Colorado 2025 assisted suicide report. Missing data.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Alex Schadenberg

Colorado citizens legalized assisted suicide by approving Proposition 106 in 2016 which came into effect in 2017. In 2024, Colorado passed assisted suicide Bill SB 068 expanding their assisted suicide law by: permitting non-physicians to prescribe the assisted suicide poison, reducing the waiting period from 15 days to 48 hours and allowing the 48 hour waiting period to be waived if the presciber believes that the person is imminently dying.

The 2025 Colorado assisted suicide report states that:

In 2025, 580 patients received prescriptions for aid-in-dying medications under the provisions of the Colorado End-of-Life Options Act. This represents a 12.4% increase in the number of prescriptions compared to 2024. Among those prescribed aid-in-dying medication in 2025, CDPHE has received reports for 261 patients to whom aid-in-dying medication was dispensed. Also among those prescribed aid-in-dying medication, CDPHE has received death certificates for 512 patients through routine vital records registration. Note that not all of these deceased patients were dispensed aid-in- dying medication, and deaths may have been due to ingestion of aid-in-dying medication, the underlying terminal illness or condition, or other causes.

The Colorado report indicates that they do not know how many people died by ingesting the lethal poison concoction. 

The reporting is suspicious!

In 2025 there were 580 lethal poison prescriptions which was up from 516 in 2024 and 261 poison prescriptions dispensed which was down from 315 in 2024.

So the data makes it appear that more people are receiving a poison prescription for assisted suicide but fewer people are dying by assisted suicide. Based on the data, 45% of the people in 2025 who were prescribed a poison prescription obtained the prescription. The data must be wrong. 

In 2022, 317 people were prescribed poison prescriptions and 249 (79%) were dispensed. In 2023, 398 people were prescribed poison prescriptions and 316 (77%) were dispensed. 

A new trend started in 2024 with 516 poison prescriptions written and (315) (61%) prescriptions dispensed and as has already been explained, in 2025 only (45%) of the poison prescriptions were dispensed.

Unless there has been a change in the culture, it is suspicious that 45% of the 580 people who received a poison prescription received the prescription. 

• Is there a pharmacy that is dispensing assisted suicide poison and not reporting?
• Is there an underground or out-of-state source of assisted suicide poison that people obtaining with the prescription?
• Or are fewer people who have received a poison prescription having that prescription dispensed?

An investigation needs to be done to identify what is actually happening.

Let's look deeper into the data about who is being approved for assisted suicide in Colorado.

When examing the data the conditions that people have that are receiving approvals for assisted suicide remain consistent accept for two areas of concern.

The first concern is the increase in people with "other conditions" who are being approved for assisted suicide. Since legalization, 4.2% of the approvals were people with "other conditions" but in 2025 40 people 6.9% had "other conditions." The report does not indicate what is included within "other conditions."

The second concern is the increase in people with eating disorders or severe protein calorie malnutrition being approved for assisted suicide. In 2021 Colorado approved one person for assisted suicide based on a eating disorder. Eating disorders accounted for 19 assisted suicide approvals in 2024 and 17 in 2025.

Based on the likelihood that there is missing data in the report,  the Euthanasia Prevention Coalition urges the Colorado Department of Public Health and Environment to conduct an independent investigation into the assisted suicide data.

The $650,000 Killing — Predators in the Living Room When “Mercy” Becomes Manslaughter

This article was published by Kelsi Sheren on her substack on April 2, 2026.

When “Mercy” Becomes Manslaughter

By Kelsi Sheren

The “Death with Dignity” crowd is lying to you, shocker. They want you to think this is about a peaceful goodbye. It’s not. It’s about vultures circling the vulnerable, and a Colorado courtroom is finally exposing the bone-chilling truth.

A family is facing manslaughter charges for the death of a 91-year-old woman. But they didn’t act alone. They had a playbook provided by the Final Exit Network (FEN)—a predatory group of “exit guides” who specialize in teaching people how to die in the shadows.

Article: Family members charged with manslaughter in Colorado "assisted suicide" (Read)

Let’s call FEN what they are, a domestic threat to our elders. They don’t provide hospice. They don’t provide comfort. They provide a technical manual for suicide. They fly across the country to whisper in the ears of the fearful, telling them that their “civil right” is to quit. They operate on the fringes of the law, hiding behind the excuse that they only provide “education.”

