DENVER — Nearly one-third of Colorado’s hospitals are refusing to offer terminally ill patients the option of physician-assisted suicide — even though voters last fall overwhelmingly approved a ballot initiative legalizing the practice.

And two of the state’s biggest health care systems, both faith-based, appear poised to bar their doctors from providing such services to patients at any of their facilities, under any circumstances — potentially running afoul of the new aid-in-dying law.

The Catholic Church strongly opposes assisted suicide and the Archdiocese of Denver spent $1.6 million campaigning against the Colorado measure. That effort failed, but faith-based health systems are now leading resistance on the ground.


“It has a chilling effect,” said Holly Armstrong, a Colorado consultant with Compassion & Choices, a national organization that advocates for end-of-life options.

The pushback came to light last week, when Centura Health — Colorado’s largest health system, which operates 15 hospitals and more than 100 physician practices and clinics — told STAT it would “opt out” of offering aid in dying. The system is jointly operated by Catholic Health Initiatives and Adventist Health System, another faith-based group that opposes assisted suicide.

Colorado’s second largest Catholic system, SCL Health, then put out a statement declaring that any patients requesting aid in dying “will be offered an opportunity to transfer to another facility of the patient’s choice.” SCL Health runs seven hospitals and dozens of clinics.

Both health systems declined repeated requests for interviews to clarify details of their policies.

But advocates for aid in dying laws said the policies appeared to be sweeping, prohibiting all physicians working for the health care systems from prescribing medication at any of their facilities to help qualified patients end their lives.

A third big health system in the state, HealthONE, has decided it won’t dispense life-terminating medications or allow patients to take them on the premises of its eight hospitals. But HealthONE, which is not faith-based, won’t impose similar restrictions on its doctors. A spokeswoman declined to provide details.

The lack of clear communication from health systems is accentuating confusion as Colorado becomes the sixth state to allow physicians to help certain patients end their lives.

The state’s law, which became effective last month, requires that such patients be 18 or older, have six months or less to live, be mentally competent, and ask for aid in dying twice over 15 days, in addition to a separate written request.

“Everyone is in a mad scramble figuring out what they’re doing to do and how they’re going to do it,” said Jennifer Moore Ballentine, president of The Iris Project, a Colorado consulting firm that is running a series of seminars on the new law over the next few weeks.

Colorado’s aid-in-dying law contains “conscience” provisions allowing physicians, nurses, and pharmacists to “opt out” of participating. Health systems can also bar the practice on their premises. Other states where aid in dying has become legal — Oregon, Washington, California, Vermont, and Montana — have similar provisions, and Catholic health care systems in those states have taken advantage of it.

But the Colorado law specifically states that health systems can’t prohibit doctors who work for them from discussing end-of-life options with patients or writing prescriptions to be taken off-site. This provision was crafted to prevent health systems from erecting barriers to access; only Vermont has a similar rule, but it doesn’t have a heavy concentration of Catholic hospitals.

Advocates for Colorado’s law say the two big Catholic health systems may be testing that provision.

“From what we’ve seen, it appears that Centura’s and SCL’s policies go beyond what is allowed under the law,” said Kat West, national director of policy and programs for Compassion & Choices. A legal challenge is “a distinct possibility,” West said.

Both Centura and SCL sent STAT statements saying they were confident their policies were lawful.

In larger cities, like Denver, patients will still have many options if the Catholic systems continue to opt out. UCHealth, which has seven hospitals and more than 100 clinics, and Kaiser Permanente Colorado, with 600,000 members, both plan to offer aid in dying.

But that will be less true in smaller communities. In Canon City, the only hospital in town is Catholic; in the towns of Frisco and Durango, there’s only one hospice — owned by a Catholic system.

Indeed, Catholic health care is a force to contend with in Colorado: Fully a third of acute care hospital beds in the state are owned by or affiliated with Catholic institutions, according to a 2016 report from MergerWatch. Only Iowa, Washington, Wisconsin, South Dakota, and Nebraska have a more substantial Catholic presence.

Ultimately, what Colorado hospitals decide may be less important than practices adopted by primary care clinics, oncology centers, and hospices — the settings most likely to encounter terminally ill patients who want to explore assisted suicide.

According to data from Oregon and Washington — the first states to adopt aid in dying — most people who pursue this option don’t end up doing so in a hospital. Ninety percent of terminally ill patients who’ve chosen assisted suicide in Oregon have died at home, while 86 percent of those from Washington have done so, according to The Iris Project.

The Colorado Medical Society, which adopted a neutral stance on the ballot measure, is advising its members to inform patients who seek aid in dying of alternatives, such as palliative care and pain control, and to remind them that they can rescind the request at any time.

