DENVER — She wants to live, more than anything. But if her brain tumor returns, Megan Igel wants the freedom to end her life.

A state ballot measure here in Colorado could give her a measure of control: It would allow physicians to prescribe a lethal dose of medication to terminally ill adults who request aid in dying.

Supporters have raised more than $5 million and a September poll found 70 percent of voters back the measure, which would make Colorado the sixth state to allow assisted suicide. (The Washington, D.C., City Council is expected to approve a similar measure later this month.)

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The Catholic Church and other religious groups are fighting back, arguing that it’s “illogical” to for the state to allow some patients to hasten their deaths, even as taxpayers are funding a public health battle against suicide in Colorado.

The measure has also drawn fire from disability rights advocates — among them, Carrie Ann Lucas, who has lived for years with a progressive neuromuscular disease that has left her reliant on a wheelchair, a ventilator, and a gastrostomy tube.

“We should be legislating to protect the most vulnerable people in our population, not putting them at further risk,” Lucas said.

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Megan Igel never expected she’d be in the thick of this controversy — a vote with the power to shape both her work and her life.

A geriatric physician’s assistant, Igel has watched seniors ready to die linger on in hospice care, often for weeks, until at last their bodies shut down.

“I wouldn’t want that,” she’s thought many times, abstractly.

Then, a year ago, after worsening headaches, Igel was diagnosed with a brain tumor. Surgery has bought her time. But it’s an incurable cancer that will recur. Doctors just can’t say when.

Just before the diagnosis, Igel had helped care for a 25-year-old woman with the same type of brain tumor, an astrocytoma. The patient couldn’t talk or walk after surgery. “I told another physician assistant friend, ‘Don’t let me be like [her], wanting to die, trapped in my body, with no quality of life,’” Iger said.

That hasn’t happened: Igel, who is 41, recovered well from brain surgery, though she has to pace herself and is often exhausted at the end of the day. She’s cut back on work and started meditating. She prays, and tries to achieve a sense of balance in her life.

“I wanted my diagnosis to make me a better person, and to learn lessons from it,” she said, sitting in the kitchen of her airy home in a Denver suburb.

As Igel talked about the future, her eyes teared and her golden retriever came over to nuzzle her. She wants to be brave. But she doesn’t know what lies ahead.

Ending her life is the last thing Igel wants to do. She has two young daughters she adores, a loving husband, a large circle of friends, and even plans for retirement.

“I want to live as fully as I can for as long as I can,” Igel said, “but if I get to a point where I don’t have any quality of life and current medications aren’t keeping me comfortable, after consulting with my family and the people I love, I would consider it.”

Megan Igel
Aaron and Megan Igel, at home in a suburb of Denver. Judy Graham

Igel has the same type of tumor as Brittany Maynard, an eloquent 29-year-old with terminal cancer who made national headlines when she began speaking out in favor of the right to “death with dignity” in 2014. Later that year, Maynard swallowed a fatal dose of medication.

Support for assisted suicide swelled.

“After Brittany there was a sea change — a big national conversation,” said Toni Broaddus, acting director of political affairs for Compassion & Choices, a Denver organization advocating for aid-in-dying measures across the country.

California voted last year to allow assisted suicide; the new provisions took effect in June. Oregon, Washington, and Vermont have similar laws, and Montana’s Supreme Court has ruled that the practice is legal in that state.

Colorado’s bill closely tracks the groundbreaking “death with dignity” law passed in Oregon in 1994. It applies to mentally competent adults told by two physicians that they have six months or less to live. Before someone can get a lethal prescription, he or she must make two voluntary verbal requests, 15 days apart, and submit a written request signed by two witnesses.

Doctors must refer patients to a psychologist or psychiatrist if they suspect depression or other types of mental illness or cognitive impairment. Every case must be reported to state authorities. And coercion is punishable as a felony.

Still, opponents say there aren’t enough safeguards to prevent abuse. The Denver Post, the state’s largest newspaper, came out in opposition to Proposition 106, calling it problematic and poorly crafted.

The evangelical group Focus on the Family, headquartered in Colorado Springs, also opposes the measure, arguing that patients may be pushed into suicides to save money. “Doctor-assisted suicide is cheaper than treatment, and that’s dangerous in a profit-driven health care system,” Carrie Gordon Earll, the group’s vice president of public policy, said in a statement.

Pressure from insurers, health care providers, and family members can be subtle but insidious, said Lucas, who founded Disabled Parent Rights, which provides legal services to parents and children with disabilities.

“As disabled people, all the time we get the message that your life isn’t worth living,” she said.

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In Colorado’s physician community, there is deep division. The Colorado Medical Society surveyed its members in February; 56 percent favored “physician-assisted suicide” while 35 percent were opposed. The margin was tighter among doctors who frequently treat patients with terminal illnesses: 50 percent in favor, 41 percent opposed.

The group voted to remain neutral on Proposition 106, but medical societies in Denver, Boulder, and Pueblo chose to endorse the measure.

