Proposition 106, also known as the Access to Medical Aid in Dying Initiative, was an initiated state statute that appeared on the November 8, 2016, ballot in the state of Colorado. The measure enacted the End of Life Options Act, legalizing assisted dying for patients with a terminal illness who are expected to die within six months.
The proposition was approved by nearly 65% of Colorado voters, making Colorado the 6th U.S. state to legalize assisted dying.
Background Legislative efforts Democratic legislators Lois Court and Joann Ginal first introduced assisted suicide legislation in February 2015 to the Colorado House of Representatives, with the bill failing 8-5 in the relevant committee. In 2016, Court and Ginal proposed similar legislation, but withdrew the bill the morning it was due to be voted on after realizing they had insufficient support from colleagues.
That same year, the Access to Medical Aid in Dying Initiative was certified for the November 2016 ballot after returning 160,000 voter signatures of support to the Colorado secretary of state. The wording of the proposition was modeled on Oregon's Measure 16, which legalized assisted dying in the state in 1994.
Effect Before the End of Life Options Act went into effect in early 2017, aiding another person in ending their life was a crime of felony manslaughter in Colorado, with assisted dying legalized in only 5 states. After Proposition 106 went into effect, aiding in the assisting dying process was decriminalized, though patients must self-administer the aid-in-dying medication after receiving a prescription from a doctor.
Proposition 106 permits terminally ill patients with a life expectancy of six or less months to self-administer drugs in order to voluntarily end their lives. Patients must be over 18, mentally capable, able to make an informed decision, and able to self-administer and ingest the drugs. To be eligible for assisted dying, a patient must write one written request with two witnesses present, as well as two verbal requests. Legally, patients must be informed that they can opt out of taking aid-in-dying medication after they receive it.
The proposition also allows terminally ill patients to have aid-in-dying medication directly prescribed to them by a physician, rather than go through a health system. Health providers and facilities are not legally required by Proposition 106 to prescribe or dispense aid-in-dying medication. The End of Life Options Act also criminalized coercing a terminally ill patient into requesting aid-in-dying drugs, though hospital staff and physicians "acting in good faith" under the act were granted immunity from civil and criminal liability.
Campaign Support Compassion & Choices, who advocate for the legalization of assisted dying, raised nearly $5,000,000USD in support of Proposition 106 – over 40% of the total donations disclosed by committees supporting the proposition. The organization argued that patients facing an "agonizing, painful death" should have the right to end their lives. Prominent individual donors included author T. A. Barron, art collector Hester Diamond, and philanthropist Eleanor Caulkins.
Speaking to Colorado Public Radio in September 2016, then-governor John Hickenlooper expressed support for Proposition 106 and pondered that "maybe it's the Libertarian streak in me, but ... [terminally ill patients should] have the final say themselves". Hickenlooper noted his disagreement with the use of the word 'suicide' by opponents of the proposition, saying "these people are going to die anyway".
Julie Selsberg, one of the two citizens who started the initiative to put the End of Life Options Act on the ballot, told Westword she had begun to advocate for medical aid in dying after her terminally ill father was unable to receive aid-in-dying drugs before his death. Selsberg's father requested she write to state legislators to persuade them into introducing assisted dying for Colorado residents, despite knowing he would not live long enough to take advantage of his proposal. Her father also asked legislators to introduce assisted dying bills in an opinion piece for The Denver Post titled "Please, I want to die", prompting his local state representative Lois Court to reply promising to legislate for assisted dying medication. Court's response was read by Selsberg to her father shortly before he passed away by choosing to stop taking any nutrition in the absence of aid-in-dying drugs. Court and fellow representative Joann Ginal went on to unsuccessfully propose assisted dying legislation for multiple years before Selsberg had the opportunity to propose a citizen-initiated ballot measure, which both legislators quickly endorsed.
