2021 Colorado Code
Title 25 - Public Health and Environment
Article 48 - End-of-Life Options
§ 25-48-112. Form of Written Request
- A request for medical aid-in-dying medication authorized by this article must be in substantially the following form:
Request for medication to end my life
in a peaceful manner
[Form Excluded]
I request that my attending physician prescribe medical aid-in-dying medication that will end my life in a peaceful manner if I choose to take it, and I authorize my attending physician to contact any pharmacist about my request.
I understand that I have the right to rescind this request at any time.
I understand the seriousness of this request, and I expect to die if I take the aid-in-dying medication prescribed.
I further understand that although most deaths occur within three hours, my death may take longer, and my attending physician has counseled me about this possibility. I make this request voluntarily, without reservation, and without being coerced, and I accept full responsibility for my actions.
[Form Excluded]
Declaration of witnesses
We declare that the individual signing this request:
Is personally known to us or has provided proof of identity;
Signed this request in our presence;
Appears to be of sound mind and not under duress, coercion, or undue influence; and
I am not the attending physician for the individual.
[Form Excluded]
Note: Of the two witnesses to the written request, at least one must not:
Be a relative (by blood, marriage, civil union, or adoption) of the individual signing this request; be entitled to any portion of the individual's estate upon death; or own, operate, or be employed at a health-care facility where the individual is a patient or resident.
And neither the individual's attending physician nor a person authorized as the individual's qualified power of attorney or durable medical power of attorney shall serve as a witness to the written request.
History. Source: Initiated 2016: Entire article added, Proposition 106, L. 2017, p. 2809 , § 1, effective upon proclamation of the Governor, December 16, 2016.
