January 25, 2017

Some Colorado hospitals are opting out of the state's 'right-to-die' law

Daily Briefing

    About a third of hospitals in Colorado are opting out of the state's new law allowing doctors to prescribe a lethal drug to terminally ill adult patients—just months after voters "overwhelmingly" approved the measure, Judith Graham writes for STAT News.

    Law details

    The new law, approved in November 2016, lets terminally ill patients with six months or less to live request life-ending medication.

    At least two physicians must agree on the patient's prognosis. The measure also requires:

    • Doctors to discuss alternative options with patients, as well as safe storage, tracking, and disposal of the drugs;
    • Physicians to annually report to the state each instance in which a lethal drug was prescribed; and
    • Terminally ill patients to administer the drugs themselves.

    The law includes so-called "conscience" provisions, which allow providers to opt out of participation. Health systems also have the authority to prohibit the practice on their campuses, Graham writes. But the law explicitly says health systems cannot bar physicians from discussing end-of-life options with patients or writing prescriptions to be taken offsite.

    Some hospitals opting out

    Nearly one-third of Colorado's hospitals, including several large Catholic health systems, are opting not to offer such services.

    For instance, Centura Health told STAT News that it would not provide aid-in-dying services. Centura—the state's largest health system, with 15 hospitals and more than 100 physician practices and clinics—is operated jointly by the Catholic Health Initiatives and Adventist Health System, which oppose medically-assisted death.

    SCL Health—the state's second-largest Catholic health system—in a statement said any patients who request aid-in-dying services "will be offered an opportunity to transfer to another facility of the patient's choice." The system operates seven hospitals and several dozen clinics.

    Centura and SCL declined to provide details on their policies to STAT News, but both health systems said they were confident that their policies comply with the law.

    HealthONE, a non-faith-based health system in the state, also said it will not dispense life-ending drugs or allow patients to take them at any of their eight hospitals. The system said it won't restrict its physicians from writing such prescriptions.

    According to Graham, there's confusion as the state works to adapt to the new law. Jennifer Moore Ballentine, president of The Iris Project, said, "Everyone is in a mad scramble figuring out what they're doing to do and how they're going to do it."

    Meanwhile, Compassion & Choices has reached out to all the hospitals, clinics, and hospices in the state to offer technical assistance in providing aid-in-dying services.

    Some state residents may not be able to access aid-in-dying services

    The decision by some health systems to opt out of providing aid-in-dying services might make it difficult for some state residents to end their own lives with medical assistance.

    Graham explains that in larger cities, terminally ill patients likely will still have access to aid-in-dying services. For instance, UCHealth, which has seven hospitals and more than 100 clinics, plans to offer such services, as does Kaiser Permanente Colorado, which has 600,000 members.

    However, smaller areas could have fewer options for aid-in-dying services, as the only nearby hospital may not offer them. And overall, according to a 2016 MergerWatch report, one-third of acute care hospital beds in the state are operated by or affiliated with Catholic organizations. 

    But ultimately, Graham writes, access to aid-in-dying services could be largely determined by what policies primary care clinics, oncology centers, and hospices—rather than hospitals—plan to adopt. Those are the settings most likely to care for terminally ill patients interested in exploring aid-in-dying services, Graham writes.

    Kate Alfano—a spokesperson for the Colorado Medical Society (CMS), which took a neutral stance on the law—said it is unclear how many physicians plan to offer aid-in-dying services. A poll last year among physicians who often care for terminally ill patients found that 50 percent favored aid-in-dying services and 41 percent opposed it.

    Currently, CMS is advising its members to share alternative options, such as palliative care, with their patients and to remind patients that they can rescind a request for aid-in-dying services at any time (Graham, STAT News, 1/19).

    5 characteristics of effective palliative care programs

    The best palliative care programs don't just provide a better experience for terminally ill patients—they also yield longer survival rates, lower costs, and improved quality.

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