Assisted Suicide and the Law

Colorado’s End-of-Life Options Act allows terminally ill patients to request and self-administer a medication intended to end their own life. About a dozen states have assisted suicide laws, allowing for death with dignity for terminally ill individuals.

For people in other states, medical aid in dying comes with the threat of criminal penalties. Colorado law eliminates criminal liability and allows doctors and qualified advanced practice registered nurses to prescribe aid-in-dying medication.

Assisted suicide laws vary by state. For medical treatment decisions, consult your physician. For legal advice, contact a local elder law attorney to understand your legal options.

Qualifying for End-of-Life Care

About a dozen states have medical aid in dying laws for terminally ill patients, including California, Oregon, and Maine. Colorado voters approved the Access to Medical Aid in Dying proposition in 2016. The law allows terminally ill patients to request and self-administer medication to end their lives.

Not just anyone can qualify for this end-of-life medical care. To request a prescription in Colorado, a qualified patient must be:

• At least 18 years old
• Of full mental capacity, capable of making and communicating healthcare decisions
• Diagnosed with a terminal illness that has a life expectancy of less than six months

If a patient meets the state requirements, they can receive medical aid-in-dying medication from a healthcare provider. But that’s not the end of it. They must fulfill several other requirements — most of them are safeguards to ensure patients have an earnest need to end their lives.

“More and more people want to be able to have choices,” says Sarah Golombek, a Denver elder law and estate planning attorney.

Requesting End-of-Life Care

Patients must make two oral requests to their attending physician that are at least seven days apart. After the waiting period, they must submit a written request, signed in the presence of two qualified adult witnesses.

A patient needs one consulting provider to confirm the diagnosis and prognosis. The patient must be capable of making informed, voluntary medical decisions. If the provider believes the patient may have impaired decision-making capacity, the patient must undergo a psychological examination to determine their mental health.

In addition, the prescribing provider needs to make several declarations:

• The terminally ill adult is not coerced
• They have informed the patient of the alternatives, including pain-management schemes and hospice care
• They have asked the patient to inform their next of kin of their decision
• They have offered the opportunity to withdraw the patient’s request
• The patient is able to self-administer the medication

In Colorado, as in other states with similar laws, it is illegal for anyone other than the terminally ill patient to administer the lethal medication, which aligns with the legal framework in other states that permit medical aid-in-dying. Visit the Colorado Department of Public Health and Environment (CDPHE) for more information.

Costs and Difficulties of Death with Dignity

“The first difficulty is getting a doctor who’s willing to assist you with it,” Golombek says. “A lot of doctors work for medical professionals or healthcare facilities that have concerns about helping people do this.”

The second issue is the cost. A single dose costs between $1,000 and $5,000, which may have to be paid out of pocket. “Federal funds like Medicare or Medicaid are not allowed to pay for the medication, and a lot of insurance may not pay for it either,” says Susie Germany, an elder law attorney in Erie, Colorado.

Terminally ill individuals must also be of sound mind and physically capable of self-administering at every step of the process. That means you can’t get “pre-certified,” says Germany. “One of people’s common fears is, ‘What if I get dementia? What if I get Alzheimer’s disease? Can I do this if that happens?’ And the answer is, no, you really can’t.”

Those with degenerative illnesses might obtain the medication but be unable to self-administer. “If you no longer have the use of your limbs, that’s problematic,” Germany says. “You don’t want to put any care provider or family member in a situation where they’re assisting with administering, because that’s not per the letter of the law.”

End-of-Life Legal Planning

There are also legal matters to address. Basic estate planning documents, such as a living will, medical power of attorney, and an advance directive, are important parts of an end-of-life plan. “A lot of people don’t realize how much more there is to an estate plan other than your money and your stuff,” Golombek says.

An agent under a medical durable power of attorney cannot consent to or obtain the drug on behalf of the person, but could still play a critical role. “This would be a worst-case scenario,” Germany says. “Let’s say the person did self-administer, things did not go as planned, and they didn’t die immediately, and they had complications. Let’s say the person is rushed to the hospital; that medical power of attorney would be important to act on the person’s behalf for any further decisions.”

Golombek recommends her clients fill out a values history form. While it’s not a legal document, the questions help clients document their health values. It can also serve as an aid for discussing their wishes with healthcare providers and family. She also recommends The Conversation Project, which can facilitate conversations about end-of-life wishes.

If these things are in place and a patient has access to willing physicians, end-of-life care doesn’t require an attorney. “Where an attorney would come in would be more for the advocacy in the event that you’re coming up against any obstacles,” she says.

“One of our roles as elder law attorneys is to provide our clients with broad-based education,” Germany says. “It’s not just about end-of-life, not just aid-in-dying, but also about palliative care and hospice care and what options clients have.”

Death Doulas

Sarah Golombek has started recommending a death doula, which is a relatively new resource for clients seeking end-of-life assistance.

“Just like a doula for birth is someone who helps someone come into the world, a death doula helps them depart this world in a way that they want to depart, and in a dignified manner,” she says.

A death doula cannot administer aid-in-dying medication, but it can be a valuable resource for those who choose to die at home.

Finding Legal Assistance for End-of-Life Decisions

The law’s requirements are strict, but there are additional legal considerations at the end of one’s life. Settling your estate helps take the burden off your loved ones. State laws for euthanasia and assisted suicide vary.

Contact a local Colorado elder law attorney who can help you and your family through this process.