Medical Aid in Dying in the State of Colorado: Perspectives, Data, and Lessons Learned in the First Years of a Uniquely Centralized Program.

In 2016, Colorado voters approved Proposition 106, "Access to Medical Aid in Dying," which amended Colorado statutes to include the Colorado End-of-life Options Act. This statute is similar to the aid in dying laws enacted in states that currently have aid in dying laws. In 2018, Denver Health and Hospital Authority, an urban, county safety-net hospital established a program to provide comprehensive medical aid in dying care via a centralized clinic with a dedicated team including a medical director, social worker, and a network of volunteer consultants. This clinic is physically located on the main campus of Denver Health Medical Center, but most patients are seen via the virtual platform. As the program has developed and matured, it has grown exponentially. This is due to its ease of accessibility, statewide educational efforts, and the relatively low cost and need-based, free services it provides. We present here the programs' five-year statistics and methodology that have resulted in a unique medical aid in dying care model. A single-center retrospective cohort study of patients who met the state law criteria with at least one visit to the clinic. As consistent with Colorado law, inclusion criteria include patients are 18 years of age or older, a resident of Colorado, have a terminal illness with a prognosis of less than six months to live, do not have any underlying mental illness, and are voluntarily expressing a desire to access the law without evidence of coercion. The patient must also be able to self-administer the medication. From January 1, 2018, through June 30, 2024, 660 patients met inclusion criteria. Diagnoses included cancer (53%), progressive neurological disease (14%), lung disease (13%), and cardiac disease (12%). Of the total 497/660 (75%) patients had two visits with physicians and 494/497 (99%) received a medication combination prescription. Of the 163 (25%) patients with only one visit, 50% had a date of death documented with 64/80 (80%) patients dying within 15 days of the first visit. In six and a half years, our centralized program assisted over 650 Colorado patients in their quest for accessing medical aid in dying care, providing a wide continuum of services from initial intake and counseling, visits, and financial aid to specific grief counseling for loved ones. We believe our centralized system may function as a model for other hospitals considering the need to improve aid in dying access and care.