Significant non-compliance with Colorado assisted suicide law.

This article was published by the Australian Care Alliance.

Colorado’s experiment in providing a safe regime for assisted suicide is a failure because it lacks any possibility of identifying problems and, five years in, authorities remain lackadaisical about significant non-compliance even with the minimal reporting requirements.

In more than one in five cases the physician failed to lodge a copy – as required by law - of the person’s written request. In more than one in four cases the physician failed to lodge the mandatory written report from the consulting physician. 

In 2021 nearly one in seven cases even the basic form from the attending/prescribing physician has not been lodged and for which even the supposed assurance given by all the boxes being ticked is not provided.

Assisted suicide has been legal in Colorado since 16 December 2016 following the passing of a ballot initiative.

Minimal  data

Five annual reports have been published with the latest covering 2021.

Even compared to the limited data reported annually in Oregon and Washington the annual reports are sparse and uninformative.

In 2021 prescriptions for a lethal substance were written for 222 people – an 18% increase from 2021 and more than three times (308%) the number of prescriptions written in 2017.

For 2021 records of the lethal substance actually being dispensed were lodged for 156 (70.3%) of these cases.

A range of experimental lethal cocktails were dispensed, including combinations of diazepam, digoxin, morphine sulfate, and propranolol (DDMP or DDMP2 – 32 cases, 20.5%), with amitriptyline instead of propranolol (DDMA – 67 cases, 42.9%), and DDMA with the addition of phenobarbital (DDMAPh – 57 cases, 36.5%).

It is not known whether the prescription was not dispensed in the other 66 cases or if the mandatory paperwork was simply not lodged. 

Death certificates for 189 people for whom a lethal prescription had been written were received. However, as the death certificates, by law, only record the underlying illness and make no mention of whether death was caused by ingesting a lethal substance, it remains unknown how many of these 189 people actually died from the lethal substance or even collected it.

The youngest person who has been prescribed a lethal substance was reported as aged in the “upper 20s”.

There is no requirement (or even any process) for reporting complications for people from taking the lethal substance despite the mandated written declaration under the law requiring a person to acknowledge “although most deaths occur within three hours, my death may take longer”. The record length of time from ingestion to death reported from Oregon is 104 hours (4 days 8 hours).[3]

Although the law requires a referral to a psychiatrist or psychologist “if the attending physician believes that the individual may not be mentally capable of making an informed decision” only 5 out of 777 (0.64%) of those people for whom a lethal prescription was written (2017-2021) were first referred for an assessment., with no referrals reported for 2021.

Although eligibility is supposedly limited to a “terminally-ill individual with a prognosis of six months or less to live” the maximum duration of time between the date of prescription and date of death was “approximately 11 months”, with once case of “approximately eight months” in 2021.

“Other”, unspecified conditions

The 2021 report includes 8 cases of a lethal prescription written for “other illnesses/conditions” with no indication of what these were. This is double the 4 reported each year in 2019 and 2020.

A Colorado medical practitioner, Dr Jennifer Gaudiani, has reported acting as a consultant in two out-of-state cases of the prescription of a lethal substance for two 36 year old women with anorexia.[4]

With no details given in the Colorado reports on “other illnesses/conditions” we may never know when cases of a prescribing a lethal substance for anorexia or other non-terminal illnesses, including mental illnesses, occurs.

Significant non-compliance by physicians

What is most concerning is the level of non-compliance by physicians who prescribe lethal substances with even the very minimal reporting requirements.

In more than one in five cases (22.4%) from 2017-2021 the physician failed to lodge a copy – as required by law - of the person’s written request.

In more than one in four cases (25.5%) the physician failed to lodge the mandatory written report from the consulting physician. 

But the Colorado Board of Health is relaxed about this massive rate of non-compliance:

While reporting of the required documentation (including prescribing forms, patients’ written requests, consulting physicians’ written confirmations, and mental health provider confirmation) may be incomplete, all attending/prescribing forms received contained physicians’ signed attestations that all requirements of the Colorado End-of-Life Options Act have been met, and that required documentation is complete and contained in patients’ records. Efforts continue to educate physicians and other health care providers about reporting requirements.

This lay back approach glosses over the  13-15% of cases in each year from 2017 to 2021 where even the basic form from the attending/prescribing physician has not been lodged and for which even the supposed assurance given by all the boxes being ticked is not provided. There was 14.9% non-compliance with this legal requirement in 2021 – up from the lowest level of non-compliance of 12.9% in 2018.

Conclusion

Colorado’s experiment in providing a safe regime for assisted suicide is a failure because it lacks any possibility of identifying problems and five years in authorities remain lackadaisical about significant non-compliance even with the minimal reporting requirements.

Download a fact sheet on Colorado (PDF Link).