Colorado (2016- )

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 third of cases (31.88%) the physician failed to lodge a copy – as required by law - of the person’s written request. In over 60% of 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.

The first annual report has been published covering 2017.

Limited data

Even compared to the limited data reported annually in Oregon and Washington the annual report is sparse and uninformative.

In 2017 prescriptions for a lethal substance were written by 37 physicians for 69 people.

Records of the lethal substance actually being dispensed were lodged for 50 of these cases. It is not known whether the prescription was not dispensed in the other 19 cases or if the mandatory paperwork was simply not lodged.

Death certificates for 56 of the 69 people were received. However, as the death certificates, by law, only record the underlying illness and make no mention of whether or not death was caused by ingesting a lethal substance, it remains unknown as to how many of the 69 people actually took the lethal substance.

The youngest person who was prescribed a lethal substance was reported as in “the early 40s”.

“The most common illnesses or conditions were malignant neoplasms (cancer), heart diseases (including heart failure), chronic lower respiratory diseases (including chronic obstructive pulmonary disease, or COPD), and amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)” but there were 5 cases of “other illnesses/conditions” for which no further information is given.

Secobarbital was the lethal substance dispensed in 21 out of 50 cases and the DDMP combination (diazepam, digoxin, morphine sulfate, propranolol) dispensed in 28 other cases.

There is no requirement (or even any process) for reporting complications for people from taking the lethal substance despite the fact that the mandated written declaration under the law requires 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 1 out of 69 (1.4%) people is reported as having been so referred.

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 third of cases (31.88%) the physician failed to lodge a copy – as required by law - of the person’s written request. In over 60% of cases 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 13% of cases where even the basic form from the attending/prescribing physician was not lodged and for which even the assurance given by all the boxes being ticked is not provided.

Conclusion

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.

 

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