The California End of Life Option Act was signed into law in October of last year, and became effective on the 9th of June. This law is designed to provide a way for patients who are dying of a terminal illness to ask their doctors for medication that they could take if and when they wished to die quickly and peacefully at a time and setting of their own choice. The law certainly includes many safeguards to prevent patients from being pressured or coerced into asking for or receiving such medications. Also, it is a potentially time-consuming process and could take up to 2-3 months.
Physicians are not required to participate, so if this is important you need to ask your doctors whether they are willing to participate with you. If they are not, they are required to be able to refer you to physicians who can serve you in this capacity.
For the record, I am willing to see patients requesting medication, assist with paperwork, and write prescriptions for the medication.
What follows is a hand-out I prepared as a Frequently Asked Question (FAQS) list with links to information and documents.
California End of Life Option Act
Signed into law by Governor Brown: 10/05/15 as AB-15
In effect: 06/09/16
Date of repeal by its own terms: 01/01/26, unless extended by the Legislature
It is now legal for dying patients to request a prescription for medication that would allow them the option to die peacefully at their own choosing if they wish, and it is now legal for doctors to prescribe such medication and for pharmacies to dispense it.
Who is eligible for medical aid in dying?
· Terminally ill
· Prognosis of six months or less to live
· Mentally capable of making own decision (Note this excludes patients with Alzheimer’s or other dementias, or patients with developmental delays.)
· California resident
· Acting voluntarily (without duress, fraud or undue influence)
· Able to take and swallow the medication
· Patients informed of all options (such as stopping life-prolonging treatment, palliative sedation, voluntarily ceasing to eat or drink, hospice care)
· Patients informed that they may obtain, but not take the medication
Do people support this?
· Yes. 68-74% of people in Gallup and Harris polls support medical aid in dying.
Do medical professionals support this?
· Yes. 54% of doctors support this in a Medscape poll.
· This Act is endorsed by the American Nurses Association/California, the California Psychological Association and the California Primary Care Association.
Do doctors have to participate?
· No, but they have to provide information about medical aid in dying, and refer patients to supportive medical providers.
What cause of death will be on the Death Certificate?
· Cause of Death will be the underlying terminal illness.
· The law specifies that death from self-administering aid-in-dying medications is not suicide.
Does this affect a will or insurance?
· No. Accessing medical aid in dying does not adversely affect a person’s will or insurance.
· The law specifically mandates that wills, insurance, contracts and annuities are not affected if a qualified individual shortens their dying process by ingesting aid-in-dying medication.
How does this apply to disabled or older people?
· The law specifically states that no one can qualify for aid-in-dying medication based solely on their disability or age.
How does this affect guardians or conservators?
· Guardians and conservators may not be appointed solely because a person makes a request for aid-in-dying medication.
How long can such a request take?
· At least 15 days, perhaps up to 3 months
How much does this cost?
· There are at least 3 doctor visits, dedicated solely to aid in dying issues
· The pharmaceutical company that makes the necessary medication increased the cost a few months ago to almost $3,000; at least for the easiest to use one that comes in easily opened capsules.
· One that comes in tablets that would have to be crushed costs about $16.
Where can I find the necessary paperwork?
· The California Department of Public Health allows you to download the necessary forms.
· Compassion & Choices is a great resource for information.
What are the steps involved in requesting aid-in-dying medication?
Please note you must have the physical and mental ability to self-administer and ingest the medication, and you must be able to prove California residency- details to follow. Also, you yourself must make the request. The request cannot be made on your behalf by any other person, regardless of their relationship to you.
1. Make a total of three voluntary requests; two oral requests 15 days apart, plus one written request using the Patient’s Request for Aid-in-Dying Drug form signed by two witnesses, directly to your doctor.
a. No specific order is needed.
b. The witnesses attest that you:
i. Are known to them or have provided proof of identity (driver license, proof of voter registration in California, proof of owning or leasing property in California, or proof of filing a California tax return for the most recent tax year), and
ii. Voluntarily signed the request in their presence, and
iii. Appear to be of sound mind, and not under duress, fraud or undue influence.
c. Only one witness may be related by blood, marriage or adoption, or be a person entitled to a portion of your estate upon your death
d. Only one witness may own, operate or be employed at a healthcare facility where you receive medical care or reside
e. Your regular doctor, consulting doctor or mental health specialist cannot be one of the witnesses.
2. Give fully informed consent.
3. A consulting doctor must complete the Consulting Physician Compliance Form, basically stating agreement with your Attending or regular physician. Your regular or attending doctor must refer you to a consulting specialist for this purpose under this law. (Health and Safety code, Section 443.5 (a)(3))
4. Complete the Final Attestation for Aid-in-Dying Drug form within 48 hours prior to ingesting the aid-in-dying medication. This re-states your intent to take the medication, and your awareness of the consequences.
a. After your death, this completed form must be delivered to your regular doctor so it can be included in your medical record.
You can use an interpreter, but your interpreter must sign the Interpreter Declaration Form which shows that you understand the needed forms as listed above when read to you by an interpreter.
Compassion & Choices materials 02/17/16
CMA On-Call Document #3459, 01/2016
Orentlicher, D. et al. (2015). Clinical Criteria for Physician Aid in Dying, J.Palliative Medicine, vol. 18, No. X.
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Please feel free to see me if you have any questions about the End of Life Option Act.