Facts Fight Fear

Coloradans deserve the facts about Prop 106, not misinformation and fear mongering. We’ve fact checked the falsehoods and lies spread by opponents of Prop 106 below, and provided some helpful resources and tools for informing your network.

Here are the facts:

Mental Health Referrals

FEAR: Doctors will have to serve as counselors for depressed or suicidal patients.

FACT: If the doctor suspects the patient is not mentally capable (i.e. depressed, suicidal, etc.), that doctor must make a referral to a mental health professional.

Insurance Coverage

FEAR: If passed, insurance companies will promote medical aid in dying instead of potentially life saving treatments.

FACT: A research article from the New England Journal of Medicine concludes insurers have no financial incentive to pressure patients to accelerate their deaths. There are no substantial cost savings. Co-authored by an opponent of aid in dying to ensure objectivity, it finds: “savings can be predicted to be very small — less than 0.1% of both total healthcare spending in the United States and an individual managed-care plan’s budget.” This myth is further dispelled by the fact that 92% of people in Oregon who choose medical aid in dying are enrolled in hospice care and not receiving expensive or intensive treatment. Hospice enjoys nearly universal insurance coverage, and hospices have charitable funds to cover those who cannot pay. Medicare fully covers hospice services, as does Medicaid – with no lag or delay in payment, as with some other services. Hospice is significantly less expensive than treatments meant to extend life, which occur before a person becomes eligible for aid in dying. Therefore, consideration of aid in dying comes at a time when the cost of care is low, and there is no financial incentive to encourage people to choose that option.

Prop 106 Reporting Requirements

FEAR: Prop 106 lacks the reporting requirements of the Oregon Death with Dignity Act.

FACT: The reporting requirements in Prop 106 are identical to the Oregon law. The health department is tasked with (and funded for) a rule-making process that could actually make the reporting requirements more stringent.

Doctor Expertise

FEAR: If you face a potentially life-ending disease, Prop 106 will allow you to choose suicide on the basis of the opinion of any old doctor, even one that has no experience with your disease or illness.

FACT: Prop 106 specifies that a mentally capable adult must have two confirming terminal diagnoses; first from the attending physician, who must be the licensed physician who has primary responsibility for the medical care of an individual; and second from a consulting physician, who must be a licensed physician who is qualified by specialty or experience to confirm a professional diagnosis and prognosis regarding an individual’s terminal illness. Doctors trained in unrelated specialties cannot serve as attending or consulting physicians.

Individual Choice

FEAR: Doctors would decide whose life is worth living.

FACT: The option to consider medical aid in dying is entirely up to the individual. Protections are in place to ensure the terminally ill person is mentally capable, free of coercion, and aware of all options available.

Limits to Medical Aid in Dying

FEAR: Prop 106 is a slippery slope toward euthanasia, mercy killing, and legalized suicide.

FACT: In 19+ years, Oregon’s medical aid in dying law has not changed in any way from the day it was passed. It’s been successful, and has zero proven cases of misuse or abuse.

Elderly and Disabled Safety

FEAR: If passed, Prop 106 will endanger the elderly, disabled and infirm in our society.

FACT: The option to consider medical aid in dying is only available for mentally capable, terminally ill adults with less than six months to live. Like all medical aid-in-dying laws, section 25-48-103(2) in the Colorado End-of-Life Options Act clearly states “The right to request medical aid-in-dying medication does not exist because of age or disability.”⁵ Careful studies of the law’s 19-year record in Oregon, the first state to pass an aid in dying law, demonstrate that concerns the law would target the disabled, elderly, frail, uninsured or any vulnerable groups have not materialized. Disability Rights Oregon, charged with protecting Oregonians with disabilities, has never received a complaint of abuse or attempted abuse under the Oregon Death with Dignity Act.

Reasons People List for Accessing Medical Aid in Dying

FEAR: Most terminally ill people do not use medical aid in dying because of suffering.

