Battle Over Colorado's Death With Dignity Law

On August 26, 2019, Dr. Barbara Morris, a primary care and geriatric physician with over 40 years of experience, was abruptly fired by Centura Health Physician Group, at the direction of Centura Health Corporation (Centura). Her termination came on the heels of her efforts in aiding a patient in his search to find a healthcare provider who would write him a prescription for aid-in-dying medication (AID). In doing so, Centura, a faith-based healthcare organization, concluded that Dr. Morris’ conduct “violated the religious principles upon which [Centura] operates and warranted the termination of her employment.”

In Colorado, one-third of the state’s hospitals operate under Catholic guidelines. 1 Centura, operating under the Ethical and Religious Directives for Catholic Health Care Services (ERDCHCS) guidelines, is one of several religious healthcare providers sponsored by the Catholic and Seventh-Day Adventist healthcare ministries. In one of its court filings, Centura proclaimed that “the religious doctrines of those [ministries] are core principles that govern, direct and inform [Centura’s] activities.” Based on its Christian principles, Centura refuses to adhere to the Colorado End-of-Life Options Act (EOLOA) as the act directly conflicts with the organization’s “beliefs to promote and defend the sacredness of every human life.” 2

Colorado's End-Of-Life Options Act

Medical aid-in-dying is the “medical practice of a physician prescribing medical aid-in-dying medication to a qualified individual that the individual may choose to self-administer to bring about a peaceful death.” 3 In 2016, Colorado voters approved Proposition 106 in a 65  to 35 percent vote. The approval successfully enacted the Colorado End-of-Life Options Act, which authorizes physicians to prescribe AID medication to qualified patients to self-administer in order to achieve a peaceful death. The Act clarifies that “[a]ctions taken in accordance with this article do not, for any purpose, constitute suicide, assisted suicide, mercy killing, homicide, or elder abuse.” 4 The Act also contains an “opt-out” provision that permits hospitals to prohibit their physicians from prescribing AID medication to qualified patients who intend to use the medication on hospital premises, rather than self-administering the medication off-site. 5

Battle For Right To Die

Dr. Morris’ patient, Cornelius “Neil” Mahoney, was diagnosed with stage 4 adenocarcinoma — an advanced and incurable form of cancer that originates in the glandular cells lining certain internal organs — in July 2019. Fearing a painful and prolonged dying process, Mr. Mahoney determined that he wanted “to obtain a prescription for aid-in-dying medication to self-administer at home” in order to “make sure [he has] some control over this and make it as easy as possible on [his] family.” Mr. Mahoney initially discussed his desire to obtain AID with his former physician, Dr. Nauman Moazzam, at the Rocky Mountain Cancer Center (RMCC). Dr. Moazzam expressed that he would not provide AID and that no one from RMCC would do so either. Mr. Mahoney was then referred to Dr. Morris by a RMCC social worker. Although Dr. Morris believed Mr. Mahoney qualified for AID, she was restricted by Centura’s policy, which would not permit her to provide AID as the organization opted out of EOLOA. Instead, Dr. Morris advised Mr. Mahoney to transfer his care to a healthcare provider “who would be permitted by institutional policy to provide AID.” This was a daunting prospect for Mr. Mahoney due to his rapidly declining health, and the stress he underwent at the thought of beginning his cancer treatment all over again at a new facility prevented him from finding a new healthcare provider.

Litigation Ensued

In light of the difficulties Mr. Mahoney’s situation presented, Dr. Morris joined him in filing suit against Centura, requesting, among other things, the Court “[d]eclare that [Centura] may not lawfully prohibit Dr. Morris from, or sanction or penalize Dr. Morris for, providing AID related services to Neil, including but not limited to, prescribing AID medication to Neil for use somewhere other than at a Centura facility.”

Their arguments centered on the assumption that Centura “cannot maintain and enforce a policy that conflicts with both EOLOA and a separate Colorado statute, C.R.S. § 25-3-103.7, that prohibits health corporations like Centura from practicing medicine and/or exercising control over a ‘physician’s independent professional judgment concerning the practice of medicine.’”

On September 11, 2019, Centura filed a Motion to Dismiss, raising several arguments under the First Amendment’s Free Exercise and Establishment clauses, and continually noting the exemptions that religious organizations are afforded in relation to state laws. Centura began its Motion by defending its termination of Dr. Morris, explaining that when she signed her Physician Employment Agreement with Centura in 2017, she expressly agreed that she would not provide any services that are in violation of the Ethical and Religious Directives for Catholic Health Care Services. Centura continued its explanation by alleging that in assisting Mr. Mahoney in his search to obtain and self-administer AID, Dr. Morris “encouraged an option she knew was morally unacceptable to her employer.” Centura further asserted that requiring religious institutions to abide by EOLOA would be a direct violation of those institutions’ religious freedoms, and encourage significant governmental interference with these institutions’ religious missions.

Current Status

In response to Centura’s Notice of Removal, U.S. District Judge Lewis Babcock ruled that while he agreed with Centura that the case raises important questions about religious freedom protected by the Constitution, he determined that other criteria requiring the case to be heard in federal court were not present. As a result, Judge Babcock remanded the case back to Arapahoe County District Court, where Mr. Mahoney and Dr. Morris originally filed it.

Following arguments related to Centura’s Motion to Dismiss, Mr. Mahoney excused himself from the lawsuit. 6 In response, on October 7, 2019, Dr. Morris filed a separate action against Centura, focusing solely on her termination. In her action, Dr. Morris contends that Centura retaliated against her in violation of EOLOA and unlawfully inserted itself in her doctor-patient relationship with Mr. Mahoney. Centura characterized Dr. Morris’ new action as nothing more than an employment contract issue, and the issues surrounding the new case do not go beyond determining whether an employer can terminate an employee for violating organization policies. 7

If you have a legal issue with a health provider, the experienced attorneys at Whitcomb, Selinsky Law PC, may be able to help you. Please call (303) 534-1958 or complete an online contact form.

1 JoNel Aleccia, Firing Doctor, Christian Hospital Sets Off National Challenge to Aid-In-Dying Laws, KAISER HEALTH NEWS (Aug. 30, 2019).

2 Sonia Gutierrez, Centura Health Responds to Lawsuit Involving Medically Assisted Suicide, 9NEWS (Sep. 12,

2019).

3 C.R.S. § 25-48-102 (7).

4 C.R.S. § 25-48-121.

5 C.R.S. § 25-48-118 (1).

6 https://www.apnews.com/a28bf207bbf549a392f4e04dba9ff896.

7 https://www.centura.org/patients-and-families/EOLOA.