Medically Assisted Death Vote: A Fight Over ‘Options’ And ‘Mistakes’

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Photo: Medically assisted death 1 | Larson family
Matt Larson, a proponent of Proposition 106, shortly after his brain surgery, and his wife Kelly.

Last spring everything changed for Denver resident Matt Larson.

“One day I was fine,” said Larson. “The next I was being rushed by ambulance to Denver Health following two very massive and violent seizures.”

The force of the seizures, from the sheer shaking, fractured and dislocated his shoulders and snapped two bones in his back. Soon his providers had life-altering test results.

“They came back and shut the door and said 'you have mass on your brain,' which was tough to hear,” said Larson.

The diagnosis, a malignant brain tumor, rocked his world. Larson, 36, and his girlfriend Kelly decided to get married. He says a couple of days later, surgeons cracked his skull open and scooped out part if his brain. Since then he’s endured the tough road of radiation and chemo, with a sobering outlook.

“I have a 50/50 probability that I’m going to live,” said Larson. “I hope to beat the odds. I desperately want to live.”

But Larson has decided if the brain cancer returns and is incurable, he’d like the option to end his own life rather than face the possibility of an agonizing and painful death.

“It would just bring me a ton of peace and comfort now to know that I have this option,” Larson said.

Oregon Inspired Colorado Ballot Measure

He’s become an advocate for Proposition 106. It would give a mentally competent adult the ability to end their life with a doctor-prescribed drug, generally a sleeping medication called secobarbital.

“We need to help people diminish their suffering and assuage their suffering any way we can,” said Dr. David Grube, a long-time family doctor in Oregon, one of five states to allow the practice.

Grube is with the national group Compassion & Choices. He became a proponent shortly before the law passed in Oregon and after one of his patients dying from bladder cancer took his life with a shotgun. Photo: Medically assisted death 3 | Dr. David Grube

"I just said to myself if I can ever prevent such a violent and tragic end to a person’s life, I should be open to helping people,” Grube said.

Colorado’s proposal is modeled after Oregon’s law. In both, two doctors must determine a patient is mentally capable of choosing to end their life and isn’t under undue influence or coercion. Grube, who is now retired, says he’s helped about 30 people die. He says about a third of those who requested medications don’t take them.

“Many more people just want to talk about it, just want to know if it’s a possible option,” said Grube. “Still, in all, it’s quite uncommon.”

According to the Oregon Public Health Division, during 2015, 218 people received prescriptions for lethal medications under the provisions of the state’s Death With Dignity Act. That was up from 155 the prior year. The division said it had received reports of 132 people who had died during 2015 from ingesting the medications prescribed under the act.

The division reports the rate of DWDA deaths in 2015 was 38.6 per 10,000 total deaths. More than 90 percent of patients died at home and were enrolled in hospice care. Since the law was passed in 1997, 1,545 people had prescriptions written under the act; 991 patients died ingesting the medications.

Patients who died listed the following concerns most frequently when asked why they decided to request the life-ending prescription: less able to engage in the activities making life enjoyable, losing autonomy and loss of dignity. Further down the list was inadequate pain control and the financial impact of the treatment.

What About Hospice And Palliative Care?

Denver Dr. Alan Rastrelli opposes the proposal. He worries it will erode the public’s trust in doctors as healers.

“Physicians will go towards this philosophy of assisting a patient in their death,” said Rastrelli. “That will destroy, I think, the patient and physician relationship.”

Rastrelli, a former anesthesiologist, changed careers to go into hospice and palliative medicine. He says when doctors help patients end their lives it creates a societal and bioethical calamity. Rastrelli worries about what the initiative doesn’t do. It doesn’t require a physician to be present when the person dies. He also said it’s difficult to know about common problems or mistakes are because reporting requirements in Oregon, and in Colorado’s proposal, are weak.Photo: Medically assisted death 4 | Dr. Alan Rastrelli

He says it’s better to help the dying palliatively, using pain relievers, spiritual and psychological support to ease suffering.

