prescription is written and when it is filled.
Under Senate Bill 68, Colorado’s 48-hour waiting period could also be waived if a patient is unlikely to live that long. (New Mexico’s law has a similar provision.)
Callinan said that there are plenty of examples in Colorado and elsewhere of terminally ill patients dying during the waiting period — which she said is really a “suffering period.”
“People find out that they are terminally ill with a prognosis of six months or less to live very late in the process,” she said.
Mike Reagan, an end-of-life doula in Boulder County, said he recently worked with a client who was diagnosed with stage 4 pancreatic cancer and given one to three months to live. The man wanted to avoid the pain of dying from the disease and hoped to avoid pain medications during his final moments so he could be lucid as he said goodbye to his friends and family, so he pursued aid in dying.
The man ended up dying within eight days of learning his prognosis.
“The reality is the prognoses that oncologists or other medical professionals offer quite often are imprecise,” Reagan said. “He was on hospice and ended up getting treated with pain medications that allowed him to deal with the pain, but it also led to that state that he wanted to avoid which was very much out of it and unable to engage lucidly with his loved ones.”
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For those who have longer than 15 days to live, the reality is that Colorado’s other medical-aid-in-dying requirements serve as an artificial waiting period because it can be difficult to find doctors to sign off on the end-of-life option.
Jesse Ankerholz, who lives near Silverthorne, said that was the case when his wife, Andrea, found out she was dying from breast cancer in late 2020. She was given six months to live and spent several months after that diagnosis trying to get her doctors’ approval for aid in dying. He said the physicians repeatedly signed off on her choice and then reneged.
It was time she would have preferred to spend with loved ones, including four children and three grandchildren.
The day she got the medication, Ankerholz said “her entire personality shifted.” It was a major weight lifted from her shoulders.
Andrea ended up living for a year after getting her diagnosis. She used Colorado’s aid-in-dying option when the time was right — Aug. 6, 2021.
“She was in no rush to get out of here,” Ankerholz said. “She valued any of that time that she could spend with family and friends.”
More than 1,090 patients were prescribed life-ending medication between 2017, when Colorado’s medical-aid-in-dying law went into effect, and 2022, according to data gathered by state health officials. Of those, 838 picked up the medication.
It’s unknown how many used the medication to end their lives. The majority of those who received the prescriptions were suffering from terminal cancer. Neurological diseases were second.
Over the six-year period, aid-in-dying prescriptions were provided by 219 Colorado doctors.
Senate Bill 68 is scheduled to get its first hearing in the Senate Health and Human Services Committee in late February. There is no registered opposition to the bill in the state’s lobbying database, though the Colorado Cross-Disability Coalition has expressed reservations.
The Catholic Church has also previously fought aid-in-dying proposals in Colorado.
It’s unclear how the measure will fare at the Capitol. Though voters overwhelmingly passed Proposition 106, when Ginal tried to pass similar legislation through the Capitol in 2016, she was rebuffed.
Ginal, in an interview at the Capitol last week, said she sees her measure as analogous to Colorado Democrats’ push to expand abortion options. If people have choices at the beginning of life, they should have choices at the end of life, too. (The other lead sponsor of the measure is Rep. Kyle Brown, D-Louisville.)
Callinan also said Senate Bill 68 is just an extension of what voters approved in 2016 and that it’s meant to prevent unintended suffering.
“We’re not changing the heart or the focus of what the voters approved,” she said. “There’s no voter who voted for this thinking that they would want (people) to have to suffer, unable to access the law, because of the criteria that were put in place.”
Ankerholz hopes Colorado lawmakers pass the measure and prevent people like his wife from having to use up some of their precious time.
“She was a firecracker,” he said. “She had the most amazing personality. She was just so much fun and so outgoing. And so kind.”