FACT: The reasons they list, as reported in Oregon, are many as most people list more than one reason for requesting the medication. Quality of life during the dying process can really only be defined by the person who is suffering. Most dying people understand their pain could be controlled if they were willing to be sedated to unconsciousness (but that is not possible for all patients). But many value consciousness so highly that they bear extraordinary pain in order to be somewhat alert during their final days. Therefore, it is not pain alone that pushes them to seek aid in dying. Also, pain is only one component of suffering; others may include extreme fatigue, nausea, vomiting, open wounds, foul smells, tumors breaking through the skin and other agonies.

 

Aid in Dying Supports the Basic Human Rights to Dignity and Self-Control

“Patients may be less likely to try to end their lives early in an illness if they know there are legal options should the pain and suffering become unbearable.”

-Andrea Maikovich-Fong, PhD, ABPP

As a cancer psychologist I believe deeply in the power of candid dialogue, the courageous type that comes from leaning into, not turning away from, what is uncomfortable or difficult to discuss. So let’s start an uncomfortable conversation by stating a difficult truth. The human body has the potential to experience immeasurable and excruciating amounts of pain. Pain that causes people who once ran marathons or corporations to curl into a ball and sob uncontrollably for hours. Pain that can become so severe one must choose between intolerable suffering and being medicated beyond the point of self-recognition. Pain that is so overpowering and difficult to watch that it robs those at the end of their lives from authentic connections with loved ones, and leaves loved ones with horrific images of a once dignified body and mind reduced to primal suffering.

Despite the hundreds of ways human bodies deteriorate, my clinical work has convinced me that the human spirit is unfathomably resilient. We humans want, desperately, to survive whatever ailments befall us. Faced with physical transformations, grim statistics, and five thousand variations of pain, we endure because we want to live. I have witnessed the grace, courage, and tenacity humans can demonstrate amidst the most difficult of human conditions.

Unfortunately, there is sometimes a point at which the human body no longer has the capability to successfully heal, and it is inevitable that death will come soon. At this point, suffering is no longer a sacrifice bravely made toward the end goal of ultimate survival, but for some it becomes simply a painful state that precedes an inevitable, close death.

Through hundreds of conversations with people facing life-threatening illnesses or the end of their lives, I now hold as truth that as human beings we must strive to help each other maintain dignity and self-efficacy throughout life’s challenges. There is no time when this commitment to each other is more important than at the end of life when tremendous suffering is involved.

Another uncomfortable truth is that there simply are more and less peaceful deaths. One of the factors that differentiates between these is the degree to which a person maintains a sense of dignity and a sense of control at the end of life.  I believe that when there is suffering without any hope of recovery, and when that suffering becomes intolerable, offering the choice of aid in dying may be the ultimate way to care for each other and honor each other’s dignity and humanity.

In conversation with a cancer and chronic pain patient who is among the bravest, most insightful people I have the honor of knowing, I have also thought about how aid in dying may actually result in the extension of life, and in decreased suicide rates among the terminally ill. Her perspective, which she gave me permission to share, is one of someone who lives with at times paralyzing fear of future increases in pain and of burdening her loved ones. She feels that terminally ill people may be less likely to end their lives through fear-inspired suicide early in a disease process if they know that there are legal options that would be available if they reached a point of impending death and intolerable pain. She feels that this option may also create space for conversations between the dying and their loved ones where loved ones may come to more of an understanding and acceptance of death. She discussed how aid in dying could “take some of the fear out of dying,” and may help people feel more in control and choose to live in as connected and meaningful a way as possible for as long as possible.

Nothing about this topic is comfortable. Nothing about death and suffering is easy to talk about. However, I believe that we fail each other as human beings if the consequence of our discomfort is that we do not acknowledge and recognize how offering the choice of aid in dying supports the basic human right to dignity and self-control at the end of life.

Andrea Maikovich-Fong, PhD, ABPP is a board-certified clinical health psychologist who works with cancer patients. Her words reflect her opinions only, and in no way reflect those of her employer.