Over the years working in hospice and palliative care, I have explored the goals of countless individuals who are near the end of life. The specifics of medical aid in dying were new to me when my family and I moved to Colorado in 2019. As a hospice and palliative nurse practitioner, I needed to learn about the end-of-life care option in order to answer my patients’ questions about it. What I was not expecting was how frequently I would hear my patients use the word “impossible” in reference to accessing medical aid in dying in our state.
Medical aid in dying is the process by which a terminally ill adult who has a prognosis of six months or less to live can request medication to peacefully end their life. The individual must have the capability to make their own medical decisions and to ingest the medication on their own. There are several steps required to complete the process, including evaluations performed by two physicians. Colorado’s 2016 End-of-Life Options Act is one of the most popular ballot measures in state history, with support from 65% of voters. Unfortunately, statewide support for the option of medical aid in dying does not equate to reasonable access to the resources needed to obtain it.
The barriers can vary based on the resources where patients live, but in conversations with hospice professionals throughout the state, I have learned that difficulty accessing this care option is common. Roadblocks to medical aid in dying are severe for some and insurmountable for too many.
For my urban patients, it frequently takes months to locate the two required physicians who will participate and prescribe aid-in-dying medication. This may be due to a physician choosing not to participate, policies of their employer, or because they may be inexperienced with the process.
For my patients who reside in rural or frontier Colorado, Advanced Practice Registered Nurses, including nurse practitioners, often serve as their primary care providers. Since these providers currently are not allowed to prescribe aid-in-dying medications or certify a patient’s prognosis in Colorado, patients may be forced to travel great distances, if they are physically able, to establish care with a new physician. This is overly burdensome to someone who is profoundly debilitated near the end of their life.
Since a patient must have a prognosis of six months or less to qualify, time is already limited. If patients are fortunate enough to find two physicians, they are then required by law to wait 15 days between their two oral requests for medical aid in dying. Considering all of the challenges outlined above, the 15-day waiting period is unnecessary red tape that delays dying Coloradans from receiving the care option that they likely voted into law.
We can work toward providing better education across the board and improving our organizational policies to help address some of the concerns with access to medical aid in dying. At the same time, we must recognize that Colorado is a predominantly rural state with a unique health care landscape. The law as written creates disadvantages for Coloradans who qualify for the option of medical aid in dying, but cannot access it due a lack of resources where they live.
Senate Bill 068, introduced in January, addresses the barriers my patients are experiencing. The bill shortens the mandatory 15-day waiting period and gives a prescribing provider the ability to waive it if the qualifying patient is not likely to survive it. The bill also gives Advanced Practice Registered Nurses the authority to write aid-in-dying prescriptions, addressing the disparity in access to prescribing health care providers, and allowing people with terminal illnesses the peace of continuity of care from the providers who know them best.
It’s important to note that the new bill keeps all of the qualifications of our current law intact: a patient must be a terminally ill adult who is capable of making their own medical decisions and able to ingest medications on their own, with a prognosis of six months or less to live. These safeguards are included in the laws of all 10 states and Washington, D.C., where medical aid in dying is authorized, and have remained when states have introduced and passed similar bills to improve access.
We have an opportunity to speak out on behalf of our patients’ real world experiences, and legislators want to hear from their constituents about issues impacting their health care options. Engaging with them can be as quick and easy as a short email or a phone call. You can find information about how to contact your legislator here.
To our legislators: I urge you to please support Senate Bill 068 and make access to health care more equitable for all Coloradans.
Ashley D. Fry, DNP, APN, AGACNP-BC, ACHPN, lives in Colorado Springs and is a board certified acute care nurse practitioner with advanced certification in hospice and palliative care nursing. She serves as the director of clinical engagement at the nonprofit organization Compassion & Choices.
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