Education? No. They provide the blueprints for a killing.

“Police say Kim attended a Final Exit Network workshop weeks before Milsy's death at The Lodge at Balfour, the same facility where Milsy lived. Texts show Kim brought in gear to make sure they had the right equipment, stating, "We've got the right equipment. I brought it in a (sic) showed it to one of the guides."

This wasn’t a doctor in a lab coat. This was a mechanical, cold-blooded execution. Following the FEN method, this 91-year-old woman was killed using a “suicide hood”—a plastic bag fitted with a tube and connected to a tank of nitrogen. They literally murdered this women with a plastic bag and called it compassion.

The goal of this method isn’t just death; it’s concealment. Nitrogen displaces oxygen, suffocating the victim while leaving almost no trace for a coroner to find. It’s designed to look like a “natural death” so the predators can walk away clean. It is a cowardly way to die and an even more cowardly way to “help” someone.

Here is the jagged pill the “mercy” activists don’t want you to swallow: $650,000.

That was the inheritance waiting on the other side of that nitrogen tank. When you normalize the idea that life is disposable, you create a market for death. If a grandmother is worth more dead than alive to the people in her own home, and an organization like Final Exit Network is there to provide the “how-to,” she is as good as gone.

This wasn’t compassion. It was a transaction. It was the ultimate abandonment of a woman who had seen 91 years of life, only to be ushered into the dark because she became an obstacle to a payout.

As a veteran, I’ve seen what happens when we decide some lives aren’t worth protecting. We are losing our collective soul to convenience and greed. We are trading our grandmothers for bank balances and calling it “progress.”

I’m done being polite about this and have been for a while. If we don’t stand up against groups like the Final Exit Network, Compassion and Choices, Dying with Dignity and the culture that empowers them, we are next and so are your kids.

Family members charged with manslaughter in Colorado "assisted suicide" death.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Boulder District Attorney Michael Dougherty

Jennifer Kovaleski reported for Denver 7 (ABC) News that Mildred “Milsy” Roller (91) died on February 18, 2024 by asphyxiation and not by assisted suicide. Assisted suicide is legal in the state of Colorado.

If you have suicidal thoughts, do not read this article, but seek help through a suicide help-line.

Kovaleski reported that:

Officers with the Louisville Police Department said they found Milsy inside her room at The Lodge at Balfour, a Boulder County assisted living facility, with a bag over her head connected by a tube to a nitrogen gas bottle. Beside her was a suicide note with the date changed from Feb. 5 to Feb. 18, 2024.

Family members have been charged with manslaughter. Kovaleski states:

An indictment details text messages, purchases, and planning that prosecutors said crossed the line from the right to die into felony manslaughter. According to the indictment, texts included statements like, "We need to talk about whether mom needs a will," and "She needs to write a suicide note and she really couldn’t today."

Court records say Milsy's daughter, Kim Roller, bought a nitrogen tank three days before Milsy died. Kim's brother-in-law David Norton ordered a pressure flow regulator from Amazon and helped Milsy install it, according to the indictment. Prosecutors say there had been a failed suicide attempt earlier that month.

According to the indictment Milsy had no terminal diagnosis and her family stood to inherit more than $650,000.

Boulder District Attorney Michael Dougher said:

"This is definitely about fighting for justice. And she doesn't have a voice in this process,"

Final Exit Network (FEN) involvement.

Kovaleski reported that Milsy's daughter Kim attended a FEN meeting where she learned how to kill her mother.

Police say Kim attended a Final Exit Network (FEN) workshop weeks before Milsy's death at The Lodge at Balfour, the same facility where Milsy lived. Texts show Kim brought in gear to make sure they had the right equipment, stating, "We've got the right equipment. I brought it in a (sic) showed it to one of the guides."

FEN is a group that provides instructions to enable people to die by suicide, but these instructions also enable people to kill, which is what happened to Milsy.

Kovaleski reported that the police have instructed the FEN to change its Colorado workshops, making sure participants understand the law and cutting out step-by-step instructions.

