Aid in Dying Colorados Difficult Policy Question Emily

Aid in Dying Colorados Difficult Policy Question Emily

Aid in Dying Colorados Difficult Policy Question Emily Johnson June 9, 2016 About Colorado Health Institute 2 Todays Discussion

International and historic context The debate: supporters and opponents Status in Colorado 3 Finding the Words Terms Used in This Presentation Aid In Dying: Patient self-administers

prescribed lethal medication. Passive Euthanasia: Withdrawing medical treatment with the intention that it will result in a patients death. Voluntary Active Euthanasia: Physician actively administers life-ending medication, usually intravenously. 4 5

Historic Context United States in the 20th Century 1948-1990 1938 1980 1990s

1997 6 Historic Context Brittany Maynard: Renewed Advocacy 7 Current Context United States

Image from Compassion & Choices 8 Current Context Physician Opinions Medscape polls in 2010 and 2014 show physician support for aid in dying has grown. When asked, should physician-assisted suicide be allowed?, doctors said: 9

Oregon Death with Dignity Act A National First Self-administration of lethal medication Requesting patient must be: - An adult - A resident of Oregon - Able to make & communicate health care decisions - Diagnosed with a terminal illness that will lead to death within 6 months

10 Oregon Death with Dignity Act Required Steps Patient: - Make two verbal requests to physician, separated by 15+ days - Provide written request to physician, signed by two witnesses Prescribing physician:

- Assess patient diagnosis and prognosis - Assess patient capability - Inform patient of feasible alternatives - Request that patient notify next-of-kin Consulting physician: - Confirm diagnosis and prognosis - Confirm patient capability 11 Oregon Death with Dignity Act

Physician Protections Physician protected from liability Participation on either side is voluntary 12 The Oregon Experience 13

The Oregon Experience Since 1997 In 2015 1,545 Prescriptions written 223 Prescriptions written by 106 doctors

991 132 Patients died from ingesting prescribed pills Patients died from ingesting prescribed

pills 14 California End of Life Option Act A New Model Differences from Oregon: - Final attestation - Interpretation services - Sunset clause - Tighter terminology California Medical Societys neutral position

15 Aspects of the Debate The Moral Question Assisted suicide is a reversal of the proper role of a doctor as a healer, comforter and consoler to an improper

role of the physician causing a patients death. -Dr. Kenneth Stevens, Oregon As a physician, I resent the term physicianassisted suicide. I have never felt I was assisting a suicidal patient, but rather aiding a patient

with his or her end-of-life choice. -Dr. Peter Goodwin, Oregon 16 Aspects of the Debate Vulnerable Populations Elderly and disabled patients [Vulnerable populations present] a legitimate

concern that we should try to guard against. But theres no evidence that people with disabilities are more likely than others to access physician aid-in-dying. -Dr. Guy Micco, California 17 Aspects of the Debate Timelines for Terminal Illness Professional agreement improves likelihood of

accuracy Admittedly, we are inaccurate in prognosticating the time of death under those circumstances. We can easily be 100 percent off, but I do not think that is a problem. If we say a patient has six months to live and we are off by 100 percent and it is really three months or even 12 months, I do not think the patient is harmed in any way - Dr. Peter Rasmussen, Oregon 18

Aspects of the Debate Coercion and Consent Elder abuse Medication monitoring Safeguards in the legislation My concern is that the option of assisted suicide is simply much cheaper, and because of how broken our system is, these competing concerns may put some of our most vulnerable populations between a rock and a hard place.

-Dr. Jessica Zitter, California 19 The Debate in Colorado House Bills 15-1135 and 16-1054 Terminally ill, capable, adult patients with a six- month prognosis could request to take their own life using medication prescribed by a physician. Prescribing physicians would not be accountable for

the death if all conditions of the bill were met and documented. Cause of death on death certificate to be listed as the underlying terminal illness. 20 The Debate in Colorado Ballot Initiatives End-of-Life Options - Similar to house bills

Medical Aid in Dying - Make aid in dying a constitutionally-protected right - Legalize voluntary euthanasia - Allow aid in dying in advance planning directives - Similar immunity for medical providers 21 Review Historical and international context The debate

- The role of medical providers - Vulnerable populations - Diagnostic accuracy - Coercion and consent Status in Colorado 22 Conclusion 23

Discussion and Questions 24

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