On a sunny Colorado morning, Asha Singh of Denver received an extremely unnerving phone call.
“Hello, is this Asha? This is your mother’s neighbor. I just found her passed out on the living room floor of her house. I called 9-1-1, can you please get here immediately?”
Singh put down the phone, grabbed her car keys and sped to her mother’s house in Littleton. She followed the ambulance to the nearest hospital.
Doctors performed multiple tests and found that her mother had stage four breast cancer. She had to begin chemotherapy sessions immediately and she suffered extreme levels of pain for up to a week after each session. Even so, after the first couple sessions, she would feel much better.
“I knew she was in pain. But she would get back to her normal self after just a week … it gave us hope,” Singh said.
Suddenly, a few months into therapy, Singh’s mother fell incredibly ill and had to be put on life support. Singh was faced with end-of-life-options: either “pulling the plug” or seeking medical aid in dying. She was adamantly against both.
“I believe in miracles,” she said. “I believe that anyone can beat the odds and numbers. This is why my family and I refused to consider end-of-life options.”
Because her mother showed wavering improvement at times, she and her family hoped that she would survive. This hope led Singh and her family members to oppose physician-assisted death.
Many chemotherapy sessions later, because of her mother’s insistence and intolerance of a hospital environment, the Singh family moved her off life support and allowed her to stay in their home so she would be more comfortable. She died within days. Even six years later, Singh said, the family is still recovering.
The “right to die” is the moral concept that humans should be able to end their life or undergo voluntary euthanasia. This principle applies primarily to people facing terminal illness and/or unbearable pain due to an illness. The argument concerning medical aid in dying or “rational suicide” lies in morality, the sanctity of life, the severity of the illness, patient consent and physician knowledge.
The Colorado “End of Life Options Act,” also known as Proposition 106, was voted on in the November 2016 election. It made assisted death legally available for patients with a terminal illness who received a prognosis of death within six months.
To qualify for the “End of Life Options Act,” a patient would have to meet six basic requirements:
- The patient must have two doctors to approve that the patient is terminally ill.
- The patient must be deemed mentally fit by two doctors.
- The patient would self-administer lethal medication.
- The state would be required to keep annual statistics.
- The patient must be at least 18 years old.
- The person must be a legal resident of Colorado.
Supporters of the proposition believe that no one should have to suffer through the last few months of a terminal illness or insufferable pain if they don’t want to.
“People should have the option of ending their own life in a peaceful and dignified manner,” said Roland Halpern, a proponent of the “End of Life Options Act” who also worked on its advocacy campaign.
Polls conducted all over the country showed that support for medical aid in dying has consistently accumulated over 50 percent approval over the past two decades. In fact, according to a Gallup poll conducted in 2015, 68 percent of Americans support euthanasia, while only 28 percent disapprove.
Halpern argues that Colorado has consistently been ahead of the game in terms of passing statutes which grant more individual liberty. It was the second state to legalize women’s suffrage, it allowed legal access to abortions six years before Roe v. Wade, it was the first state to legalize medical marijuana, it tied with the state of Washington to legalize recreational marijuana in 2012 and it approved civil unions by 2013.
“Colorado has a history of recognizing privacy, personal choice and autonomy issues,” said Halpern.
He believes this is what makes Colorado a generally libertarian and progressive-thinking state. Halpern foresees many improvements in Colorado’s health care system. Looking at Oregon as an example, the use of morphine to treat pain has increased significantly. Physicians are also spending more time gaining more knowledge on treating pain, treating illnesses and how to handle end-of-life-options in general.
“Legalization takes something that has been practiced clandestinely and replaces it with adequate safeguards to ensure that only those who actually qualify for the option will have access to it,” Halpern said with regards to concerns that it will be easy to access.
Halpern said that having a safe and legal option also leads to a more candid discourse about death, without necessarily committing the patient to psychiatric care for suicidal thoughts. The patient will also have no concerns about the family participating in illegal, unsafe and/or risky activity.