FEN is a type of "criminal" killing organization, as it provides information and advice to people to enable them to kill.

FEN has been associated with multiple concerning deaths. 

• In February 2026 a Texas woman was arrested for assisting her husband's suicide (Read).

• In July 2024, a retired doctor and assisted suicide activist, who worked with FEN, was charged with manslaughter in New York State (Read).

• In June 2021, FEN launched a court case to try to overturn the Minnesota assisted suicide law. The court case was an attempt to overturn the 2015 conviction in the death of Doreen in 2007. The Final Exit Network or FEN was found guilty, by a jury, of assisted suicide in the suicide of Doreen Dunn (57) in 2007, who was depressed but not terminally ill. (Read).

FEN continues their work under the guise of free speech and they avoid being prosecuted based on the fact that dead people don't talk.

Milsy Roller was not terminally ill. Milsy was allegedly killed by her daughter and son-in-law with instructions and coaching from the FEN.  

Since assisted suicide is legal in Colorado, If Milsy was terminally ill she may have been pressured to death by "legal" assisted suicide. So what's the difference.

Being killed by assisted suicide is legal. They cannot prove coercion in assisted suicide deaths. Being killed by manslaughter, a type of murder, is not legal with the same outcome.

It's time that we simply stop allowing people to kill people.

Colorado assisted suicide expansion court case lacks standing.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On May 22, 2025 the assisted suicide lobby filed a federal lawsuit on behalf of Jeff McComas and two Colorado physicians challenging the state assisted suicide law residency requirement.

The complaint argued that the Colorado assisted suicide law residency requirement violates the U.S. Constitution’s Privileges and Immunities Clause which “prohibits State officials from restricting non-resident visitors’ access to medical care within its borders absent a substantial State interest and restrictions narrowly tailored to those interests.”

Michael Karlik reported for Coloradopolitics on September 22 that:

A federal judge on Friday asked those challenging a provision of Colorado’s aid-in-dying law to reconsider whether they want to continue litigating, after a key plaintiff died earlier this month.

Jeff McComas from Minnesota, died on September 8 and the other two plaintiffs are doctors who are willing to participate in assisted suicide but they lack standing in the case that is based on out-of-state residents seeking to die by assisted suicide in Colorado.

Karlik reported U.S. District Court Senior Judge R. Brooke Jackson as writing:

“the Court wonders if this is the best case to challenge the Colorado statute. Please give this more thought and conferral, as the Court does not wish for the parties to waste their time and resources, or the Court’s, if there is no standing.”

This is not a victory but rather a set-back for the assisted suicide lobby who want to expand assisted suicide nationally by eliminating state assisted suicide residency requirements.

The assisted suicide lobby made the same arguments in Oregon, Vermont and New Jersey. Oregon and Vermont subsequently removed their state assisted suicide law residency requirement whereas New Jersey successfully defended their state assisted suicide law residency requirement in court.

Assisted suicide is not medical treatment or care therefore the Privileges and Immunities Clause does not apply to assisted suicide.

Colorado legalized assisted suicide by passing Proposition 106 during the November 2016 election. In 2024, Colorado passed Senate Bill 24-068 expanding their assisted suicide law by:

• allowing advanced practice registered nurses to approve and prescribe lethal poison,
• reducing the waiting period from 15 days to 7 days, and
• allowing doctors or advanced practise registered nurse to waive the waiting period if the person is near to death.

The original version of SB 24-068 allowed non-residents to die by assisted suicide in Colorado but this amendment was rejected by legislators. 

The 2024 Colorado assisted suicide report indicated that there were 510 lethal poison prescriptions written in 2024 which was up by 28% from 398 in 2023. 18 of the lethal poison prescriptions were based on the person having an eating disorder.

Assisted suicide lobby launches court case to force Colorado to permit suicide tourism.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On May 22, the assisted suicide lobby filed a federal lawsuit on behalf of Jeff McComas and two Colorado physicians challenging the state assisted suicide law residency requirement. 

The complaint argued that the Colorado assisted suicide law residency requirement violates the U.S. Constitution’s Privileges and Immunities Clause which “prohibits State officials from restricting non-resident visitors’ access to medical care within its borders absent a substantial State interest and restrictions narrowly tailored to those interests.”

