D

ENVER — 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.

advertisement

“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.

Sign up for Morning Rounds

A daily dose of health and medicine news — and a finalist for Digiday’s best email newsletter.

Recommended Stories