“The option of medical aid in dying is just that: an option,” Halpern said.
Rupande Patel, a health professional working in Dallas, Texas, also believes that it is ethical to have the option of medical aid in dying — but only in certain situations. According to Patel, if the patient has a terminal and debilitating illness with no other option except to live in constant pain with no quality of life, medical aid in death is feasible. Patel also emphasized it needs to be the patient’s choice.
Patients have the right to refuse unwanted medical treatment, even if that warrants foreseeable death, and they do not have to be terminally ill to do so. For example, patients may not want to be kept alive by artificial means or undergo certain surgical procedures (such as an organ transplant), knowing that they will die otherwise. The unresolved question is whether there is a significant difference between a patient’s decision to stop medical treatment and allowing someone who has a terminal illness the right to end their life through a self-administered drug.
In Oregon, where an “aid in dying” law has been in effect since 1998, there has not been a single proven case of abuse of the law, according to Halpern. During its first 18 years in effect, 1,545 prescriptions were written for the self-administered drug. Of that, 991 took the medication, while 554 chose not to; they later died due to their illnesses. Many terminally ill people simply want the assurance that there is an end-of-life-option, if all other treatments fail to minimize pain and suffering.
On Oct. 11, 2016, the Denver Post editorial board posted a piece encouraging Colorado voters to vote against Proposition 106. The writers believed that “those facing their final months are in a vulnerable place” and can fall victim to depression, internalize guilt over burdening family members, stress about the cost of health care and face other personal pressures.
The lack of safeguards concerned those opposing the measure — such as the possibility of insurance companies neglecting to cover expensive medical treatments for terminal patients. The wording of the proposition also wouldn’t prevent “doctor shopping” — or the practice of visiting multiple physicians to obtain multiple prescriptions for otherwise illegal drugs. It doesn’t require a doctor to be present at the time of death. The proposal also does not prevent a beneficiary in the patient’s will from trying to plot the death of an ill family member, said Jeff Hunt, director of the Centennial Institute at Colorado Christian University, according to the Denver Post.
Opponents of Proposition 106 included Colorado Christian University, Focus on the Family and the Archdiocese of Denver, donating nearly a combined $1.8 million to the “No Assisted Suicide Campaign.” Many Catholic groups also contributed to the campaign, including the Colorado Catholic Conference — the location of the “No on Prop 106” campaign.
According to the now vacated “No on Proposition 106” website, under the “Fatal Flaws” section, the proposition does not require the medical diagnosis of trained psychiatrists or psychologists to determine if the patient is in a suitable mental state. This caused concern for opponents because doctors who are not trained in mental health might not give the best diagnosis of a patient’s mental stability.
Those opposed to Proposition 106 for Colorado also had a history of opposing the legalization of recreational marijuana, stating that the details of the initiative are as blurry and susceptible to “mid-course corrections.” In 2012, Proposition 64, the vote for recreational marijuana, was similarly criticized.
A major platform of the Republican party is preserving the sanctity of life (apparent in the party’s adamant anti-abortion position), and the allowance of this end-of-life option seems to go against that belief. States that have legalized medical aid in dying are historically and currently blue states.
“Right to die” decisions are personal, difficult and psychological choices that can leave friends and family devastated. They can also be psychologically difficult for doctors to go through the process. While there are many concerns from opponents — greedy heirs, lack of safeguards, the sanctity of life and so on — for proponents, it comes down to the option of having an alternate to a terminal illness and/or insufferable pain.
Nearly 65 percent of voters — 1,765,565 people — voted “Yes” for Proposition 106. Colorado follows Oregon, California, Washington and Vermont in passing such a measure, despite high levels of resistance from religious and various other organizations and campaigns. The “End of Life Options Act” has been changed to Title 25, Article 48 of the state constitution.
This is a student submission from the CU Boulder News Corp reporting class, written by Vasundhara Tyagi.