The assisted suicide lobby made the same arguments in Oregon, Vermont and New Jersey. Oregon and Vermont subsequently removed their state assisted suicide law residency requirement whereas New Jersey has successfully defended their state assisted suicide law residency requirement in the court.

Jeff McComas's rights are not being infringed by Colorado's assisted suicide law that limits lethal poison prescriptions to state residents.

First: Oregon and Vermont will assist the suicide of out-of-state residents. McComas has access to assisted suicide in Oregon and Vermont, therefore his constitutional rights are not being violated.

Second: Assisted suicide is not a form of medical treatment or care therefore the Privileges and Immunities Clause does not apply to assisted suicide.

Colorado legalized assisted suicide by passing Proposition 106 during the November 2016 election. In 2024, Colorado passed Senate Bill 24-068 expanding their assisted suicide law by: 

• allowing advanced practice registered nurses to approve and prescribe lethal poison, 
• reducing the waiting period from 15 days to 7 days, and
• allowing doctors or advanced practise registered nurse to waive the waiting period if the person is near to death.

The original version of SB 24-068 allowed non-residents to die by assisted suicide in Colorado but this amendment was rejected by legislators.

The 2024 Colorado assisted suicide report indicated that there were 510 lethal poison prescriptions written in 2024 up by 28% from 398 in 2023. 18 of the lethal poison prescriptions were based on the person having an eating disorder.

Colorado assisted suicide deaths increase in 2023.

Alex Schadenberg
Executive Director,
Euthanasia Prevention Coalition

The 2023 Colorado assisted suicide report indicates that assisted suicide poison prescriptions and deaths have continued to rise every year since legalization.

Even though the number of assisted suicide deaths is continually increasing Colorado Governor Gary Polis signed Senate Bill 24-068 on June 5 to expand their State assisted suicide law. Nearly every state that has legalized assisted suicide has expanded their law.

The Colorado assisted suicide report indicated that in 2023 there were 389 lethal poison prescriptions written, which was up by more than 22% from 318 in 2022, 218 in 2021 and 185 in 2020.

The Colorado report indicated that in 2023, 294 of the lethal poison prescriptions were dispensed which was up by more than 18% from 249 in 2022, 164 in 2021 and 149 in 2020.

The data seems confusing since Colorado collects information on the number of lethal poison prescriptions that are written and it collects information on the number of lethal poison prescriptions dispensed but it doesn't collect information on how many people actually died by assisted suicide.

We expect that the 2024 Colorado assisted suicide report will show more increases in deaths now that Colorado expanded their assisted suicide law in 2024.

The assisted suicide lobby knows that it is harder to legalize assisted suicide than to expand the law once it is legal. Nearly every state that has legalized assisted suicide has later expanded their law.

Jacqueline Abernathy opposing Colorado assisted suicide expansion Bill SB 068

Dear Honorable Members of the Colorado State Assembly Senate Health & Human Services Committee,

Jacqueline Abernathy

I write today to urge you to oppose SB 068 and its blatant attempt to welcome suicide tourism in Colorado and put Coloradans at risk by expanding assisted suicide access to non-residents. I implore you as a public policy scholar fearful of how Colorado could betray the safety of its own most vulnerable citizens simply to put other citizens at risk as well. Your bill is a gross overstep to endanger citizens in other states while increasing the threat to your own constituents. 

I speak as an expert on this very topic, a bioethicist with a Ph.D. in Public Administration and Policy and a bibliography of scholarly peer-reviewed publications on assisted suicide and end-of-life medical decision-making. Where your duty is to the people of Colorado, entertaining the overreach inherent to SB 068 betrays the health and safety of those you are called to protect. This is why all eyes are upon you and non-residents like myself, who have an equal entitlement to weigh in on your decision in Colorado.

