Second Regular Session
Sixty-first General Assembly
LLS NO. R980182.01 JGG
STATE OF COLORADO
BY REPRESENTATIVE Morrison
HOUSE JOINT RESOLUTION 98-1005
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are withheld or withdrawn, allowing a disease process to continue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.