Making lethal, legal 

Right-to-die legislation stirs up strong feelings, concerns

Like any bill in the state legislature, House Bill 15-1135, which is slated to be heard in committee this Friday, will move through various approvals until it's killed or made a law. But it isn't just any bill.

The "Colorado Death with Dignity Act" asks the big questions, and when people answer them, facts often take a back seat to feelings, morals and personal experiences.

Co-sponsor Sen. Michael Merrifield, D-Colorado Springs, says he first wanted to propose a right-to-die bill years ago, when he was a state representative, but was discouraged by leadership. After being elected to the Senate in November, he was determined to bring it up again.

He wanted to do it for his father, who died in 2002 from prostate cancer. In the last month of his life, Merrifield says, his dad suffered horribly, and told him he wished he had killed himself before he was taken to the hospital. He even asked his son to bring his pistol to him.

"It was a horrendous time," Merrifield remembers. "He'd be screaming in pain, cursing, screaming at my mother."

Eventually, the older man slipped into a coma. Two weeks later, he died.

In 2007, Merrifield fought his own cancer and he remembers thinking, "If I was going to die the death my father was going to die, I wasn't going to do it."

HB15-1135, sponsored by Reps. Lois Court and Joann Ginal and Sen. Lucía Guzmán, would allow a physician to give a terminal patient, believed to have six months or less to live, a lethal dose of drugs, which the patient could self-administer. There are many protections in the bill. It would only be available to Colorado residents over 18, of sound judgment. It would have to be requested on several occasions and witnessed by disinterested parties who believe the patient is not being coerced. If the patient is thought to be depressed, or incompetent in any way, an evaluation by a psychologist would be required.

Merrifield gives the bill a 50-50 chance of passing. Though the sponsors are Democrats, he suspects that any vote on it won't divide neatly along party lines because many legislators will be influenced by their personal experiences, religious convictions, or the stories of others.

Take Rep. Dianne Primavera, D-Broomfield, who is chair of the committee the bill is assigned to. She says she's on the fence.

"The Dems that I've talked to, a lot of them are split also," she says. "It's not like we're voting on raising a fee on some sort of driver's license or something. I mean, this is life or death."

Legislation like this is so controversial that there's even disagreement about what to call it. Proponents, such as the national nonprofit Compassion & Choices, often reject the term "physician-assisted suicide," saying that a mentally sound terminal patient who chooses to die early isn't really committing suicide.

Right-to-die laws exist in five states. Oregon's has been in place since 1997. Recently, 29-year-old Brittany Maynard moved there from California after finding out she had terminal brain cancer. An online video of her explaining her reasons for ending her life got more than 11 million hits and reignited discussions about whether people really have a right to die on their own terms. (Maynard ended her life in November.)

Merrifield says he's talked to many families who've lost loved ones over the years, and while he knows not everyone would want the same exit Maynard chose, he thinks most want the option. A recent poll supports that. Talmey-Drake Research & Strategy of Boulder surveyed 512 Colorado voters in January and found 68 percent wanting their legislator to vote in favor of the proposed bill.

Scores of groups have banded together across the state to form Coloradans Against Physician-Assisted Suicide. It includes medical groups, hospice providers, disability-rights groups and religious groups like Focus on the Family. Notably, the American Medical Association also opposes physician-assisted suicide.

One of the main reasons cited against a right to die is the availability of hospice and palliative care, which can ease the suffering of dying patients with medications and counseling. Others give religious reasons. But there are more complex explanations as well.

Carrie Lucas, a juvenile and disability rights attorney who lives in Windsor, is among the opponents. Lucas has muscular dystrophy that began shutting down her muscle function in her teens. Now 43, she is a quadriplegic who needs a ventilator to breathe. Since her disease is terminal, and without assistance she would be within hours of death, Lucas says she'd qualify for assisted suicide under HB15-1135.

But she wouldn't want to. Lucas has four kids and is successful in her career. She says there's a misconception that people who have terminal illnesses that cause disabilities are unhappy. Generally, she says, they're just like other people.

"We have a country that worships youth and vigor and it's idolized, which is some of the concern, because attitudes about disability are so poor, and people's presumptions are that it's just terrible or awful," she says. "And it's not true at all."