Regardless of what instigates it, suicide is generally an impulsive act of desperation, most often borne of fear. Enabling hasty irreversible decisions to self-destruct is not meant to limit any negative outcomes to the patient through delays. This bill will simply accommodate non-residents who travel to Colorado to obtain a deadly prescription from a total stranger who will only have them as a patient as long as it takes to dispense the lethal dose. SB 068 would create a market for these niche practices that do nothing but dispense deadly suicide drugs. The provisions negated in SB 068 include competent physician requirements, reflection and review periods, second opinions about prognoses and mental capacity, and the independence of physician assessments of each patient’s case. This bill eschews any semblance of an existing doctor-patient relationship by a physician well acquainted with the patient and their particular set of circumstances. SB 068 does not feign to value doctor opinions at all, striking every use of the word “physician” in favor of provider in order to allow lesser-qualified non-physicians to dispense the deadly poisons in a fraction of the time. This appears to accommodate specialty death clinics of ideologically pro-euthanasia on-demand doctors and nurses who can blindly validate each other’s conclusions out of their position that death on demand is a personal right for those who meet any legal or ethical criteria. This directly affronts the reason for the Colorado law to require a consultative review: as a safeguard to independently assess and concur with the attending physician’s conclusion that a patient is indeed terminally ill and mentally competent without signs of coercion or duress.

SB 068’s embrace of logistics to enable vendor suicide businesses negates any remaining provisions meant to protect Colorado citizens as total smokescreen. Whereas 14 days was the length of time for a resident advised by their existing doctor, surrounded by their family, greater community, extended support network and familiar resources, now anyone can visit a clinic for a rubber-stamped approval to kill themselves within two days. It strikes time for an adequate review of each patient’s case, limiting opportunity for further reflection by patients. There is no time for scrutiny or basic due diligence regarding someone’s alleged terminal prognosis and increases the likelihood of patient misdiagnosis and the possibility of treatable depression. A review of studies also determined that physicians’ medical diagnoses were often incorrect, both in declaring a patient to have a terminal condition and estimating their life expectancy at six months or fewer. Another study of physicians who were willing to prescribe the lethal dose found that 27 percent were not confident that they could determine if a patient only had six months or fewer to live. There is also substantial evidence that many patients opting to end their lives suffer from treatable depression and physicians report that patients for whom interventions were made (like treating depression) were more likely to change their minds about wanting to end their lives.

Whereas tax exportation to increase state budgets by encouraging tourism is within your scope as lawmakers, this would only increase revenue at the invaluable health and safety expense of those citizens who no longer have any safeguards thanks to enabling non-residents, but furthermore, this does not factor in the actual monetary and human costs of cleaning up after the deceased. 

The bill assumes that non-residents would just be trying to subvert their own state laws against assisted suicide but how many might be trying to subvert loved ones back home as well or have no one to return to anyway? While it is true that most suicides (77%) occur at home, those who travel here from their homes out-of-state just to obtain deadly drugs because SB 068 designed this option for that express purpose that they will not leave alive. Where do suicidal people who don’t have as ready access to their home as a place to end their lives? National parks are prime suicide destinations as is, particularly in the west where suicide the second leading cause of death, costs over a quarter-million dollars in recovery and identification efforts per victim. The Colorado National Monument attracts dozens of despondent people who self-destruct each year, but with the means to death in their pocket, any public place can become the spot someone chooses to die if they are inclined. There can only be added costs and psychological trauma to the Colorado residents who will face the aftermath of inviting this added violence. Mere exposure to suicide often leads to suicide among the responders and survivors, and this is true of those who discover a deceased loved one at home. For every quick, exported suicide that was started in Colorado but completed in a neighboring state for those residents to deal with the unpleasant consequences, there are sure to be secret, expedited death plans of residents enabled by SB 068. Making suicide so quick and easy can only mean more shocked survivors of hasty death plans by Coloradans hiding their intentions, leaving notes for their children or spouses explaining that they sought a hasty overdose from a nurse in Denver just days after learning their diagnosis because they “didn’t want to be a burden,” never knowing that their grieving survivors would give anything to have had a chance to tell them how desperately their family wanted to care for them for what precious time they had left.

In a state that ranks among the highest for per capita suicides (46 out of 50), so this would merely add a so-called legitimate form of self-violence to what your state calls a “public health crisis” and cost enormous sums of tax dollars to prevent. SB 068 only serves to usher in more death and destruction of Colorado residents by inviting the death and destruction of non-residents. Attempting to usurp the laws of other state legislatures to impose your will can only be done by endangering and burdening the citizens you are called to protect. 