Opposition Proposition 106 received widespread opposition from religious groups, including both local and national archdioceses and the Church of Jesus Christ of Latter-day Saints. The Archdiocese of Denver donated more than $1,600,000USD to a committee campaigning against Proposition 106, while evangelical organization Focus on the Family donated $20,000. Business executive Richard D. McCormick and Nebraska governor Pete Ricketts donated $10,000 each, making them the largest individual donors against Proposition 106. The Colorado Christian University described the proposition as "fatally flawed", arguing that the measure lacked wording to prohibit patients from doctor shopping to receive a prescription for aid-in-dying drugs.
Thomas S. Monson, the then-president of the LDS Church, and his counselors issued a letter to Colorado's Mormon community urging them to "let their voices be heard in opposition to measures that would legalize physician-assisted suicide." The letter noted that while Mormons are permitted discretion regarding end-of-life decisions for their relatives, the church's policy guide Handbook 2 explicitly discourages ending a life "even when the person may be suffering from an incurable condition or disease."
Disability rights group Not Dead Yet opposed Proposition 106, stating that assisted dying was "a form of discrimination against old, ill and disabled people." Carrie Ann Lucas, a member of Not Dead Yet Colorado, said that the End of Life Options Act lacks safeguards to prevent terminally ill patients from being pressured into taking aid-in-dying medication. Lucas also criticized the bill for not requiring an unaffiliated witness to be present while the patient self-administers the medication.
Some opponents to Proposition 106 believed legalizing assisted dying would worsen Colorado's suicide rates, which were the seventh highest in the nation at the time. The Colorado Springs Gazette endorsed against the proposition in an editorial piece, calling suicide a "crisis" that would be worsened by the legalization of assisted dying, while The Denver Post said Proposition 106 "lacks proper safeguards" to prevent misuse and could increase the state's suicide rates. Similarly, leading Catholic bishops criticized supporters for "promot[ing] and/or facilitat[ing] suicide ... while recognizing suicide as a serious statewide public health concern", in reference to a statewide zero-suicide initiative introduced two years prior.
Endorsements
Polling Poll source Date(s)administered Samplesize Marginof error Yes No UndecidedFranklin & Marshall-Colorado Mesa UniversitySeptember 14–18, 2016540 (RV)± 5.10%70%22%8%
Results
By county County For Against Total votes cast # % # % Adams116,982 62.48% 70,236 37.52% 187,218 Alamosa3,92457.16%2,94142.84%6,865 Arapahoe191,89964.39%106,12035.61%298,019 Archuleta4,44262.59%2,65537.41%7,097 Baca78937.77%1,30062.23%2,089 Bent 85445.38%1,02854.62%1,882 Boulder144,33179.43%37,38020.57%181,711 Broomfield25,39268.23%11,82331.77%37,215 Chaffee 7,46266.81% 3,707 33.19% 11,169 Cheyenne 398 36.58% 690 62.42% 1,088 Clear Creek 4,28174.01% 1,503 25.99% 5,784 Conejos 1,49237.73% 2,46262.27% 3,954 Costilla 93552.74% 83847.26% 1,773 Crowley 68145.43% 81854.57% 1,499 Custer 1,67454.92%1,37445.08%3,048 Delta 9,32856.15% 7,28643.85%16,614 Denver241,72074.70%81,88425.30%323,604 Dolores 68856.86%522 43.14%1,210 Douglas 113,66161.41%71,41938.59%185,080 Eagle 18,87877.04%5,62622.96%24,504 El Paso 173,13655.39% 139,43744.61%312,573 Elbert 8,91656.39%6,89643.61%15,812 Fremont 12,05155.57% 9,636 44.43%21,687 Garfield 