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Second Regular Session

Sixty-first General Assembly

LLS NO. R98­0182.01 JGG




WHEREAS, Numerous people suffer from intractable and untreatable pain and terminal illness; and

WHEREAS, Many of these people are of sound mind and wish to direct the withholding of life­sustaining nutrition and hydration that artificially preserves their lives; and

WHEREAS, Others suffering from pain and terminal illness, or their relatives who witness their loved ones' pain and suffering, desire to take a more active approach to end the person's suffering; and

WHEREAS, Physicians treating patients with intractable pain and terminal illness are faced with the ethical dilemma of preserving human life and obeying the law while respecting the wishes of their patients; and

WHEREAS, The debate concerning the appropriate societal policy on euthanasia and physician­assisted suicide continues to be a significant and emotional issue throughout the nation; and

WHEREAS, The United States Supreme Court has recently ruled that certain state legislation prohibiting assisted suicide does not violate the Due Process or Equal Protection Clauses of the United States Constitution while at the same time the 1994 Oregon law authorizing physician­assisted suicide was reaffirmed by the Oregon voters on November 4, 1997; and

WHEREAS, The Colorado Medical Society has elected to address the controversial issue of assisted suicide and has adopted the following sensitive and comprehensive policy on euthanasia to guide physicians:

I. Euthanasia means a good death. Only the competent patient or the authentic proxy of the incompetent patient may decide what for each patient constitutes a good death.

II. Passive euthanasia means that medical interventions are withheld or withdrawn, allowing a disease process to continue its natural course leading to death. Competent patients have a moral right to seek a good death by refusing treatment if that is their wish. Furthermore, physicians have a moral obligation to honor the wishes of their competent patients or the authentic proxy of their incompetent patients, with respect to withholding and withdrawing undesired medical interventions.

III. Active euthanasia means that an intervention by someone other than the patient is intended directly and immediately to bring about the death of a suffering patient at the patient's request. However, providing treatment or medication with the intention of easing the pain of a dying patient is acceptable treatment and not active euthanasia, even though such treatment or medication may foreseeably hasten the moment of death.

IV. Suicide means that one intentionally terminated one's life. Refusing a treatment which may delay the moment of death is not suicide. However, intentionally taking a lethal dose of medication even when fatally ill would be suicide. A physician who intentionally provides a lethal dose of medication for the purpose of aiding a patient to commit suicide is assisting suicide. This differs from providing an adequate dose of medication for the purpose of pain relief, even though it may foreseeably hasten death.

V. Physicians share with all society a duty to obey the law which currently prohibits both active euthanasia and assisting suicide. Because controversy surrounds these issues, physicians ought to continue to evaluate their responsibility to society regarding these practices.

VI. It is critical that the medical profession redouble its efforts to ensure that dying patients are provided optimal treatment for their pain and other discomfort. The use of more aggressive comfort care measures, including greater reliance on hospice care, can alleviate the physical and emotional suffering that dying patients experience. Evaluation and treatment by a health professional with expertise in the psychiatric aspects of terminal illness can often alleviate the suffering that leads a patient to desire assisted suicide.

VII. Physicians must resist the natural tendency to withdraw physically and emotionally from their terminally ill patients. When the treatment goals for a patient in the end stages of a terminal illness shift from curative efforts to comfort care, the level of physician involvement in the patient's care should in no way decrease.

VIII. Requests for physician­assisted suicide should be a signal to the physician that the patient's needs are unmet and further evaluation to identify the elements contributing to the patient's suffering is necessary. Multidisciplinary intervention, including specialty consultation, pastoral care, family counseling and other modalities, should be sought as clinically indicated.

IX. Further efforts to educate physicians about advanced pain management techniques, both at the undergraduate and graduate levels are necessary to overcome any shortcomings in this area. Physicians should recognize that courts and regulatory bodies readily distinguish between use of narcotic drugs to relieve pain in dying patients and use in other situations.

X. The principle of patient autonomy requires that physicians must respect the decision to forego life­sustaining treatment of a patient who possesses decision­making capacity. Life­sustaining treatment is any medical treatment that serves to prolong life without reversing the underlying medical condition. Life­sustaining treatment includes, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics and artificial nutrition and hydration.

XI. There is no ethical distinction between withdrawing and withholding life­sustaining treatment.

XII. Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death. More research must be pursued examining the degree to which palliative care reduces the requests for euthanasia or assisted suicide.

XIII. Physician­assisted suicide is fundamentally inconsistent with the physician's professional role.

Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients' deaths is too great to condone active euthanasia or physician­assisted suicide.

Now, Therefore, Be It Resolved by the House of Representatives of the Sixty­first General Assembly of the State of Colorado, the Senate concurring herein:

That the policy on euthanasia adopted by the Colorado Medical Society be adopted by the Colorado Board of Medical Examiners and used as a guideline for all medical physicians licensed by the state of Colorado.

Be It Further Resolved, That a copy of this resolution be sent to each member of the Colorado Board of Medical Examiners and to each medical physician licensed by the state of Colorado pursuant to article 36 of title 12, Colorado Revised Statutes.