Kate Alfano, a spokeswoman, said the society didn’t know how many physicians planned to offer medical assistance to those seeking to end their lives. Last year, a poll of physicians who frequently treat patients with terminal illness found 50 percent in favor of this option and 41 against.

For its part, Compassion & Choices has reached out to every hospital, medical clinic, and hospice in Colorado, offering technical assistance, West said.

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  • Diana, your comment makes me furious. It’s fine that the law permits doctors to opt out — it’s not fine that Catholic hospitals are prohibiting doctors with hospital privileges or on their staff to NOT provide aid in dying even when those doctors do NOT share Catholic beliefs and are in reality willing to do so and willing to help patients from their off-the-premises-offices, but Catholic hospitals are forcing them to NOT do so. It’s disgusting and your description does not meet the reality of what is happening.

    No one wants to force Catholics to violate their beliefs (though not all practicing Catholics agree with the official Church position). We just want to stop Catholics’ preventing others from willingly helping their patients.

    • It should be expected by the physician who is employed/has hospital privileges by a Catholic health system that this hospital system will adhere to Catholic doctrine. If a provider is shocked by the stance of the hospital system, this provider clearly has not done his/her research on its foundation and should seek employment elsewhere.

  • The problem with all these is that the timetable for dying of cancer or any other terminal illness is not necessarily predictable, and the patient may slip into a situation where asking for help to end this is no longer possible, and certainly not spread out over several weeks. To follow the rules you would have to be still in good enough condition and therefore be leaving prematurely, to avoid the risk of waiting too long and then not getting the help you need.

    • You want the health care industry to keep doing painful, useless things to people and ensure the continuation of suffering. Amazing to me how people like several posters here are so hardhearted they want government to enforce suffering. How cruel. Why don’t you mind your own business and not try to force these views on other people? That a religion would decline to help alleviate suffering tells us a lot about it.

    • lou,
      No one has to consent to any surgery, procedure, or treatment that he or she considers burdensome or unnecessary. If he or she is unable to refuse, his or her health care power of attorney can do it on his/her behalf. This has been legal for many years. It’s simple to for people to buy dog tags or pendants to indicate their preference for DNR/DNI orders. Some people even have tattoos, for haven’s sake!

  • Let’s see if Denver, Colorado
    will become the location of the
    first right-to-die hospice.
    The voters of Colorado voted
    strongly in favor of the right-to-die.
    Now some public-spirited individuals
    should incorporate themselves
    as a new hospice service that will provide
    ALL legal end-of-life medical care,
    including the new medical aid in dying.
    Here is a handbook explaining how
    a right-to-die hospice would operate:

  • Correction please: Here is the rest of the story.
    Your source has done you a disservice. The promoters of assisted suicide have worn out their thesaurus attempting to imply that it is legal in Montana. Assisted suicide is a homicide in Montana. Our MT Supreme Court did ruled that if a doctor is charged with a homicide they might have a potential defense based on consent. The MT Supreme Court acknowledged it is a homicide in the ruling.

    The Court did not address civil liabilities and they vacated the lower court’s claim that it was a constitutional right. Unlike Oregon no one in Montana has immunity from civil or criminal prosecution, death certificates are not legally falsified and investigations are not prohibited like in OR, WA and CA. Does that sound legal to you? Does that sound shielded to you?

    Perhaps the promoters are frustrated that even though they were the largest lobbying spender in Montana their Oregon model legalizing assisted suicide bills have been rejected in Montana in 2011, 2013 and 2015.

    Your source has done the public a disservice. Their ordinary bait and switch campaign is demonstrated by their selling “must self-administer” then they do not provide in their legislation for an ordinary witness of the “self-administration”, which you used in your article.
    The difference is that a witness would honor individual rights and choices, without a witness it allows euthanasia. If the individual struggled is not known by this non transparent policy.
    This omission eviscerates the flaunted safeguards putting the entire population at risk of exploitation by the medical-industrial-complex, human trafficking by predatory corporations, organ traffickers, predatory heirs and “new best friends” like the killers of Oregon’s Thomas Middleton. All of Oregon model laws/bills including Hawaii’s, DC and Colorado’s non transparent Prop 106 simply allow forced euthanasia. Welcome to the Oregon experience.
    Respectfully submitted,
    Bradley Williams
    Mtaas org

    • It’s a greater crying shame that so many who have voted for AS or desire it have been railroaded by C&C. Why should a doctor who is pledged to uphold life, now be compelled to uphold death? A doctor who pushes for AS challenges the public trust in all capacities, but mostly in his oath to be a healer not a killer.

    • Spring Texan, what would happen if Catholic hospitals and organizations didn’t exist? The Catholic Church is the largest non-governmental provider of healthcare services and the largest charitable organization in the world.

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