Thirteen months, ago on October 5, 2015, advocates for expanding end-of-life options celebrated a historic win. California Governor Jerry Brown had just signed into law the California End of Life Option Act, authorizing medical aid in dying in the nation’s most populous state. Our movement was now center stage. California was the most populous state in the nation, and its diverse population is a microcosm of the United States.  

While a celebration was certainly in order, so was careful examination, analysis and planning with an eye toward ensuring our next victory. The senior leadership and staff at Compassion & Choices (C&C and the Compassion & Choices Action Network (CCAN) knew that the win was a pivotal moment in the movement.

The question now: How do we continue the momentum?

The answer: Win in another state within one year to replicate the model that was successfully used in the marriage-equality movement of creating a domino effect. And we are well on our way!

Why Colorado Next?

After careful analysis of the movement and the political landscape, we decided to put our talents and resources toward launching a citizen-led initiative campaign in Colorado. It made sense because we have a very strong presence in Colorado with a flagship office in Denver, two active board members and a volunteer base of more than 15,000 people. In addition, Colorado offered a very favorable political climate. Public opinion polls showed strong support; the Denver and Boulder medical societies and the editorial boards of most of the major daily newspapers favored similar aid-in-dying legislation introduced in the state Legislature; and Colorado voters had a history of passing progressive ballot initiatives, like recreational marijuana. Colorado seemed poised for victory!

Lessons From Massachusetts

While the crystal ball looked promising, victory was far from guaranteed. In 2012, the voters of Massachusetts put a similar initiative on the ballot. Unfortunately, we were brought into the initiative late and could not engage in the early planning needed to  secure a positive outcome. During the campaign’s final weeks, opponents flooded the airwaves with millions of dollars in false advertising, and the initiative failed to garner enough votes to pass. This was a devastating loss, but much was learned.  

We planned for a different outcome in Colorado. This time around, we entered the campaign on day one. This early start would enable us to leverage our deep understanding of the issue, extensive message research and lessons learned from our successful initiative campaigns in Oregon and Washington, and legislative campaigns in Vermont and California. In addition, we knew that we needed to sufficiently fund the Colorado campaign to effectively compete with the opposition.    

Filing the Petition and Developing the Title

After nearly a decade organizing in Colorado, C&C had very strong relationships with the two Colorado petitioners: Julie Selsberg and Jaren Ducker. We worked closely with them and applied our knowledge and understanding of medical aid-in-dying laws across the country to file the petition and draft the ballot title. We hired the best referendum attorney in the state to help Julie and Jaren navigate the title, ballot and blue-book process. And the investment paid off.  The proposal’s proponents secured a very strong ballot title that accurately named the legislation medical aid in dying, as well as strong language in Colorado’s blue book — a voter guide developed by the secretary of state’s office and mailed to every registered voter in the state. Longtime, respected Colorado political operatives say accurate blue-book language is pivotal to the success of initiatives in the state.

Assessing the Cost and Fundraising Potential

At the same time, we conducted a feasibility analysis with two questions in mind: 1) how much will the initiative cost; and 2) can a local campaign raise enough money to be successful?

We knew there would be strong opposition from the Catholic Church, which has had 2,000 years to organize. Priests also had the advantage of being able to preach from the pulpit to 1 million out of the state’s 5 million residents who are Catholic, a free, intimate communication vehicle that it is not replicable in the political arena. To win, the campaign needed to have enough resources to:

• gather nearly 100,000 qualified signatures to get on the ballot
• remain competitive with ads promoting the referendum on the airwaves
• manage a robust volunteer field operation
• establish a speakers bureau with a diverse array of spokespeople willing to share why this referendum was personally important to them
• develop and manage a website and social media outlets like Facebook and Twitter
• conduct outreach to constituency groups — including local medical societies, faith leaders and communities of color — to secure supportive or neutral positions
• conduct  an earned-media outreach campaign to secure editorial support and positive news coverage

We felt very strongly that we were either all in or all out. A failure to win was worse for the movement than not going to ballot at all. So as leaders of the national end-of-life choice movement, we had to be prepared to use our reserves to help the ballot initiative proponents.  

The Need for Resources and the Strike Fund

Our analysis showed a successful Colorado ballot initiative campaign likely would require at least $6 million. Unfortunately, our fundraising assessment showed that a local campaign could not raise this quantity of money in the remaining seven months between April 2016 and the Nov. 2016 initiative.

This was devastating news that we grappled with for several weeks. We either needed to pass on the opportunity to help further an initiative in Colorado, or we needed to cough up some pretty significant dough.  

In April 2016, we brought our conundrum to the C&C and CCAN boards. Both unanimously agreed the movement needed an immediate victory, and Colorado was our best hope. C&C agreed to provide in-kind support to the initiative in the form of staff expertise and infrastructure assistance.  The CCAN board approved reaching into our strike fund — money raised over the past eight years from loyal supporters committed to seeing the advancement of medical aid in dying across the country — and invest a maximum of $5 million into a Colorado initiative.

Formation of a Separate Committee

With the board’s blessing, we encouraged the formation of a separate campaign organization: Yes on Colorado End-of-Life Options. C&C and CCAN’s president and CEO, Barbara Coombs Lee, served as the board chair of the Yes committee. Several talented C&C staff members were recruited to serve in key roles on the Yes committee, including the Campaign Director Jessica Grennan, who previously served as C&C’s national political affairs and advocacy director at Compassion & Choices. She and several others took a leave of absence and relocated to Colorado to ensure the success of this initiative.

Legally we could have operated the Yes campaign out of a separate committee within CCAN. In fact, we did establish a CCAN Colorado committee for the purposes of raising money, but we knew that creating an entirely independent organization was essential to keeping the decision-making structure nimble enough to operate at the lightning-fast pace of an election campaign. This approach proved to be pivotal to the campaign’s success.

The Yes committee organized the citizen-led campaign to promote the Colorado End-of-Life Options Act. Jessica and her team ran a flawless operation. In just a few short months, the committee gathered more than enough signatures to place the initiative on the ballot ahead of the deadline, securing us a favorable position on the ballot, and waged a robust organizing and advertising campaign to build on a strong foundation of public support. It successfully combated two opposition groups, one of which had the power of the pulpit behind it. As an example of just how nimble the Yes committee was, when opponents ran their ads attacking the initiative, the Yes campaign had a response ad on the air within 14 hours. This type of rapid response is essential for an effective campaign and something that is difficult to achieve in a larger organization.  

The Outcome

Fortunately, our smarts and your investment led to success! Colorado is now the sixth state to authorize medical aid in dying. The Colorado victory does not just benefit the state’s residents — it benefits all supporters of end-of-life choice. With each state that authorizes medical aid in dying, another domino falls, and the climate becomes more and more favorable for securing authorization of this compassionate end-of-life care option in all 50 states.   

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