Threading the Needle: Hospice and Medical Aid in Dying

I have thought about writing this column for several months, and up to now I have chosen to write about topics that were not necessarily “easier” but clearer and less controversial. Ultimately, however, as the President of the oldest community-based nonprofit hospice Northern Colorado I feel it is important to clarify our position on medical aid in dying (MAID).

The Colorado End of Life Options Act, which became law on December 16, 2016, established a legal process through which terminally ill adults can end their lives if they meet the following criteria:

• A prognosis of six months or less;
• Mental capacity to make an informed decision;
• Residency in Colorado; and
• Has requested and obtained a prescription for medical aid-in-dying medication.

Two physicians must certify that the patient has a terminal prognosis of six months or less, and that the individual is mentally capable and making an informed decision. Colorado residency must also be established, along with a number of other steps that ultimately lead to the patient obtaining a prescription for a lethal dose of pills that are crushed in water and the patient must self-administer.  For more detailed information visit: https://www.colorado.gov/pacific/cdphe/medical-aid-dying.

The challenge for hospice organizations stems from conflicting guiding principles. One states that hospice neither hastens nor postpones death, and clearly MAID hastens death. That said, it is also a prime directive that hospice honors and helps every patient achieve their vision of “a good death” – and MAID is legal in Colorado. Pathways and other hospices throughout the state balance these competing interests by adopting a position of neutrality.

Patients who avail themselves of the MAID option are not denied access to or discharged from our care, but hospice physicians will not sign the MAID certifications nor will they prescribe the required medications; patients need to work with their attending or another physician for these steps. We always offer to have one of our nurses attend the death in case the patient experiences any distress, and the family is offered grief support just as we do after any death.

It is also important for us to provide support to our clinical staff who are working with a patient who makes this choice. MAID is not a “typical” hospice death, and some of our staff carry a certain degree of moral distress when working with someone who chooses to end their own life. Our internal policy allows any clinician to be reassigned if they are working with a patient who elects MAID and they have a strong moral or religious objection. To date, however, none of our staff have opted out.

MAID is both a choice and a challenge for Coloradoans and the hospices who care for them. Pathways and other hospices’ position of neutrality is how we thread the needle and continue to honor the choices of all our patients.

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