“Woody Allen said I’m not afraid of dying, I just don’t want to be there when it happens,” Rastrelli said. “We can help people be okay all the way through to the end.”

That makes a lot of sense to advocates with Not Dead Yet. That’s a national group run by people with disabilities that opposes the proposal.

“Doctors make mistakes,” said the group’s Anita Cameron. “They’re humans and they make mistakes.”

Cameron says seven years ago her mother Alice was diagnosed with end-stage chronic lung disease. Then in her 60s, she was given less than six months to live. Today, Cameron’s mother is still alive.

“Had the law been in place, I’m pretty sure those doctors would have convinced my mom to take the pills,” Cameron said. “And she’d be dead.”Photo: Medically assisted death 2 | Anita Cameron

Cameron has several disabilities, including multiple sclerosis. She worries the ballot proposal will encourage those with disabilities to kill themselves. She also thinks in some cases insurers will agree to pay for end-of-life medications, but not measures to keep someone alive.

“When is it going to be a duty to die?” said Cameron. “That’s what euthanasia is and when is going to stop being a choice?”

Battle Draws Big Bucks

The ballot initiative is drawing not just passion. but plenty of money.

According to the latest filings with the Colorado Secretary of State’s office, backers have raised about $5.3 million, mostly from the group Compassion & Choices Action Network. That’s roughly three times more than the No Assisted Suicide Colorado campaign, which has raised $1.8 million.

That money is primarily coming from the Archdiocese of Denver, which has donated $1.1 million. The Roman Catholic Diocese of Colorado Springs gave $500,000. The campaign has also drawn financial support from Catholic dioceses large and small from around the country including archdioceses in Kansas City, Kansas ($25,000), Oklahoma City ($25,000), Grand Rapids, Michigan ($10,000) and Orange, California ($10,000).

The group’s contributions also include $50,000 from Colorado Christian University in Lakewood and $20,000 from Focus on the Family in Colorado Springs.

Both groups have also received numerous smaller donations.

The two sides are trading jabs over a campaign finance complaint opponents have filed with Colorado’s Secretary of State. The No Assisted Suicide campaign accuses the main funder behind the pro side, Compassion & Choices Action Network (CCAN) of failing to file as an issue committee.

In a press release, the No campaign said CCAN has “served as a conduit to hide the true source of over $4.5 million in contributions.” It said “there is no way to know who donated” that money and that “the identities of the campaign donors are being hidden.”

Compassion & Choices Action Network fired back calling the complaint frivolous and without merit” and “publicity stunt.”

In a statement, Barbara Coombs Lee, president of Compassion & Choice Action Network said CCAN set up a registered issue committee, CCAN-CO, which has filed all registration and disclosure forms.

“Long-term donors have given with the intention of funding, without restriction, our advocacy efforts across the country,” said Coombs. “Since influencing the CO ballot measure was not their intention in donating, it would be unethical to release their names, and it’s our duty to defend their right to privacy.

CCAN said it was requesting an immediate hearing and dismissal of the complaint.

A spokesperson with the Secretary of State’s office said the complaint has been forwarded to an administrative law judge, who would determine if there’s been any violation.

Colorado to join five other states allowing the practice?

Five states -- Washington, Oregon, California and Vermont -- currently allow the practice. Montana has effectively legalized it, due to a court ruling protecting from prosecution doctors who help dying patients.

The board of the Colorado Medical Society, the state’s largest physicians group, voted to take a neutral position on the measure. In a statement, President-elect Dr. Katie Lozano called the proposal “the most personal of decisions that must be left to our patients” to decide.

A poll of 618 CMS physicians, done in February, before the ballot measure was proposed, found support within the group for physician-assisted death in general. Fifty-six percent of CMS members favored it, 35 percent opposed.

Among those who “frequently” treat patients in later stages of a terminal illness, the gap was smaller, with 50 percent backing physician-assisted death and 41 percent opposing it.

The group said there was a consensus that the medical society should focus on protecting patients and doctors, increasing awareness of end-of-life choices and the importance of palliative and hospice care, if the law were to pass.

Election ballots start going out in the mail in mid-October.