Compassion for individuals facing terminal illness drove efforts to legalize physician-assisted suicide, or PAS (also known as medical assistance in dying), in Colorado in 2016. Compassion is again the motivation behind lawmakers’ attempts to loosen requirements and increase assisted suicide. Access to physician-assisted suicide is now available through Senate Bill 068. While its intentions are laudable, this bill could actually increase suffering and have serious unintended consequences for vulnerable individuals and communities across the state.
When the End of Life Options ballot initiative was passed, many Coloradans thought they were voting to give patients with incurable pain and suffering, especially terminal cancer patients, options. In reality, fear of pain or actual pain is a small reason why a patient chooses her PAS in jurisdictions where it is legal. Colorado law does not require doctors to provide a reason why a patient chooses PAS, but other states have more robust data collection and safeguards in place.
In Oregon, which has the longest PAS program in the country, only 28% cited poor pain management or anticipation of pain as a factor in their decision-making. In fact, when evaluated prospectively, the amount of pain and suffering endured by patients who choose PAS is no different from that of patients who do not choose PAS.
Coloradans may be surprised to learn some of the factors often cited in PAS decisions. The 2022 Oregon report found that burden on family (48%), loss of dignity (72%) and loss of autonomy (90%) all outweigh the pain. These feelings are not inevitable at the end of life. It may reflect a growing disability-first mentality in our country. They also highlight the inadequacy of our social safety net.
When I change my one-year-old grandson’s diaper, I never think that he has no value or dignity. Similarly, when I helped my 96-year-old father with his personal hygiene work near the end of his life, I realized that he was not a man because he was unable to perform some activities of daily living independently. That never happened.
Dependency does not take away a person’s worth or dignity. But that is precisely the message frequently portrayed by PAS supporters and the media that follow them. The word “dignity” is frequently cited in public testimony to PAS. Choosing PAS is often perceived as “courageous.” Equating disability and dependency with worth and dignity immediately sends a message that resonates with vulnerable Coloradans.
By making PAS more accessible, we will further this disability-first message. Senate Bill 068 expands who a nurse can prescribe her PAS to. This will allow patients from other states to participate in her PAS. It also reduces the wait time required for a patient to receive her PAS medication from her 15 days to her 48 hours or less.
As assisted suicide becomes more normalized, explicit and implicit messages to consider assisted suicide will increase among vulnerable Coloradans. What initially began as a “right” was nurtured by the medical community, and as the public’s consciousness changed, it turned into an obligation.
What is often overlooked, if not intentionally ignored, is that a significant proportion of people seeking PAS are depressed. The End of Life Option Act required PAS participants to be “mentally competent.” The reality is that less than 1% of people prescribed PAS medications in Colorado receive mental health counseling. Conservative estimates suggest that at least 8% and up to 47% of patients seeking PAS have clinical depression, which is why clinical depression cannot be treated with state-sanctioned suicide. There is a high possibility that Senate Bill 068 would make the problem even worse by reducing the waiting period to just 48 hours, ensuring that impulsive decisions to pursue PAS are not deterred.
Suicide is a serious problem in Colorado and is the focus of public and private surveillance and prevention efforts. Colorado’s current public health posture is causing cognitive dissonance. Meanwhile, we are doing everything we can to prevent suicide, especially among vulnerable teenagers. On the other hand, it promotes suicide among the sick, elderly, and disabled through PAS. And under Senate Bill 068, even if death from natural causes is imminent.
It is well known that suicide is contagious. Our vulnerable teens are listening and watching. Can you imagine the message they internalize when they see their grandmother being praised for ending her life “on her own terms”? They believe suicide is a rationalization for existential and physical pain. I understand that this is considered a negative reaction. It is not surprising that preliminary research suggests that PAS is associated with increased rates of unassisted suicide.
We should reorient our compassion. By promoting PAS, Senate Bill 068 reinforces disability discrimination and diminishes the value and dignity of terminally ill patients. This bill does nothing to address the problem of depression that drives some people into PAS. Deaths may increase among vulnerable (non-terminal) populations, including at-risk teenagers. For all of these reasons, Coloradans should let their state senators and representatives know that this bill has no place in Colorado.
Thomas J. Perrill lives in Englewood, is a physician, and is president of the Colorado Democratic Party for Life.
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