Do your duty. Vote NO on SB 068.

Sincerely,

Jacqueline Harvey Abernathy, Ph.D., M.S.S.W.
Dallas, Texas

Lethal assisted suicide drugs were accidentally ingested in Colorado.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was cleaning up my emails and found a report that was published in the Journal of Emergency Medical Services on November 29, 2022 titled: Death with Dignty: When the Medical Aid in Dying cocktail gets into the Wrong Hands. 

The report concerns an emergency whereby a 35-year-old man in Colorado self-administered part of a lethal cocktail of assisted suicide drugs. The report states:

Ambulance 64 is dispatched to a 35-year-old male with possible alcohol overdose. Upon arrival, the crew is directed to a back bedroom where they find two fully clothed males with their legs hanging off a bed. One is elderly, the other is middle aged. Both are unconscious and unresponsive with shallow respirations. A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg. She remarks that the older man “should be dead” and the younger one “should be alive.”

The bystander states that the older man is a “death with dignity” patient who invited loved ones to be present while he consumed the MAID medication. After his first swallow, he remarked, “Man that burns!” The younger man said, “Let me see,” and then also took a swallow. The attending paramedic directs rescuers to begin ventilating the younger man while requesting evidence of advance directives for the older man. Care was not rendered to the death with dignity patient because he had a valid Medical Orders for Scope of Treatment (MOST) form stating he wanted no lifesaving measures performed on him. The medication bottle was prescribed to the patient. Hospice was contacted to verify he was a terminally ill patient of theirs. Medical control was also contacted for a consult because this was not a typical call.

The younger male patient is found to be atraumatic. His skin signs were significant for cyanosis but otherwise warm and dry. Pupils were constricted, equal and reactive. Without ventilations, his respiratory effort is 6; Sp02 was 72%. The patient is placed on a cardiac monitor and the heart rate is recorded at 144 bpm, blood pressure is auscultated and found to be 134/96 mmHg. Blood glucose is 172 mg/dl. Intravenous access is achieved with a 16-gauge catheter placed in his right external jugular vein. After there is no change in the patient’s presentation following Narcan 2 mg via IV, he is endotracheal intubated. End tidal carbon dioxide is then measured at 56 mmHg. The receiving facility is notified that a patient with a massive polypharmacy ingestion is en route.

...This challenging case is an excellent illustration of the importance of prehospital providers to have an understanding of end-of-life-care as it pertains to advanced directives and to be aware they may practice in an area where they encounter patients who may be in a MAID program. In this case, the paramedic had to juggle a complicated scene with two potential patients who both were near death. Education regarding such programs should be a priority to EMS agencies, as is how to handle instances where family members are requesting that no resuscitation be attempted and either advance directives are not in place, or copies of them cannot be located.

The report continues with information about the recovery of the man who self-administered the lethal cocktail without legal permission and it then concludes:

Should accidental ingestion occur, care is mainly supportive. The patient should be placed on a cardiac monitor and have a 12-lead rhythm strip to evaluate for QRS prolongation and consideration of sodium bicarbonate administration. Continuous pulse oximetry monitoring and assisting ventilation as necessary is indicated. If necessary, placement of advanced airway with assisted ventilations with BVM and confirmation by end-tidal CO2 is appropriate. Intravenous or intraosseous access should be obtained and intravenous fluids can be administered if the patient is hypotensive. Naloxone can be trialed, although may not have much effect given the high dose of opiates in the compound. Consideration may be made for transport to an ECMO capable facility.

The US states that have legalized assisted suicide have done so in a completely irresponsible manner. Prescribing a lethal cocktail of drugs for suicide is always ethically wrong, but to do so without monitoring is irresponsible.

Is it possible that a grand child could find the lethal assisted suicide cocktail by the bed side or in the medicine cabinet? What happens to the lethal drugs that are not consumed?

The concept of freedom to choose to die is a lie. People don't ask for a lethal drug cocktail to express their freedom but rather it is a reaction to a social abandonment that has left them feeling that there is no hope, purpose or value to continuing life.

