Colorado End of Life Options Act

To be eligible, a patient must be:

• 18 years or older
• A resident of Colorado
• Terminally ill
• Acting voluntarily
• Given a prognosis of six months or less to live
• Mentally capable of making their own health care decisions
• Capable of self-administering and ingesting the aid-in-dying drug

• No. Providers, nurses, pharmacists and staff members may choose to not participate in the Act. This is their right under the law. UCHealth allows its providers to choose whether to participate.
• If a patient’s provider chooses not to participate, the patient may transfer his or her care to another provider.

• Many UCHealth locations offer health care providers who are experienced in palliative care medicine, a specialty designed to assist patients who are facing a serious or terminal diagnosis and their family members.
• Palliative care specialists are focused on relief of pain, stress and other debilitating symptoms of a serious illness.

• An individual must make two oral requests that are separated by at least 15 days. The requests must be made to the patient’s attending physician.
• The patient must also provide a written request that meets requirements established by the law.

• Yes. The Act requires a patient to work with his or her attending physician to make this request and be evaluated under the requirements of the Act. This means that the patient needs to be a patient at a UCHealth facility for a UCHealth attending physician to serve as an attending physician to serve as an attending physician for purposes of the Act.
• According to the Act, the attending physician is a physician who has primary responsibility for the care of the terminally ill patient and the treatment of the patient’s illness.
• If a non-UCHealth patient is interested in transferring care for his or her terminal illness to a physician at a UCHealth facility, he or she should follow usual referral mechanisms for connecting with the appropriate specialty or primary care to establish care.

• The written request must contain the elements required by Colorado law.
• The written request must be signed and dated by the patient who is seeking the medical aid-in-dying medication.
• The written request must be witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is:
  • Mentally capable;
  • Acting voluntarily; and
  • Not being coerced to sign the request.

• Neither the patient’s attending physician nor a person authorized to be the patient’s qualified power of attorney or durable medical power of attorney can serve as a witness to the written request.
• Of the two witnesses, at least one must not be:
  • Related to the patient by blood, marriage, civil union or adoption;
  • An individual who, at the time the request is signed, is entitled under a will or by operation of law, to any portion of the individual’s estate upon his or her death; or
  • An owner, operator or employee of a health care facility where the individual is receiving medical treatment or is a resident.

An informed decision is a decision that is:

• Made by an individual to obtain a prescription for aid-in-dying medication that the individual may decide to self-administer;
• Based on an understanding and acknowledgment of the relevant facts;
• Made after the attending physician has fully informed the individual of:
  • His or her medical diagnosis and prognosis of six months or less;
  • The potential risks associated with taking the medical aid-in-dying medication to be prescribed;
  • The probable result of taking the medical aid-in-dying medication to be prescribed;
  • All feasible alternatives or additional treatment opportunities, including comfort care, palliative care, hospice care, and pain control; and
  • The choices available to an individual that demonstrate his or her self-determination and intent to end his or her life in a peaceful manner, including the ability to choose whether to: (a) request medical aid in dying; (b) obtain a prescription for medical aid-in-dying medication to end his or her life; (c) fill the prescription and possess medical aid-in-dying medication to end his or her life; (d) ultimately self-administer the medical aid-in-dying medication to bring about a peaceful death.

Yes, an individual can rescind his or her request for aid-in-dying medication at any time.

The patient’s attending physician is the physician who has primary responsibility for the care of a terminally ill individual and the treatment of the individual’s terminal illness.

If the physician chooses to participate, he or she is required to determine all of the following:

• That the individual has a terminal illness. “Terminal illness” means an incurable and irreversible illness that will, within reasonable medical judgment, result in death.
• That the individual has a prognosis of six months or less.
• That the individual is mentally capable. “Mental capacity” or “mentally capable” means that in the opinion of an individual’s attending physician, consulting physician, psychiatrist or psychologist, the individual has the ability to make and communicate an informed decision to health care providers.
• That the individual is making an informed decision.
• That the individual has made the request voluntarily.
• The attending physician must also refer the patient to a consulting physician (a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding a terminally ill individual’s illness) for medical confirmation of the following
  • The diagnosis and prognosis.
  • The determination of whether the individual is mentally capable.
  • The determination of whether the individual is making an informed decision.
  • The determination of whether the individual is acting voluntarily.
• The attending physician must also provide full, individual-centered disclosures to ensure the individual is making an informed decision by discussing and documenting all of the following information:
  • His or her medical diagnosis and prognosis of six months or less.
  • The feasible alternatives or additional treatment opportunities, including comfort care, palliative care, hospice care, and pain control.
  • The potential risks associated with taking the medical aid-in-dying medication to be prescribed.
  • The probable result of taking the medical aid-in-dying medication to be prescribed.
  • The possibility that the individual can obtain the medical aid-in-dying medication but choose not to use it.

The attending physician must also:

• Request that the individual requesting the aid-in-dying medication demonstrate Colorado residency.
• Provide care that confirms to established medical standards and accepted medical guidelines.
• Confirm that the individual’s request does not arise from coercion or undue influence by discussing with the patient, outside the presence of others, whether the individual feels coerced or unduly influenced;
• Counsel the individual about the importance of
  • Having another person present when the individual self-administers the medical aid-in-dying medication prescribed
  • Not taking the medical aid-in-dying medication in public
  • Safekeeping and proper disposal of unused medical aid-in-dying medication
  • Notifying his or her next of kin of the request for medical aid-in-dying medication
• Inform the individual that he or she may rescind the request for medical aid-in-dying medication at any time;
• Under certain circumstances, the attending physician must refer patients requesting aid-in-dying medication to a psychologist or psychiatrist.

• UCHealth pharmacies will only fill a prescription for aid-in-dying medication that is written by an attending physician who is practicing at a UCHealth facility.
• The aid-in-dying medication might not be immediately in stock and it may require special preparation by the pharmacist, so individuals should expect a delay of at least several days for the pharmacy to acquire and fill the prescription.
• The medication can be expensive. Federal law prohibits federal funds (including Medicare) from paying for the medication.  Patients should ask their insurance provider or the pharmacist what their individual responsibility for the cost of the medication might be.

• The individual decides if, when and where he or she will self-administer the medication. In states that already have these options in place, most individuals have taken the medication at home.
• If a patient is considering self-administering the aid-in-dying medication inside a UCHealth hospital, the individual must notify his or her attending physician. Hospital policy must be followed in this circumstance.
  • UCHealth does not permit patients to be hospitalized for the sole purpose of self-administering aid-in-dying medications. The patient must otherwise meet criteria for hospitalization.
• It is not appropriate to self-administer aid-in-dying medications in the clinic setting.

The individual must demonstrate residency in Colorado by providing any of the following documentation to his or her attending physician:

• Colorado driver’s license or identification card that meets state requirements
• Colorado voter registration card
• Evidence the individual owns or leases property in Colorado; or
• A Colorado income tax return for the most recent tax year

If the physician chooses to participate, he or she is required to determine all of the following:

• Examine the individual and his or her relevant medical records
• Confirm, in writing, to the attending physician:
  • That the individual has a terminal illness,
  • The individual has a prognosis of six months or less,
  • That the individual is making an informed decision, and
  • That the individual is mentally capable, or provide documentation that the consulting physician has referred the individual for further evaluation.

An individual can obtain the medical aid-in-dying medication but choose not to use it. The medication should be disposed of properly. The Drug Disposal section on the Drug Enforcement Agency website contains information on proper medication disposal.