2018 Colorado Revised Statutes | Title 25: Public Health and Environment Health Care | Article 48: End-of-Life Options
The following provisions from Colorado's assisted suicide law are relevant to the protection of freedom of conscience.
Under the Act, physician assisted suicide is available to any terminally ill Colorado resident who is 18 years of age or older, has a prognosis of six months or less ot live, who has mental capacity, and has made an informed decision.
The Act explicitly states that health care providers (including physicians and institutions) may refuse "to participate in providing" assisted suicide drugs (25-48-117), but must cooperate in a transferring medical records to a willing physician found by the patient (25-48-113, 25-48-117). However, the Act imposes a series of obligations on attending physicians preliminary to actually providing the drugs (25-48-106), so adequate protection depends upon refusal to participate being understood to include these preliminary but necessary activities.
The provision ostensibly providing protection for objecting health care facilities (25-48-118) is more limited and ambiguous.
Health care facilities may prohibit physicians employed by them or under contract with them from writing prescriptions for assisted suicide for someone who intends to use the prescription on their premises (subsection 1). However, it appears that they cannot prohibit physician employees or contractors from writing prescriptions for lethal drugs on their premises, nor prohibit them from fulfilling all of the other responsibilities of attending or consulting physician on their premises. Moreover, while the heading of the section includes reference to sanctions for violating a policy against writing prescriptions, the text of the section authorizes only prohibition, not sanction, and subsection (2) actually prohibits facilities from imposing a sanction or penalty on physicians or others "for actions taken in good-faith reliance on this article or for refusing to act under this article."
Hence, it seems the Act enables objecting institutions to prohibit assisted suicide from taking place on their premises, and to sanction physician employees or contractors who attempt to violate the prohibition, but nothing more.
CO Rev Stat § 25-48-102 (2018)
As used in this article, unless the context otherwise requires:
(2) "Attending physician" means a physician who has primary responsibility for the care of a terminally ill individual and the treatment of the individual's terminal illness.
(4) "Health care provider" or "provider" means a person who is licensed, certified, registered, or otherwise authorized or permitted by law to administer health care or dispense medication in the ordinary course of business or practice of a profession. The term includes a health care facility, including a long-term care facility as defined in section 25-3-103.7 (1)(f.3) and a continuing care retirement community as described in section 25.5-6-203 (1)(c)(I), C.R.S.
(11) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine by the Colorado medical board.
CO Rev Stat § 25-48-106 (2018)
Attending physician responsibilities
(1) The attending physician shall:
(a) Make the initial determination of whether an individual requesting medical aid-in- dying medication has a terminal illness, has a prognosis of six months or less, is mentally capable, is making an informed decision, and has made the request voluntarily;
(b) Request that the individual demonstrate colorado residency by providing documentation as described in section 25-48-102 (14);
(c) Provide care that conforms to established medical standards and accepted medical guidelines;
(d) Refer the individual to a consulting physician for medical confirmation of the diagnosis and prognosis and for a determination of whether the individual is mentally capable, is making an informed decision, and acting voluntarily;
(e) Provide full, individual-centered disclosures to ensure that the individual is making an informed decision by discussing with the individual:
(I) His or her medical diagnosis and prognosis of six months or less;
(II) The feasible alternatives or additional treatment opportunities, including comfort care, palliative care, hospice care, and pain control;
(III) The potential risks associated with taking the medical aid-in-dying medication to be prescribed;
(IV) The probable result of taking the medical aid-in-dying medication to be prescribed; and
(V) The possibility that the individual can obtain the medical aid-in-dying medication but choose not to use it;
(f) Refer the individual to a licensed mental health professional pursuant to section 25-48-108 if the attending physician believes that the individual may not be mentally capable of making an informed decision;
(g) Confirm that the individual's request does not arise from coercion or undue influence by another person by discussing with the individual, outside the presence of other persons, whether the individual is feeling coerced or unduly influenced by another person;
(h) Counsel the individual about the importance of:
(I) Having another person present when the individual self-administers the medical aid-in-dying medication prescribed pursuant to this article;
(II) Not taking the medical aid-in-dying medication in a public place;
(III) Safe-keeping and proper disposal of unused medical aid-in-dying medication in accordance with section 25-48-120; and
(IV) Notifying his or her next of kin of the request for medical aid-in-dying medication; (i) Inform the individual that he or she may rescind the request for medical aid-in-dying medication at any time and in any manner;
(j) Verify, immediately prior to writing the prescription for medical aid-in-dying medication, that the individual is making an informed decision;
(k) Ensure that all appropriate steps are carried out in accordance with this article before writing a prescription for medical aid-in-dying medication; and
(I) Dispense medical aid-in-dying medications directly to the qualified individual, including ancillary medications intended to minimize the individual's discomfort, if the attending physician has a current drug enforcement administration certificate and complies with any applicable administrative rule; or
(II) Deliver the written prescription personally, by mail, or through authorized electronic transmission in the manner permitted under article 42.5 of title 12, C.R.S., to a licensed pharmacist, who shall dispense the medical aid-in-dying medication to the qualified individual, the attending physician, or an individual expressly designated by the qualified individual.
CO Rev Stat § 25-48-113 (2018)
Standard of care
(1) Physicians and health care providers shall provide medical services under this act that meet or exceed the standard of care for end-of-life medical care.
(2) If a health care provider is unable or unwilling to carry out an eligible individual's request and the individual transfers care to a new health care provider, the health care provider shall coordinate transfer of the individual's medical records to a new health care provider.
CO Rev Stat § 25-48-116 (2018)
Immunity for actions in good faith - prohibition against reprisals
(1) A person is not subject to civil or criminal liability or professional disciplinary action for acting in good faith under this article, which includes being present when a qualified individual self-administers the prescribed medical aid-in-dying medication.
(2) Except as provided for in section 25-48-118, a health care provider or professional organization or association shall not subject an individual to any of the following for participating or refusing to participate in good-faith compliance under this article:
(d) Loss of license, privileges, or membership; or
(e) Any other penalty.
(3) A request by an individual for, or the provision by an attending physician of, medical aid-in-dying medication in good-faith compliance with this article does not:
(a) Constitute neglect or elder abuse for any purpose of law; or
(b) Provide the basis for the appointment of
a guardian or conservator.
(4) This section does not limit civil or criminal liability for negligence, recklessness, or intentional misconduct.
CO Rev Stat § 25-48-117 (2018)
No duty to prescribe or dispense
(1) A health care provider may choose whether to participate in providing medical aid-in-dying medication to an individual in accordance with this article.
(2) If a health care provider is unable or unwilling to carry out an individual's request for medical aid-in-dying medication made in accordance with this article, and the individual transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the individual's relevant medical records to the new health care provider.
CO Rev Stat § 25-48-118 (2018)
Health care facility permissible prohibitions - sanctions if provider violates policy
(1) A health care facility may prohibit a physician employed or under contract from writing a prescription for medical aid-in-dying medication for a qualified individual who intends to use the medical aid-in-dying medication on the facility's premises. The health care facility must notify the physician in writing of its policy with regard to prescriptions for medical aid-in-dying medication. A health care facility that fails to provide advance notice to the physician shall not be entitled to enforce such a policy against the physician.
(2) A health care facility or health care provider shall not subject a physician, nurse, pharmacist, or other person to discipline, suspension, loss of license or privileges, or any other penalty or sanction for actions taken in good-faith reliance on this article or for refusing to act under this article.
(3) A health care facility must notify patients in writing of its policy with regard to medical aid-in-dying. A health care facility that fails to provide advance notification to patients shall not be entitled to enforce such a policy.