That alarms Dr. Alan Rastrelli, medical director of a Catholic hospice in Denver. “We physicians aren’t doing our job if people are suffering at the end of life. We should embrace the means to relieve suffering, not kill the sufferer,” he said.

Palliative care and hospice care are the answer, not assisted suicide, Rastrelli said. Yet these services are not widely available outside metropolitan areas in Colorado, research indicates.

On the other side of the divide, Dr. David Hibbard of Boulder, who’s board certified in hospice and palliative care, takes professional and personal comfort from the prospect of aid-in-dying.

“While a vast majority of patients would benefit from hospice, there are a minority whose suffering can’t be well-addressed,” he said. Sometimes this suffering is physical; sometimes it’s emotional or existential. Addressing this misery is part of his obligation to patients, Hibbard said.

Hibbard has a personal stake in the debate, too: Diagnosed with Parkinson’s disease 10 years ago, he uses a cane to walk and can no longer type or write independently. Should the time come when he can’t feed himself, dress himself, use the toilet, or get out of bed, he said he would consider aid-in-dying.

“It’s an option I would like to have available,” Hibbard said. “I might not use it, but I would certainly be comforted knowing it was available to me.”

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  • During the 2016 Elections, Colorado added a new proposal that would allow a person who has been diagnosed with a terminal illness to end their life. Proposal 106 was approved by an alarming vote and will be set in order in January of 2017. Proposal 106: Colorado End-Of-Life Options Act states that a person who is eighteen (18) years or older, who has been diagnosed with a terminal illness and only has six or less months to live, who is mentally stable, who has consulted with two separate physicians, and who can properly self-administer the fatal drug, can indeed take their own life with a prescribed pill.
    Conservatives who oppose this bill argue that there are not enough safe-guards in place. For example, patients pick the pill up from the pharmacy and take it home. What if it is not properly stored? Could a child get ahold of this medication, could somebody else who is depressed and suicidal get ahold of this pill, could the person lose this pill? What happens if this patient is being pressured by their family members because they will receive a substantial life insurance policy? Being told that you have an illness and there is no hope for you at all, will surely depress a person. All hope and all gladness can most definitely be stripped away. That is most likely when a person will be at their lowest point, which in any other case, is when psychologists try to step in and discourage suicide. Conservative opposition has also brought out factors with health insurance companies. It will get to a point where insurance companies will not cover expensive end of life costs, but they will cover this inexpensive drug, so you can end your life. Doesn’t this seem outlandish? Some health care providers have stated that they have come up with new ways to help a person progress their death, if the patient desires this. They are able to take off their oxygen when their time is limited, to allow their body to deplete oxygen levels naturally. Patients are also able to refrain from consuming fluids, this will cause the digestive system and other organs to slow down naturally. Natural death is the way we were created to pass away and taking matters into our own hands seems so wrong. Pain and suffering is something that people have to go through to understand it fully. However, there is always hope and there is always peace. These are two things anyone can understand.

  • False advertising disqualifies Prop 106 as it simply allows non voluntary euthanasia. The Colorado promoters of assisted suicide are guilty of false advertising. Their bills do not deliver as promised. If they are really supporting individual choices and rights they would provide an ordinary witness to the self administration of the lethal dose. Without a witness they are allowing forced euthanasia. I learned after caring for my wife’s last 18 months of declining autonomy. I learned that you can work on 4 hours sleep. I am focused on how this Prop 106 is written, it’s omissions and how it could be administered to my wife.
    Colorado Prop 106 provides no ordinary witness to the “self-administration of poison”.
    Even as the promoters have inundated us with their chant that the lethal dose “must be self-administered” and mentioned it 9 times in their 11 page Prop 106 they do not provide an ordinary witness to the act. That omission effectively eviscerates all of the so called safeguards. The difference between having a witness to “self administration” and no witness is that one honors individual rights and the other is non voluntary euthanasia. A promoter was once asked “why don’t you just legalize euthanasia?” He said “the public is not ready to accept euthanasia.”
    The process seems to be full of requirements on the front end up until the script is written. Then an heir can pick up the script and administer it without oversight. Know that only 2% of the doctors have attended these events in other states.
    Even the front end “requirements” have fatal flaws. A predatory heir may be a witness to the initial request along with a staff member of the facility. Does that sound like good public policy?
    The rest of the family is not required to be contacted. And everyone involved gets instant immunity. The death certificate is falsified by this law which makes it impossible to prosecute a murder when the death certificate states the underlying illness is the cause of death. There really is no transparent reason not to post poison as the cause.
    This bill Final #145 Article 48 provides that a predatory heir can facilitate the signup process, murder the individual and receive immunity all before the rest of the family is notified. This is neither reasonable nor prudent public policy. This is dangerous public policy that puts the entire population (all ages) at risk of exploitation by the medical-industrial-complex, organ traffickers and predatory heirs.
    I encourage people to read the Oregon model bill before taking a, or expounding on their position. We will agree no matter our starting position that this Prop 106 does not deliver.
    This bill is not the one.
    Respectfully submitted,
    Bradley Williams
    President
    MTaas dot org

  • I heard an old Tracy Chapman song a few days ago. It’s a song I have always loved for its simple message and heartfelt delivery. It could have been cheesy, but instead its simple beauty hits me like a slap to the face every time I hear it. Line after line of truth, followed by the repeated deeper truth of “all that you have is your soul.”

