While the idea of death can be uncomfortable, thinking about our feelings and preferences before we start to decline can help us and our loved ones in the future. Effective last month, California passed a new law (The End of Life Option Act) that allows a terminally ill patient to request a prescription from a doctor for a lethal drug to end their life. California is now the fifth state in the United States to approve this type of law. California’s law is strict, with an intention of making sure that patients have given careful thought to such a decision and are making the decision voluntarily. It’s important to understand the important details of California’s new End of Life Option law, and how it can impact our end of life choices.
To help you understand The End of Life Option Act, we’ve tried to lay it out in laymans terms.
The following requirements for a potential patient:
- The patient must have a terminal disease, with no cure and an estimate of having only six months or less to live. Both the patient’s physician and a second consulting physician (who has evaluated the patient and reviewed their medical records) must agree on the diagnosis and six month timeline.
- The patient must have the capacity to actively make medical decisions. Patients cannot request aid in dying in written documents such as advance directives, nor can health care agents or conservators request such on the patient’s behalf, even if they know that is what the patient would have wanted. The patient must be an active participant at the current time, and able to directly make their request known.
- The patient cannot have impaired judgement due to a mental disorder.
- The patient must be able mentally and physically to swallow the drug orally at the time they want to take it, as the law requires the drug be self-administered.
For patients who meet the above criteria, here are the key steps to be followed:
1) The patient’s treating physician determines that the illness is terminal, and that the patient has the capacity to make medical decisions.
2) The patient makes two oral requests directly to their doctor for the aid-in-dying drug, at least 15 days apart. After the two oral requests are made, the patient has to request the drug in writing via a form titled: “Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner.” When the patient discusses their request with their doctor, it must be a private conversation with no one else present, to ensure it is a voluntary decision on the part of the patient.
3) The patient sees a second physician for consultation to confirm the diagnosis, terminal prognosis, and ability to make medical decisions.
4) The patient and their treating doctor meet to discuss the following:
- How the aid-in-dying drug will affect the patient, and the fact that death may not be immediate.
- Realistic alternatives including palliative care, hospice care, and pain control options.
- Whether the patient wants to withdraw their request.
- If the patient plans to notify next of kin, or have a witness present with them when taking the drug. (The patient is not required to do either of these.)
- Ensure the patient knows they don’t have to take the drug, even after they have filled the prescription.
5) If the patient still wishes, the physician will write the prescription. Before taking the drug, the patient must sign a form stating they took the drug voluntarily. Patients who have followed these steps will not be considered to have committed suicide.
How does The End of Life Option Act affect a patient’s wills, insurance, or other contracts?
- The Act protects the patient.
- The patient cannot be denied health insurance, life insurance benefits, or annuities based on requesting or taking the aid-in-dying drug.
- Health insurers cannot tell a patient that aid-in-dying is covered, unless the patient asks.
- Health insurers cannot refuse treatments for the terminal illness while at the same time offering coverage for aid-in-dying.
- A will or contract cannot require a patient to receive aid-in-dying or prevent them from doing so.
Doctors who help patients with this process will be providing a new and legal form of end of life care, and are protected from legal liability or sanction, if the requirements are followed. Doctors, hospitals, and pharmacies are not required to comply with the patient’s request, and can choose not to participate.
Knowing all of our options as the end of life nears is important and empowering. California’s End of Life Option Act will not apply to everyone. Alzheimer’s and dementia patients don’t qualify under this law as they are not mentally competent to make the decision.
No matter your situation, figuring out a plan of care you are comfortable with can be overwhelming. Our expert care team at Eldercare Services is available to partner with you and connect you with all available care resources. You are not alone!
For more information to help you understand the End of Life Option Act:
http://www.cnn.com/2016/06/09/health/california-end-of-life-law/
https://bayareaendoflifeoptions.com/
http://coalitionccc.org/tools-resources/end-of-life-option-act/
https://www.compassionandchoices.org/