I recently attended a presentation on what is commonly referred to as the Colorado Death with Dignity Act.  Its official name is the Colorado “End of Life Options” Act.  Before I begin, I would like to give a big shout out to Pam Peterson-Hohs, Director of Elder Law Crisis Management at the Hughes Law Firm for doing the presentation.  She did a great job and had a lot of valuable information to share on this topic.  If you have a chance to take in one of her presentations I highly recommend it.  Much of the information contained in this blog comes from the content presented by Pam and handed out at the seminar.  Also, thanks to Northglenn Heights Assisted Living for hosting the event.

In this blog we will look at the Death with Dignity Act from the perspective of the care provider company and individual professional caregiver and what they need to know or do when someone they are caring for is considering that option.

Placing the new law in context:  The Colorado End of Life Options Act authorizes medical aid-in-dying.  Medical Aid-In-Dying is a safe and trusted medical practice in which a terminally ill, mentally capable adult with a prognosis of six months or less to live, may request from his or her doctor a prescription for medication which they can choose to self-ingest to bring about a peaceful death.

The law offers terminally ill patients a way to access life-ending doctor prescribed sleep medication so that they may die peacefully.  To be perfectly clear, a person exercising their right under this law is not committing suicide and the act is not euthanasia.  It is important that as care providers and caregivers we do not use those terms when discussing the option with patients and their families.   For someone exercising their right to die in accordance with the law the cause of death will be listed as the underlying condition.

There is a defined process that a patient must follow in order to receive the drug.  We won’t go through the entire process in detail here.  However, you should know that it requires the agreement of two different physicians over the course of a minimum 15 day waiting period where one physician prescribes the drug and the other offers a confirming consulting opinion.  It is also important to note that the request cannot be made by a designee or third party including relatives or anyone with a medical power of attorney, and the request cannot be made via an advance directive.

To qualify the patient must be mentally sound and physically capable of self-administering the drug without assistance.  In other words, if the patient has a diagnosis of Alzheimer’s or other form of dementia they are not eligible to receive the prescription drug.  The drug must also be orally ingested or taken through a feeding tube self-administered by the patient.  It cannot be injected.

If you are operating a care provider or health care facility you have responsibilities and there are things you should do with respect to this law.  You must make a policy decision whether your organization is going to opt in or opt out under the Act. In other words, you have to decide and write a policy around your decision to support aid-in-dying procedures consistent with the facility’s scope of service, or not support aid-in-dying. The policy should address and define your process, personnel responsibilities, risk management, reporting requirements, prescribing and self-administering procedures. In making the decision to opt in it is important to take into consideration the resources necessary to implement the Acts required procedures and that you have staff who are willing to serve.  A few important notes here for organizations electing to opt in:

• If your organization decides to opt in there may be people on your staff that do not want to participate. Your personnel policies should address this situation.  Additionally, new and existing staff should be made aware of the organizations policy stance on aid-in-dying so that employees and potential employees can make informed decisions about accepting or continuing in a position with your organization.
• Although the Act provides immunity for facility and staff acting in good faith, the potential risk for litigation still exists. Your organization and staff should be aware of the legal risks.
• As an operator of a care provider or health care facility you are required to provide advance written notice to patients/residents of the policy regarding your organizations stance with regard to aid-in-dying, i.e., whether your organization is opted in or opted out.
• You should have a written policy for all aspects of patient self-administration of medication and ensure that the policy is well known and understood by all staff.

If you elect to opt out a policy should be adopted reflecting this decision, how you will respond if someone under your care asks for aid-in-dying help, and how to address unplanned situations.  Here are a couple important notes for organizations electing to opt out:

• As an operator of a care provider or health care facility you are required to provide advance written notice to patients/residents of the policy regarding your organizations stance with regard to aid-in-dying, i.e., whether your organization is opted in or opted out.
• If your organization is opting out, you have a responsibility and should have a policy and process for a patient or resident who makes a request to obtain the medication. Generally speaking this would be some sort of advice or direction on where they can go to get the help they are requesting.

As a professional caregiver it is your responsibility to know and understand your organization’s policy and procedures with regard to caring for terminally ill patients that may elect the aid-in-dying option.  It is also very important that you think about your own stance as a caregiver in working with someone that might make this election and ask for your participation, and to be prepared with your response should someone make the request to you.