Live and Let Die

Colorado’s relationship with doctor-assisted suicide

by Hannah Westerman; photo by Venn Liu

Last February, Colorado lawmakers considered the Colorado Death with Dignity Act. The bill was modeled after Oregon’s Death with Dignity Act, implemented in 1998. Oregon was the first state to legalize doctor-assisted suicide, followed by Washington and Vermont. And though it has no actual Death with Dignity Statute, Montana’s Supreme Court has ruled that there is nothing in the state law that prohibits a physician from prescribing medication to end a terminally ill, mentally competent patient’s life. Recently, California made headlines when Governor Brown signed into law the End of Life Option Act, inspired by Brittany Maynard who, after being diagnosed with terminal brain cancer, moved from California to Oregon in order to obtain a doctor-assisted death. 

Senator Michael Merrifield of Colorado Springs was the senate co-prime sponsor of the bill. The Colorado Death with Dignity Act was rejected by the state’s House of Representatives Public Health and Human Services Committee by an eight to five vote. The same day this bill was struck down, Canada’s Supreme Court ruled that a 1993 ban on doctor-assisted suicide infringed on Canadian citizens’ rights. 

Sitting across the booth in Wooglin’s after his usual 7 a.m. breakfast, Merrifield talks in an even and firm tone about how he refuses to let the loss stop his efforts. He sees the new California statute as a sign that the issue may be gaining momentum, particularly since the bill was signed into law by Governor Brown, a Catholic, despite some religious groups calling doctor-assisted suicide a sin. 

“It will help,” said Merrifield. “California frequently leads the world in different issues. And this will give us an opportunity.”

Merrifield plans to help introduce a new Death with Dignity bill in 2016.

“We’re optimistic, cautiously optimistic, that we can get it out of the House,” said Merrifield. “We’re going to put it into the House again because the House is majority Democrat and there is more sympathy from the Democrats, although it is a bipartisan issue for sure.”

Merrifield says that the bill actually died in committee in part due to the vote of the Democrat Chairwoman, Dianne Primavera. “[She] just could not bring herself to vote for it. And that was an interesting situation because she’s a three-time survivor of cancer. So she felt like she had that personal tie in to the situation.” He pauses before continuing. “And everybody has some kind of story on one side or the other. The reason I’m so committed passionately to the issue is because my father died from prostate cancer, a really very horrific, painful, drawn-out death. He actually asked me if I would kill him or provide him with his handgun so that he could kill himself.” 

Merrifield, a cancer survivor himself, believes strongly in the necessity of the Death with Dignity legislature. However, local and national groups, including disability rights organizations have rallied against Colorado joining the ranks of right to die states. Anita Cameron, a leader of Not Dead Yet Colorado, the Colorado branch of a national disability rights group which opposes the legalization of assisted suicide, also takes some of her inspiration from a parent. 

“Supposedly [my mom] was in the final stages of [her illness] and she was pretty sick,” said Cameron, whose sentences run together as she speaks. “She was in hospice for a while and things were getting worse and worse. And she decided, she was in Washington, and she decided that she was going to come home to Colorado to die. The doctors said that her body had begun the dying process. Well, once she came home, she didn’t die and this was back in 2009. So you know the doctors made a mistake. That’s certainly another reason why Not Dead Yet is against physician-assisted suicide—because doctors make mistakes.”

Opponents argue that the passing of a bill like Merrifield’s could lead to discrimination against people with disabilities, who would receive “suicide-assistance” instead of suicide prevention and mental health care. Merrifield disagrees, looking at notes on his iPad as he lists off the bill’s requirements.

“Well that’s why we have put so many safeguards in there which we think answers their concerns. The problem is some people just refuse to be convinced that there’s any way [the Death with Dignity bill] could be logically drafted. We require two doctors to confirm that it’s a terminal illness and they only have six months to live, and multiple people have to witness a verbal request from the patient and written request from the patient. The person has to be capable of administering the drug themselves.”

But Merrifield does have one concern about the safeguards—the requirement of self-administration. Scrolling through his Facebook messages, he shows a recent message he received from a citizen with ALS expressing the worry that there are mentally competent patients who, due to the nature of their disease or disability, may not be able to physically administer the medication.

“She considers it to be faulty that a person with the most severe form of ALS cannot self-administer,” said Merrifield. “So that’s another challenge to be met. And I absolutely agree with her. There are cases like that where a person can’t self-administer but has expressed a desire to terminate their life. And that will be a tough one because doctors are on both sides of this story. Some strongly believe the patient should have the right to make that decision. Others strongly believe that a doctor should never be involved in taking a patient’s life because of the Hippocratic Oath.” 