Colorado court: Defense of consent does not apply to man who killed his terminally ill wife.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Bruce Bagwell was convicted of first-degree murder for killing his terminally ill wife on February 6, 2019 in Colorado. Bagwell appealed his conviction by claiming a "defense of consent." 

Last week, a three judge court of appeal panel decided that a "defense of consent" was not available to him because his act caused a serious injury (death) and his act was intentional. This is an interesting decision based on the fact that Colorado legalized assisted suicide in 2016.

According to the court decision:

In the hour after the shooting, Bagwell admitted to his wife’s father, his wife’s sister, and the arresting officers that he shot his wife because she asked him to do so to end her suffering. He told law enforcement that his wife had begged him to shoot her each of the preceding five days, and he explained that it was a “mercy killing.” In a videotaped interrogation, Bagwell again admitted to two detectives that he had killed his wife.

Bagwell was tried and convicted of first degree murder in October 2019 and appealed the decision by contending the trial court erred by denying him a defense of consent.

The court of appeal found that Bagwell cannot claim a defense of consent the injury was serious (caused death) and Bagwell clearly intended to cause death. 

An article by Michael Karlik published in The Gazette stated:

"An injury that causes a victim’s death is necessarily 'serious,'" wrote Judge W. Eric Kuhn in the panel's April 21 opinion, "because it involves a permanent and dangerous impairment of the victim’s physical condition. The consent defense is not available, then, when a defendant intentionally kills a victim who consents to her own death."

When reading the court decision, the court of appeal did not find signs of pressure from the police, Bagwell freely confessed to the crime.

Considering the nature of the act, the use of the defense of consent should also apply to euthanasia and assisted suicide. 

The euthanasia lobby argues that they are carrying out the wishes of a person who has asked to die. The act of euthanasia, which is usually done by lethal injection, intentionally causes the death of the person. Whether a person has requested it or not, precedent should apply to the act, that being, there is no defense to consent when intentionally killing another person.

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).

Assisted suicide for anorexia nervosa expands assisted suicide from terminal to chronic conditions.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January I wrote an article about assisted suicide for anorexia nervosa. In the article I quoted from a case report published by the ACAMAID, an organization of assisted suicide practitioners who approved assisted suicide for anorexia nervosa by defining the condition as being "terminal." 

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reports on Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders and who published a paper on her experience with prescribing assisted suicide for three people with anorexia nervosa.

Gaudiani defines anorexia as a terminally illness. Colorado's assisted suicide law does not permit assisted suicide for chronic or mental illnesses. Gaudiani considers anorexia to be a terminal condition because of the high rate of death among those who struggle with the condition. Brown writes:

In the paper, published in February in the Journal of Eating Disorders, Gaudiani ... writes that, although anorexia doesn’t have delineated levels of severity like cancer, which has stages of progression and a terminal phase, it can be brutally lethal. It is widely believed to have the second-highest mortality rate of all mental illnesses, behind only substance use disorders.

Based on the fact that anorexia has the second-highest mortality rate of all mental illnesses, second to substance use disorder, does that mean that people with substance use disorder also qualify for assisted suicide?

Is anorexia nervosa a terminal or a chronic condition?

A study by Kamryn Eddy et al., published in the Journal of Clinical Psychiatry in February 2017 titled: Recovery from Anorexia Nervosa and Bulimia Nervosa at 22 year Follow-Up recognizes that some people with Anorexia Nervosa die from the condition, but the study considers anorexia nervosa to be a chronic condition, not a terminal condition. The study is based on a 22 year follow-up and it concludes that for many people recovery is slow but nearly two-thirds of the participants fully recovered by year 22.

The study by Eddy is significant as it began in 1987 and followed up the participants at regular intervals including the 9 year interval and the 22 year interval. The study found:

Results:
At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa but not in bulimia nervosa.

Conclusion:
At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

There are several significant findings in this study:

1. Recovery from anorexia nervosa was slower than bulimia nervosa. Whereas 31.4% of the participants with anorexia nervosa were fully recovered by year 9 and 62.8% were fully recovered by year 22, with bulimia nervosa 68.2% were fully recovered by year 9 and 68.2% were fully recovered by year 22.

