CALIFORNIA’S NEW END OF LIFE OPTION ACT

Effective June 9, 2016, a new California law permits terminally ill but competent patients age 18 and older to decide to be prescribed an aid-in-dying medication.  The End of Life Option Act makes California the fifth state to enact an aid-in-dying law. There are avid supporters and opponents of this new law who have raised numerous ethical, moral, religious and practical concerns. The new legislation seeks to strike a balance between both sides of the debate by requiring numerous procedural prerequisites that are intended to make sure the decision is made voluntarily and thoughtfully by a person with full capacity to make the decision. Below is a brief summary of the new law. PREREQUISITES To invoke the law’s provisions, an adult (age 18 and older) California resident must:

1. Be diagnosed with an incurable and irreversible disease which will, within reasonable medical judgement, be terminal, i.e., result in death within six months;
2. Be able to make medical decisions;
3. Request a prescription for an aid-in-dying drug without influence from others;
4. Be able to take the drug by himself/herself; and
5. Make the request personally. It cannot be made through a power of attorney, advance health care directive, a conservator, or other legally recognized agent.

HEALTH CARE PROVIDER ALSO MUST PARTICIPATE VOLUNTARIY Participation in the End of Life Option Act also is voluntary for health care providers as well as health systems, HMOs, hospitals, medical offices, nursing homes, pharmacies and hospices. In addition, Insurers are not required to cover aid-in-dying drugs or related physician fees. If the patient’s provider or the organization where the patient receives care is not participating in the End of Life Option Act, the patient may request basic information or ask for a referral. PROCEDURE TO REQUEST AID-IN-DYING DRUGS If an eligible patient meets the above requirements to receive the aid-in-dying drug, the patient and his or her attending physician must follow several steps which are carefully defined in the law, which include:

1. The patient must make two oral requests, at least 15 days apart, directly to his or her attending physician.
2. The patient must also make one request in writing, using the Patient’s Request for Aid-in-Dying Drug form which must be signed by the patient and two witnesses, and provided directly to his or her attending physician.
3. The patient must discuss the aid-in-dying drug request with his/her attending physician without anyone else present (except an interpreter, if needed), to make sure the decision is voluntary.
4. The patient must then see a second consulting physician who can confirm the patient’s diagnosis, prognosis, and ability to make medical decisions.

If either the attending or consulting physician thinks the patient might have a mental disorder, the patient must also see a mental health specialist to make sure his or her judgment is not impaired. If the patient still wishes to proceed and the attending physician agrees, the attending physician may provide the aid-in-dying drug by either dispensing it directly to the patient or by delivering the prescription to a participating pharmacist. By law, the physician cannot hand the prescription directly to the patient or their representative. Finally, before taking the drug, the patient must sign a Final Attestation for Aid-in-Dying Drug form  which confirms they are taking the drug voluntarily, are under no obligation to take the drug, and may rescind the request at any time.