Some people, however, believe that the current proposed safeguards are entirely insufficient.

“I don’t think any amount of safeguards, or so-called safeguards, would prevent misuse,” said Cameron, uncharacteristically succinct in her answer.

Cameron testified when the now-failed bill was introduced. She takes issue with the idea that doctor-assisted suicide would just be used to end undue suffering. 

“It’s not just fear of pain. All the reasons that [the supporters] gave are stuff that people with disabilities, some of us, go through every day. It seems like better off dead than disabled kind of rhetoric.”

Yet Cameron is not entirely against the concept of patients of choosing death. She is, however, vehemently opposed to the involvement of doctors and the legal system. 

“I don’t think it should be codified in law,” said Cameron, pausing for emphasis. “I hate to sound crass about it, but if you want to kill yourself, then kill yourself. There are ways to do it without involving a doctor. That’s my stance on the matter. If you want to make that choice, then…go right ahead. But involving doctors and legalizing and all that other stuff, then you put others in danger. When you want to kill yourself, that is a decision between yourself and whoever you think your Maker is or isn’t, but when you codify that in law then you potentially involve the entire community of people with disabilities. And that’s what I’m against. If you want to die, you’ve got the choice. Suicide is not illegal.”

By the early 1990s, only two states still listed suicide as a crime, and those classifications have since been removed. Some states do classify attempted suicide as a criminal act so that offenders can be compelled to undergo hospitalization and psychological observation. What is illegal is providing assistance in a suicide, unless you’re an approved doctor in a right to die state. This leaves many people, such as the disabled or the hospital-bound, with very limited options if they try to take their life without doctor assistance. To Death with Dignity supporters like Merrifield, this seems almost undemocratic. 

“It’s got to be one of our most basic rights, that decision to make ourselves if we reach a point where we feel like life is no longer rewarding or the pain is so extreme that it’s not logical even to continue—you should have a right to make that choice,” said Merrifield.

While Merrifield sees the lack of end of life choices as a failing, Cameron and the other members of Not Dead Yet see Death with Dignity laws as inherently discriminatory. Many of the opponents believe that if doctor-assisted suicide laws are passed, then it will lead to coercion of the elderly and disabled by their caregivers or will lead to prioritizing providing suicide over mental health care to people with disabilities, particularly the newly-disabled, such as accident victims.

“If we’re not careful, [doctor-assisted suicide laws] could turn to people who are not terminally ill, people with disabilities who have a lot of pain, but they’re not terminally ill,” said Cameron.   

Supporters of the Death with Dignity movement would strongly disagree with Cameron’s slippery slope argument.

“In any of the five states that have assisted suicide, Death with Dignity, there’s never been one case where it’s been misused on someone who should not be permitted, a disabled person for instance,” said Merrifield. “There’s not been one case of misuse in the statute,” he repeats. 

As for the issue of mental health, Merrifield says that there are multiple safeguards in place. Patients have to be at least 18 years old. When the two doctors are confirming that the patient only has six month to live, they must also check for any underlying psychiatric or mental conditions that may be influencing the patient’s choice. Also, counseling for alternatives like hospice care and pain management would be mandatory in the Colorado bill.

Merrifield recognizes that end of life options have wider effects than just the patients themselves. 

“Of course patients would be the most affected, but their families and their friends would not have to, as I did, watch their loved ones go through terrible pain and suffering and loss of capacity, mental and physical,” said Merrifield. “It was a terrible three months that I sat with my dad while he died.” 

Merrifield is hopeful that in the new 2016 bill they have answered enough of their opponents’ objections to be able to get it passed. He points out that public support, while split, does show a majority in favor of doctor-assisted suicide. A 2015 Gallup shows that sixty-eight percent of Americans believe that doctors should be legally allowed to help terminally ill patients commit suicide. 

Cameron, a black woman, ends her interview by pointing out that a larger percentage of black and Latino Americans are against doctor-assisted suicide than white Americans. A Pew Research Center survey in 2013 did show a significant difference in approval levels of doctor-assisted suicide between black and white Americans. Fifty-three percent of the white Americans surveyed approved doctor-assisted suicide while only twenty-nine percent of black Americans did. 

Whether it is an issue of disability or religious morality, it looks like the controversy of Death with Dignity or doctor-assisted suicide in America will remain for a long time. People across the country, with the aid of supporters like Merrifield, will continue to fight for their contested right to die. At the same time, members of organizations like Cameron’s will stand in the way of what they perceive as a threat to all disabled Americans. Everyone seems to agree that no one should have to face undue suffering or medical neglect, but what that means has yet to be universally determined.