Colorado’s experiment in providing a safe regime for assisted suicide is a fail because it lacks any possibility of identifying problems and is already lackadaisical about significant non-compliance in basic reporting. In nearly one in four of cases (24.7%) the physician failed to lodge a copy – as required by law - of the person’s written request. In three out of ten cases the physician failed to lodge the mandatory written report from the consulting physician.
Assisted suicide has been legal in Colorado since 16 December 2016 following the passing of a ballot initiative.
Even compared to the limited data reported annually in Oregon and Washington the annual reports are sparse and uninformative.
In 2020 prescriptions for a lethal substance were written for 188 people – a 9.9% increase from 2019 and 261% of prescriptions written in 2017.
For 2020 records of the lethal substance actually being dispensed were lodged for 145 (77.1%) of these cases. Of these 76 (52.4%) were given DDMP or DDMP2 and the remaining 69 (47.6%) received DDMA.
It is not known whether the prescription was not dispensed in the other 43 cases or if the mandatory paperwork was simply not lodged.
Death certificates for 156 people for whom a lethal prescription had been written were received. However, as the death certificates, by law, only record the underlying illness and make no mention of whether death was caused by ingesting a lethal substance, it remains unknown how many of these 156 people actually died from the lethal substance or even collected it.
The youngest person who has been prescribed a lethal substance was reported as aged in “upper 20s”.
There is no requirement (or even any process) for reporting complications for people from taking the lethal substance despite the mandated written declaration under the law requiring a person to acknowledge “although most deaths occur within three hours, my death may take longer”. The record length of time from ingestion to death reported from Oregon is 104 hours (4 days 8 hours).
Although the law requires a referral to a psychiatrist or psychologist “if the attending physician believes that the individual may not be mentally capable of making an informed decision” only 5 out of 554 (0.9%) of those people for whom a lethal prescription was written (2017-2020) were first referred for an assessment.
Although eligibility is supposedly limited to a “terminally-ill individual with a prognosis of six months or less to live” the maximum duration of time between the date of prescription and date of death was “approximately 11 months”.
Significant non-compliance by physicians
What is most concerning is the level of non-compliance by physicians who prescribe lethal substances with even the very minimal reporting requirements.
In nearly one in four cases (24.7%) from 2017-2020 the physician failed to lodge a copy – as required by law - of the person’s written request. In nearly three out of ten cases (29.4%) the physician failed to lodge the mandatory written report from the consulting physician.
But the Colorado Board of Health is relaxed about this massive rate of non-compliance:
While reporting of the required documentation (including prescribing forms, patients’ written requests, consulting physicians’ written confirmations, and mental health provider confirmation) may be incomplete, all attending/prescribing forms received contained physicians’ signed attestations that all requirements of the Colorado End-of-Life Options Act have been met, and that required documentation is complete and contained in patients’ records. Efforts continue to educate physicians and other health care providers about reporting requirements.
This lay back approach glosses over the 82 cases (14.8%) cases where even the basic form from the attending/prescribing physician has not been lodged and for which even the supposed assurance given by all the boxes being ticked is not provided.
Colorado’s experiment in providing a safe regime for assisted suicide is a failure because it lacks any possibility of identifying problems and four years in remains lackadaisical about significant non-compliance even with the minimal reporting requirements.