In both anorexia nervosa and bulimia nervosa, some of the participants who had fully recovered by year 9 were no longer fully recovered by year 22, but that also suggests that these are chronic conditions. Anorexia nervosa often requires a longer term treatment commitment to achieve full recovery which also indicates that anorexia nervosa is a chronic condition andnot a terminal condition.

2. The data in the study indicates that of the 246 study participants 18 people were known to have died by the 20 - 25 year interval. There is some missing data since researchers lost contact with 15 of the participants, and 37 participants decided not to continue participating in the study, nonetheless, if anorexia nervosa were a terminal condition the death rate by the 20 - 25 year interval would be much higher. The study does not indicate if all of the 18 participants who were known ot have died, died from the chronic condition or if some died from another cause.

Eddy refers to a study by Hay and colleages who suggested that:

“both the clinician and [chronically ill] patient often share the experience of hopelessness and despair about the likelihood of meaningful change.”

I suggest that feelings of hopelessness and despair are leading assisted suicide clinicians to redefine anorexia nervosa as a terminal illness and thus prescribe death as a treatment.

The recent Oregon 2021 assisted suicide report also listed anorexia as a reason for assisted suicide.

 My earlier comments that assisted suicide for anorexia nervosa is abandonment is supported by the conclusion of the study which states:

Our data indicate that the majority will recover from anorexia nervosa and bulimia nervosa over time. Yet 2 decades of illness represents considerably meaningful life lost, and our findings emphasize the importance of developing interventions to reduce the duration of illness. Our findings that recovery remains possible even after long-term illness argue for active treatment rather than palliative care for most patients. Increased research attention to identifying early predictors, mediators, and moderators of recovery in naturalistic and controlled treatment trials is needed to guide treatment disposition recommendations.

By prescribing lethal drugs for assisted suicide or lethally injecting a person (euthanasia) the clinician is abandoning the patient rather than helping the patient find hope with the potential of long-term recovery.

Assisted suicide for anorexia is abandonment

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In January I wrote an article about assisted suicide for anorexia. In the article I quoted from a case report published by the ACAMAID, an organization of assisted suicide practitioners who approved assisted suicide for anorexia and stated:

If the patient’s eating disorder treating physician and evaluating psychiatrist agreed that she had a “terminal disease” and retained decision-making capacity, she would meet those requirements of the aid in dying statute in her jurisdiction.

An article by Jennifer Brown that was published in the Colorado Sun on March 14 reports on Dr. Jennifer Gaudiani, an internal medicine doctor who specializes in eating disorders, who has published a paper on her experience with approving assisted suicide for three people with anorexia.

Colorado's assisted suicide law does not permit assisted suicide for mental illness therefore Gaudiani has defined anorexia as a  terminally ill. Gaudiani considers anorexia to be a terminal condition because of the high rate of death among those who struggle with the condition. Brown writes:

In the paper, published in February in the Journal of Eating Disorders, Gaudiani advocates for allowing patients who are dying from anorexia to end their lives on their own terms. She writes that, although anorexia doesn’t have delineated levels of severity like cancer, which has stages of progression and a terminal phase, it can be brutally lethal. It is widely believed to have the second-highest mortality rate of all mental illnesses, behind only substance use disorders.

Based on the fact that anorexia has the second-highest mortality rate of all mental illnesses, second to substance use disorder, does that mean that people with substance use disorder also qualify for assisted suicide?

This is abandonment. Even the ACAMAID consultation service acknowledged that:

There is no consensus in the eating disorder literature regarding whether a patient who has severe enduring anorexia nervosa is “terminally” and “irreversibly” ill according to the definition in the State statute.

The recent Oregon 2021 assisted suicide report also listed anorexia as a reason for assisted suicide.

People with anorexia have a high mortality rate and many people live with anorexia for many years, nonetheless, the Beat Eating Disorders website contains multiple stories of people who were treated and successfully recovered.

I am not suggesting that everyone recovers from an eating disorder. I am saying that assisted suicide for anorexia is abandonment. Death by assisted suicide denies the opportunity to recover. 

My experience with assisted death is that once someone is convinced that death is their only option, treatment becomes more difficult since thd person is focused on death and not recovery. Assisted suicide is not about the "freedom" to die, but rather it is about medical abandonment.