Lucas says her major problem with right-to-die laws is that they treat people with terminal disabilities differently than other people. If a healthy person tells her doctor she wants to die, she's put on a 72-hour hold and given counseling and mental health treatment. But if Lucas did the same thing, under this new law, her doctor might help her complete the act, she says. And what if she were simply depressed? What if her dog had died, or her practice had gone south and she just needed therapy?

Lucas says she doesn't believe it's justifiable to treat a group like people with disabilities differently under the law. In her mind, suicidal ideation should be universally treated, or universally accepted. "If [suicide] is a right, then it's a right for everybody and we have to accept it," she says. "Then it's a right for the 16-year-old that just broke up with his girlfriend."

Dr. Jim Small, a pathologist and leader of the American Academy of Medical Ethics Colorado, says he understands the emotions behind right-to-die bills.

"I have sat in my living room holding a loved dog's head while the dog was put to sleep and it was peaceful and quiet," he says. "My heart totally understands the reasons behind this bill — but as a physician, I have to listen to my head."

He says there are huge problems with a bill like this. Patients might feel pressured to die to preserve inheritances for their families. Insurance companies may offer to cover a lethal dose of prescriptions, but not an expensive treatment that might prolong life.

"It just turns life into too much of an economic decision," he says.

And Small says he still worries that depression may be overlooked. Doctors make mistakes.

"If you screw up on a treatment and the person has a side effect that causes them problems, that's one thing," he says. "But if you screw up on a depression diagnosis and they're dead, what do you have?"

Dr. Alan Rastrelli agrees that there are dangers. He was an anesthesiologist for about 25 years, but when a right-to-die law was passed in Oregon, he was inspired to switch to hospice and palliative care. He has now been in the field for about 12 years and works at Divine Mercy Supportive Care in Denver.

Rastrelli says that when right-to-die laws first passed, a lot of the support came from families of patients who had suffered horribly in their final months. Doctors back then often would say, "There's nothing more I can do" when the options for treating a disease were exhausted, instead of continuing to care for patients through their deaths.

Rastrelli recalls thinking that the solution wasn't physician-assisted suicide — it was making sure no one had to suffer as they died.

Some patients are difficult to comfort or console, he says, but most find peace in a process that treats their discomfort as well as their emotions and their families. He's seen grown children find comfort in caring for their dying parents. It's a natural need, he says, to care for those you love, and it can be an important part of the grieving process. Hospice and palliative care, he says, already offers what assisted-suicide claims to: the right to choose a peaceful death on your own terms.

You'd be hard-pressed to find a doctor who doesn't think palliative care is a good thing. But some say that an option for physician-assisted suicide is still important.

Dr. Charles Hamlin, a retired Denver surgeon, says he believes the protections written into the law would make it extremely unlikely that it would be abused. And, he adds, the record of the laws in America shows that it hasn't been. (A study that ran in the Journal of Medical Ethics in 2007 looked at physician-assisted suicides in Oregon and the Netherlands to see if "vulnerable groups" were being disproportionately impacted – with he exception of AIDS patients, there was no evidence they were.)

A significant percentage of people prescribed life-ending medication never choose to use it, Hamlin says; they simply take comfort in knowing they could.

That's especially important because not all symptoms can be controlled. Extreme pain, seizures, nausea and vomiting can be so persistent that the only option is to put the patient in "a narcotic haze" until their death. Hospice, he says, doesn't "permit someone to say, 'I have gathered my family and I am ready.'"

And to Hamlin, who watched both his parents struggle to their deaths, that seems un-American. "Freedom of choice is a part of the American DNA."

Dr. Jean Abbott, a professor emerita in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus, says she also supports HB15-1135. "If I were to ask all my medical students what is their primary role, they would say in saving lives," she says. "[But] the fact of the matter is that everybody dies." She adds, "Doctors need to get better about journeying with patients toward their death."

That means involving them in decisions and trying to understand their desires. Patients need to understand their options and be able to decide how long they want to seek treatment. Hospice and palliative care, she notes, have made huge leaps, and most patients don't need to suffer. Because of that, she doubts that many people will opt for physician-assisted suicide.

But, she says, "A lot of it has to do with individual values about what makes a life worth living and what doesn't."

For instance, people who lose mobility due to a stroke usually learn to find joy in their lives again with the help of some counseling. But some never do.

"There's an old quote in medicine," she says, "that says it's not so much what disease the patient has, as what patient has the disease."

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