Sunday's Daily Camera had an extensive article on page one about BCH’s
implementation of the Colorado End-of-Life options act.
Chief Medical Officer Dr. Ben Keidan and Vice President and Chief Nursing
Officer Jackie Attlesey-Pries were quoted extensively to explain the thoughtful
approach BCH took in implementing this complex law.
You can read more about our policy
on our website.
full article here or below:
Boulder Community Health sets policies on aid-in-dying law
Hospital is 'better prepared today than ... when the law came out'
By Charlie Brennan
Boulder Daily Camera
Boulder Community Hospital this week announced implementation of its policies
for supporting patients who choose to end their lives in accordance with
Colorado's aid-in-dying law, and now has 13 of its physicians qualified
with privileges to assist those who choose to use it.
BCH officials discussed the policies Thursday, the same day that the Colorado
Department of Public Health and Environment reported that in 2017, 69
terminally ill Coloradans received a physician's prescription for
aid-in-dying medication required to voluntarily end their lives.
CDPHE statistics showed that the aid-in-dying medication was dispensed
by Colorado pharmacies to 50 patients. State data do not show whether
people ingested the aid-in-dying medications dispensed by pharmacies.
However, among those prescribed the medication, the department has received
death certificates for 56 patients through routine vital records registration.
Of those 56, some may have died from ingesting the aid-in-dying medication,
their underlying terminal illness or other causes, according to the state.
Separately, BCH officials said this week that it was aware of two BCH patients
who have completed the process to receive a prescription for medical aid-in-dying
medication since the law took effect Dec. 14, 2016, and had used those
prescriptions — but had not done so on hospital property, which
is not permitted.
The BCH board approved its policies Jan. 31, 2017, relating to what is
formally known as the Colorado End-of-Life Options Act — which passed
in Boulder County with nearly 79.5 percent of the vote in November 2016.
But it took the better part of the year to complete the process of educating
the hospital's staff and care providers on how to most effectively
respond to the dictates of the law as written, which require that a patient
be terminally ill with less than six months to live, to have support of
a primary care and second, consulting physician, and to be able to self-administer
the prescribed medication.
Three local hospitals last year — Longmont United Health, Good Samaritan
in Lafayette and Avista Adventist in Louisville —
decided to opt out of participating in the measure.
UCHealth spokeswoman Kelly Tracer said all UCHealth locations, including
the new Longs Peak Hospital in Longmont, have opted in and are allowing
providers to work with patients who want to pursue the aid-in-dying option.
'Not for everybody'
"This is not for everybody, from a provider's standpoint, and
obviously, from a patient's standpoint, as well," said Jacqueline
Attlesey-Pries, vice president of operations and chief nursing officer at BCH.
"We needed to assure our physicians that no one was going to force
them to do it, and no one was going to prevent them from participating.
All of that took conversations with our medical staff, in order to kind
of figure out how we would move forward. And then, of course, implementing
those and getting those all set up, so that if someone gets a call in
scheduling or gets a phone call from a patient, how do we direct them
appropriately within the system?"
BCH Chief Medical Officer Dr. Ben Keidan said establishing medical aid-in-dying
privileges for 11 of its 110 to 120 staff physicians — plus another
two who are community-based — was not a simple process.
"The idea was to give people the easy access to education, and then
we developed policies that you can sort of follow line by line,"
Keidan said. "I'm not sure I could recite all the requirements
off the top of my head, so (the goal was) having them in front of the
providers at the time that they might need them, and having resources
like nursing care coordinators who could help us organize and coordinate
this in a safe and effective manner."
In a statement, the hospital announced, "BCH will offer medical aid-in-dying
counseling and prescriptions to qualified patients who have an established
relationship with an affiliated physician or advanced practice provider
(physician assistants and nurse practitioners). The process adopted by
BCH is designed to inform terminally ill patients about the full range
of end-of-life options, including hospice, palliative care and pain management,
as well as the potential use of medical aid-in-dying medication. Participating
physicians can counsel and write prescriptions for patients at any BCH
'There was no such list'
The fact that the new law took effect just five weeks after its passage
— Colorado was only the seventh jurisdiction to approve such a measure,
along with Oregon, Washington, Montana, California, Vermont and the District
of Columbia — perhaps made it inevitable that there would be confusion
and unanswered questions surrounding its launch.
