There are many cultural, religious and medical, familial and psychological taboos surrounding death – particularly at one’s own hand – and for good reason. Humans are born with an inherent drive to survive, and when an individual’s instinct to live is compromised, it should raise concerns for those surrounding him. At the same time, death is just as natural an element of humanity, and finding ways to approach it with dignity, comfort and on one’s own terms is an important, if difficult, challenge for individuals, families, physicians, clergy and lawmakers. Once again, Colorado legislators are attempting to broaden the conversation to allow end-of-life choices for the terminally ill, and the effort is both warranted and admirable.
It will not come without significant opposition, though it will be largely philosophical. The focus should remain on the pragmatics of the proposed legislation – two bills; one in the House of Representatives and a second in the Senate – which articulate clear parameters by which terminally ill patients can receive life-ending medication from a physician. It is not a decision to be made lightly, and the end-of-life bills ensure that the path is a considered, safe journey.
A patient seeking aid-in-dying medication would be granted the access only after a series of standards are reached. First, the patient must be diagnosed with a terminal illness, and then have that diagnosis confirmed by an additional physician who, along with the patient’s attending physician, determines the patient to be capable of making such a significant decision about ending his or her life. Doctors must inform the patient of alternatives to life-ending medication, including pain management or hospice care. The patient must request the life-ending medication orally twice and then a third time in writing – with two witnesses – neither of whom can be an involved physician nor beneficiaries to the patient’s estate. Finally, the patient must administer the life-ending drugs himself.
Underlying these provisions laden with safeguards for patients and physicians is one articulating that patients can rescind their decision to seek aid-in-dying drugs at any time. That, and the high standard of care and consultation by which the process must occur, ensures that the end-of-life measures allowed by the bills pending in Colorado will not be taken lightly, nor lead to the slippery slope opponents worry will emerge.
Instead, the bills give terminally ill patients facing an excruciating, protracted demise some agency in how they end their lives. It is not a comfortable conversation, nor should it be considered a stepping stone to relaxing end-of-life standards. Advocates for people with disabilities or mental illness are concerned that aid-in-dying legislation will be perceived as shifting cultural norms to encourage suicide. Religious opponents echo those concerns, saying measures promote a throw-away culture. In fact, they do the opposite. Both the House and Senate bills require patients facing certain and imminent death to engage with their caregivers and their community in making an informed decision that, if implemented, can alleviate unnecessary suffering in the final days or weeks of life. Doing so gives patients a choice – not to be made quickly or blithely – at a time when few things are within their control.
The Colorado Legislature is courageous in considering the matter and should usher aid-in-dying provisions into state law.