17,84468.69%8,13431.31%25,978 Gilpin 2,68176.10% 84223.90% 3,523 Grand 5,87468.77% 2,66831.23% 8,542 Gunnison 7,16377.04% 2,13522.96%9,298 Hinsdale 38965.38%20634.62%595 Huerfano 2,21559.69%1,49640.31%3,711 Jackson 53664.58%294 35.42%830 Jefferson 215,34066.31%109,38433.69%324,724 Kiowa 333 40.46%49059.54%823 Kit Carson 1,662 46.10%1,94353.90%3,605 La Plata 22,134|74.16%| 7,713 |25.84% | 29,847 |- style="text-align:center;" | Lake | 2,182|69.76%|946 |30.24% |3,128 |- style="text-align:center;" | Larimer | 128,051|67.00%| 63,057 |33.00% | 191,108 |- style="text-align:center;" | Las Animas | 3,530| 53.36%|3,085 | 46.64% |6,615 |- style="text-align:center;" | Lincoln | 1,146 |47.99% |1,242|52.01%|2,388 |- style="text-align:center;" | Logan | 4,615 |48.33% | 4,934|51.67%|9,549 |- style="text-align:center;" | Mesa | 45,877| 60.37%| 30,118 | 39.63% | 75,995 |- style="text-align:center;" | Mineral | 440| 68.54%| 202 | 31.46% | 642 |- style="text-align:center;" | Moffat | 3,569| 56.14%| 2,788 | 43.86% | 6,357 |- style="text-align:center;" | Montezuma | 7,424| 59.29%|5,097 | 40.61% |12,522 |- style="text-align:center;" | Montrose | 11,874|57.06%| 8,934 | 42.84% | 20,808 |- style="text-align:center;" | Morgan | 5,955|50.74%| 5,782 |49.26% | 11,737 |- style="text-align:center;" | Otero | 3,970 |46.74% | 4,523|53.26%| 8,493 |- style="text-align:center;" | Ouray | 2,421|74.47%| 830 | 25.53% | 3,251 |- style="text-align:center;" | Park | 6,841| 63.04%| 3,440 | 36.96% |10,281 |- style="text-align:center;" | Phillips | 903 |39.43% |1,387|60.57%|2,290 |- style="text-align:center;" | Pitkin | 8,565|85.47%| 1,456 |14.53% | 10,021 |- style="text-align:center;" | Prowers | 2,152 |43.88% |2,757|56.12%|4,909 |- style="text-align:center;" | Pueblo | 42,025|53.77%|33,137 |46.23% |78,162 |- style="text-align:center;" | Rio Blanco | 1,819|54.31%|1,530 |45.69% |3,349 |- style="text-align:center;" | Rio Grande | 2,838|51.02%|2,725 |48.98% |5,563 |- style="text-align:center;" | Routt | 10,633|77.29%|3,124 |22.71% |13,757 |- style="text-align:center;" | Saguache | 1,732|63.21%|1,008 |36.79% |2,740 |- style="text-align:center;" | San Juan | 367|77.26%|108 | 22.73% |475 |- style="text-align:center;" | San Miguel | 3,57685.80%59214.20%4,168 Sedgwick69451.60%651 48.40%1,345 Summit 12,283 77.91% 3,483 22.08% 15,766 Teller 7,86855.72% 6,25244.28% 14,120 Washington 1,06339.58%1,62360.42%2,686 Weld 76,28557.73%55,85842.27%132,148 Yuma 2,002 42.51% 2,708 57.49%4,710Total 1,765,78664.87% 956,26335.13% 2,722,049
Analysis Almost four-fifths of Colorado's 64 counties supported Proposition 106, with 13 of the 14 counties in opposition to the proposition being in Eastern Colorado. Every county that voted against Proposition 106 concurrently voted for Donald Trump in the 2016 presidential election, while all counties that supported Hillary Clinton also supported the proposition. 28 counties voted for Trump while approving Proposition 106.
Conejos County, which has a 45% Mormon population, rejected Proposition 106 by a 24-point margin. Quin Monson, a professor of political science at Brigham Young University, said before the election that public opposition to Proposition 106 from Church leaders would have a significant impact on the way Colorado's 145,000 Mormons would vote, stating that "[w]e have a lot of direct evidence that these messages work."
Aftermath From 2017 to 2021, a total of 777 Colorado residents were prescribed aid-in-dying drugs, with 583 of those prescriptions dispensed. Almost 75% of those prescribed aid-in-dying medication were over 65 years old, while 85% were in hospice care.