Will Eiserman is on the faculty of Utah State University, but resides in
Boulder. In the past year, he became deeply involved in assisting a 47-year-old
Boulder woman suffering from terminal breast cancer. As her illness was
progressing toward an inevitable conclusion, he and other friends assisted
her in many ways — including helping her explore the possibility
of utilizing the aid-in-dying option.
With Eiserman's help, she finally located a physician to write the
prescription for the Secobarbital needed to end her life. However, by
the time she was physically compromised to the point of wanting to use
it, she had lost the capacity to self-administer the drug, as the law requires.
Eiserman said he was less than satisfied when he joined her weeks earlier
in approaching BCH last fall for assistance in pursuing the option afforded
by the new law.
"When I was in Boulder Community Hospital with my friend, we met with
the chaplain there and the social worker, and they said, 'I have a
list I can give you. It will tell you exactly who to go to.' I was
surprised but cautiously encouraged," Eiserman recalled. "I
waited, and then he didn't give it, and they eventually said, 'Just go to
CompassionandChoices.org (a national nonprofit devoted to education and assistance concerning end-of-life
options).' That website is very helpful, but it clearly states that
it does not give information about specific providers who can assist.
There was no such list."
Eiserman said: "They assuaged our worries that it was going to be
hard, and then they didn't really follow through on this important
part. They didn't really want to come out and say, 'We won't
help you with that,' but clearly, they couldn't, or wouldn't."
Attlesey-Pries said a patient asking the same questions at BCH today would
have a different experience.
"They would, because back last fall, we did not even have anybody
credentialed yet, or privileged to do it," she said. "We were
still not clear on all of our processes internally.
"We're better prepared today than we were last fall, or we were
a year ago, when the law came out very quickly, without any ability to
be able to prepare ahead of the law going into effect. So that was a little
bit of a problem."
No 'slippery slope'
Dr. Cory Carroll, a solo family practitioner in Fort Collins, pointed out
that the 75,000-member Colorado Medical Society's board of directors
in 2016 voted to take a neutral stance on the law, after a
survey showed 56 percent of its members in favor of physician aid in dying, with 35 percent opposed.
Carroll is among those who supported it, and he had requests from six of
his patients in 2017 for the medication needed to complete the aid-in-dying
process. He is not surprised by difficulties people have met in the first
full year of the law — but declined to comment on BCH requiring
a full year to publicly roll out its policies around the measure.
He voiced compassion for patients who are having difficulty finding a doctor
who will participate in the process, and that its broad acceptance across
the medical community has been slow.
"I do think it is more because doctors are more constrained today,
with (circumstances of) their employment, and the fear of what may happen,"
Carroll said. "But I don't think there is any evidence of a slippery
slope, or flaws that make this a bad thing."
Dr. David Hibbard, of Boulder,
fought for passage of the law, and is now devoting his practice solely to people who are facing their
end of life and want to exercise their right under the provisions of the
Colorado End-of-Life Options Act.
"I'm pretty much happy with it," he said of its implementation.
"Among my colleagues who are dealing with this, there does seem to
be a feeling that there are not quite enough physicians who are taking
the spot of the (second) consulting physicians. There are not as many
of those as would be desirable."
Hibbard is now focusing on making himself available to fill that role.
Keidan, at BCH, believes a significant positive of the law is that it has
set people to talking about an often uncomfortable subject.
"This law has created a lot of opportunities to explore all of these
other things, like hospice, palliative care, end-of-life even," Keidan said.
"In my own clinic, people have asked me, 'Will you do medical
aid-in-dying?' And I think that's kind of an opening ... to explore
just a little bit more about what people are hoping for at end-of-life,
and what their options are. That's a really good thing, and that will
touch a lot more people than the number of people — that hopefully
will be small — that go through the medical aid-in-dying process."
Requirements for obtaining end-of-life medicine under Colorado law
Proposition 106 created the Colorado End-of-Life Options Act, which allows
individuals with a terminal illness to request from their physician and
self-administer medical aid-in-dying medication. To be eligible to request
medication, the individual must:
• Be a Colorado resident 18 years of age or older
• Be able to make and communicate an informed decision to health care providers
• Have a terminal illness with a prognosis of six months to live that
has been confirmed by two physicians, including the individual's primary
physician and a second consulting physician
• Be determined mentally capable by two physicians, who have concluded
the individual understands the consequences of his or her decision
• Voluntarily express his or her wish to receive the medication
• Be capable of self-administering the aid-in-dying medication
Charlie Brennan: 303-473-1327,