    Just before I heard the song, I had heard a report on the local public radio station about a bill in New York that, if passed, would make New York the sixth state in the nation to allow terminally ill patients to end their own lives by taking a prescribed dose of lethal medicine. The reporter interviewed supporters and opponents of the bill and allowed each a few sentences to explain their positions.

    If that reporter were to have asked me my opinion of the bill, I would have said New York State should adopt the bill immediately. For my reason I would simply sing the refrain from Tracy Chapman’s song: All that you have is your soul.

    It is easy to go long stretches without considering the fact that you yourself will one day die. As a child the idea is so remote and unlikely as to be almost impossible to truly consider. At some point, someone close dies and if we are old enough when that happens for the first time, we can’t help but come around to the thought that one day we will also be dead. But then, if you are like most people, you shove that thought aside and get on with life.

    Which is the right thing to do. Living in fear of death as a young person is unnatural.

    But then you hit middle age. Maybe a friend dies young and you go to the funeral. Your own inevitable death looms a bit larger, but still you put those thoughts aside. You have work to do, a life to lead. Your own death might become something you start to plan for a bit—you write a will, you look into insurance—but still it is more hypothetical than immediate.

    Maybe while lying in bed one night you broach the subject with your spouse. You talk a bit about your wishes—burial or cremation? Big memorial service or small gathering of close friends and family? Heroic measures or pull the plug? But again, you quickly make a light joke of it by calling dibs on getting to go first. Then you change the subject before turning out the light.

    And then a parent dies. It knocks you flat. One, because your mother or father is gone forever. And two, (if you are honest) because your own unavoidable end rises up in front of you in a way you cannot deny. There will come a day when you will no longer be. And your children, if you have any, will feel as lost as you do in the aftermath. As far as we can tell, humans are the only species whose members carry with them an awareness of their own impending death.

    Which means we also have the opportunity to plan ahead for our own death. Of course, many of us die in a way that does not allow for much planning. We have a heart attack; we have an accident; we have a stroke. But a fair number of people die of diseases that kill slowly and painfully over time. It is precisely circumstances like these that allow for us to have conversations with people we love about our exact wishes. People lie in bed in the dark side by side and say things like “If I ever get to the point where I am being kept alive by machines, I want you to pull the plug.”

    And states throughout the country have recognized the power of these spoken wishes time and again. If we are beyond the help of modern medicine with no signs of conscious mental function and no likelihood of ever coming back to consciousness, our loved ones can ask that our wishes be honored and we be allowed to die.

    But what if we are not that far gone? What if, instead, we have a fatal disease and we are taking inevitable steps toward our own death, but we are still conscious and able to feel pain? In five states you would have the option of asking a physician to help you die. In 45 states, you would be told the choice to live or die is not yours—it is the state’s.

    And this is where I come back to Tracy Chapman and “All That You Have is Your Soul.” I believe that when you are born there is one thing you own and that is your own self. It can be easy to believe we own many other things as we grow up, fall in love, get jobs, have children, and accumulate people and things. The house we live in, the car we drive, the partner we marry, the children we have—-all of these can come to feel like they are ours. But really, they are not. These things come and they go and in the end there is nothing you can do to stop them.

    In the end, the only thing that is yours is your own soul. And if you are at the point where medical science is useless and you are tired of constant pain and the indignity of being unable to feed yourself or wash yourself or even get yourself to the toilet and you decide you are ready to die, you should be able to ask a doctor to prescribe you a lethal dose of medicine so you can have one least measure of control over your own life.

    The Medical Aid in Dying Act was introduced in the New York State Legislature this week to provide for this very control. I will write to my state legislators right away to let them know I support this bill. In the end, whose life is it? Mine? Or New York State’s?

  • I understand why for people coming from certain religious traditions, enabling suicide by prescription is anathema. But I really don’t understand the position of those claiming to speak for disabled persons to oppose this law. Disability and terminal illness are not comparable, and there is absolutely no suggestion from advocates of these laws that anyone other than the individual in question make a determination as to whether their life is no longer worth living.

    Personally, if I ended up quadriplegic, I would almost certainly believe my life no longer worth enduring … but neither does that indicate that I think others in the same situation should reach the same conclusion (I emphatically don’t think everyone would or should), nor does it have anything to do with this law, unless in addition to being quadriplegic I was also in terminal decline. It is the terminality of one’s medical situation that is the determining factor in this law, not any other aspect of it.

    I would also say to those disabled persons advocates – I agree that no one has any grounds for telling a disabled person the value of their life, but neither do you have any grounds for telling anyone else the value of theirs. I should be as empowered to determine that the further value of my life is not worth the cost in pain and suffering as any person is to insist that theirs is.

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