Advocates praised Senate Health & Human Services Vice Chair Joann Ginal (Larimer County) and Rep. Kyle Brown (Boulder & Broomfield counties) for introducing a new bill Monday to improve dying patients’ access to the state’s 2016 End-of-Life Options Act. The law allows mentally capable, terminally ill adults with a prognosis of six months or less to live to use medical aid in dying to gently end their suffering. The first hearing on the bill is scheduled before the Senate Health & Human Services Committee on Feb. 29.

Boulder, Colorado, death doula Mike Reagan

”We know from experience in Colorado, as well as other states with similar medical aid-in-dying laws, that a significant percentage of terminally ill Coloradans are unable to access the End-of-Life Options Act because some of the provisions are regulatory roadblocks, rather than safeguards.” said Gina Gentry, Colorado campaign director for Compassion & Choices. “We deeply appreciate the leadership of Senator Ginal and Rep. Brown to improve access to the law, so fewer Coloradans will die with needless suffering because they were unable to access medical aid in dying.”

After carefully evaluating how the current law is working compared to other states where medical aid in dying is authorized, the bill, SB24-068, would allow more eligible patients to access medical aid in dying while still protecting medically vulnerable populations by making the following improvements:

• Allowing Advanced Practice Registered Nurses (APRNs) to practice within their scope of work and prescribe aid-in-dying medication to qualifying patients. The original 2016 law only allowed physicians to prescribe aid-in-dying medication.

• Reducing the mandatory waiting period between verbal requests for medical aid in dying from 15 days to 48 hours.

• Allowing prescribing providers to waive the mandatory 48-hour waiting period if the patient is unlikely to survive that long and meets all other qualifications.

• Removing the stigmatic residency requirement for qualifying patients to access medical aid in dying

Shelby Marcuse and her mother Vyki Bishop

The mandatory minimum 15-day waiting period, originally intended as a safeguard for eligible patients, can become a significant barrier to access for people whose conditions advance rapidly.

According to Katie Sue Van Valkenburg, Program Coordinator for Medical Aid in Dying at Denver Health, nearly 1 in 4 of their eligible patients going through the medical aid-in-dying process from 2018-2022 died during the minimum 15-day waiting period.

Mike Reagan, a Boulder death doula and founder of Peaceful Presence End-of-Life Services, can attest to the devastating consequences of a mandatory waiting period that is needlessly long. One of his recent patients, referred to as “Paul,” had been diagnosed with stage four pancreatic cancer and given a prognosis of one to two months to live.

Though Paul was vigilant and timely in taking all of the necessary steps to obtain his medication, “…the waiting period took so long that Paul wasn’t able to take advantage of Colorado’s law; he died waiting,” shared Reagan. “There is so much benefit to Colorado’s End-of-Life Options Act, and yet there is room for improvement. Reducing the waiting period to a much shorter period of time is appropriate, compassionate, and valuable. Fifteen days can be entirely too long for a dying person in severe pain and suffering, and with very limited time to make their wish happen.”

“I still keep in touch with Paul’s family, and his daughter’s wish now is that, in his memory, changes be made to this law to improve access,” Reagan added. “If my dad’s story can help others avoid pain, that would be a great gift.”

Another significant challenge for qualifying patients is identifying medical providers who are willing and authorized to help them start the process of formally requesting and obtaining aid-in-dying medication. The Denver Post reported in July 2023 numerous statewide accounts of increasing wait times for medical care, some as long as several months to a year, due to a supply of new doctors that “hasn’t kept up with the needs of [an] aging, chronically ill population.” This issue is only exacerbated in rural areas of Colorado, where one in four people said they couldn’t get the health care they needed.

Advocate Shelby Marcuse, of Colorado Springs, faced numerous hurdles in finding providers who would grant her mother, Vyki Bishop, access to medical aid in dying in 2023. After several dead-ends, they were finally able to secure an appointment, but it was in Denver, an hour-and-a-half drive each way. This travel time wasn’t physically feasible for her mom, who was extremely sick from her cancer and her debilitating chemo treatment. Accessing the law is too challenging for people who are in their last six months or less of life and typically in physical pain with mobility limitations.

“We desperately need more authorized providers in Colorado. It might mean one less gauntlet for a dying person to endure,” said Marcuse.

Colorado is one of 28 jurisdictions that give APRNs the authority to independently carry out all medical acts consistent with their education and training, and prescribe all forms of medication, including controlled substances. Allowing APRNs to participate as providers under the End-of-Life Options Act is consistent with their scope of practice and would help address the critical disparity in access to participating providers, particularly in rural areas.

Colorado is one of 10 states — including California, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington— as well as Washington, D.C., that have authorized medical aid in dying. Collectively, these 11 jurisdictions represent more than one out of five U.S. residents (22%) and have decades of combined experience using this end-of-life care option, starting with Oregon in 1997.

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