In December 2016, the End of Life Options Act went into effect after Colorado voters passed it by a 2-to-1 margin — the largest medical aid-in-dying ballot victory to date. But that history-making win is just one step in expanding and protecting the end-of-life choice movement.

Matt Larson with wife, Kelly, and their dog, Otis.

On November 8, 2016, the Colorado End of Life Options Act, or Proposition 106, passed by a 30-point margin, with 65 percent of voters endorsing medical aid in dying in their state. Coloradans won a long, hard battle for expanded end-of-life options. After multiple failed attempts in the Legislature, Compassion & Choices and the Compassion & Choices Action Network inspired a citizen-led ballot initiative and provided financial and technical support to the Yes on Colorado End-of-Life Options campaign.

The campaign took off in the major swing state with a diverse electorate from across the political spectrum, proving that even in a turbulent election cycle, end-of-life options are a nonpartisan issue. As Matt Larson, a Colorado native who became an advocate after being diagnosed with brain cancer at 35, put it, “This is not a left or right issue. This is not a political issue. This is an issue of compassion. More than two-thirds of people that understand the process and eligibility requirements support this. Try to get two-thirds of anybody to agree on anything these days.” Voters across a broad demographic range wanted this law, according to exit polling by The Associated Press and TV networks in Colorado. Men and women, Hispanics and whites, and people with and without college degrees said they backed the proposal.

The resounding support in Colorado was evident from the beginning of the campaign. In August, volunteers and advocates delivered more than 160,000 petitions to the secretary of state’s office, and the measure was certified for the November ballot a few weeks later. A dozen newspapers endorsed the measure, including the Boulder Daily Camera and the Grand Junction Daily Sentinel, and people across Colorado debated the issue in their papers’ opinion columns. Dan Diaz, Brittany Maynard’s husband, and former Oregon Governor Barbara Roberts appeared in television advertisements along with 36-year-old Larson. Even more young people showed their support through vocal endorsements from groups like New Era Colorado and ProgressNow. Also, the Colorado Medical Society dropped its decades-long opposition to medical aid in dying.

The win in Colorado expands on the momentum created by dedicated supporters and volunteers from across the country who have committed years to the movement for end-of-life options. Unfortunately, that hard work could be for naught if the law isn’t implemented effectively. That’s why Compassion & Choices is still in Colorado working on an access campaign.

The organization’s work in Oregon, Washington, Vermont and California has shown time and again that some hospital systems and health providers will resist honoring medical aid-in-dying laws without pressure from the very citizens that voted the option into existence. According to Matt Whitaker, Compassion & Choices’ multi-state implementation manager, when hospitals refuse to allow their physicians to participate in medical aid in dying, they cut off access for large swaths of people, creating a major health-equity issue. Now that Proposition 106 is law, Compassion & Choices’ goal is to ensure all Coloradans can access it.

In Colorado, as in other states with medical aid-indying laws, one-third of hospitals have refused to allow their physicians to prescribe aid-in-dying medication. When hospitals opt not to participate in the practice, they make it extremely difficult for people who rely solely on that facility for their care to access the law, an acute issue in rural areas and regions dominated by one large health system. Terminally ill people with only months to live could be forced to travel a hundred miles to a participating hospital, or may not be able to access the law at all. This isn’t due to a lack of support from the citizens of Colorado, as voting numbers prove. It’s hospital executives and bureaucrats making decisions for entire regions of a state. That’s why Compassion & Choices encourages people to demand access through letter-writing campaigns and educational events in their communities on a grassroots level.

When citizens make their voices heard, hospital systems listen. In California, Huntington Hospital announced it would forbid its 800 affiliated physicians from participating in the state’s law. In response, Compassion & Choices volunteers and staff organized local residents who were outraged by the decision. The result? Huntington Hospital reversed its position, even announcing it in an open letter they published in the Los Angeles Times. This is just one example of how residents in states where medical aid in dying is authorized can change healthcare system policy.

The Compassion & Choices Access Campaign also provides resources to help patients and doctors comply with the guidelines of their state’s law. The organization’s staff reaches out to physicians and healthcare providers, offering education and staffwide informational sessions regarding the requirements for medical aid in dying. Just as the ballot initiative was unique to Colorado, the Access Campaign is tailored to the specific needs of regions and communities within the state.

The more Americans who have access to the end-of-life option of medical aid in dying, the more the practice becomes open, accessible and trusted. Every time another state authorizes medical aid in dying, it builds momentum for more states to do the same. With support from nearly 7 out of 10 voters nationally, it is clear that public opinion continues to move in favor of this option. And with 21 states considering aid-in-dying bills this year, more lawmakers understand that this is an option their constituents want.

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