Since 2016, California’s End of Life Option Act (EoLOA) has provided terminally ill, decision-capable adults with an option to legally and safely end their suffering. But the law isn’t as simple as choosing to end one’s life; the petitioning individual must meet specific criteria and follow the steps exactly as prescribed by the law to receive the California law’s protection. As should be the case with something as critical as choosing to end one’s life, this law isn’t meant to make it easy, it’s meant to make it available. Even then, there are natural barriers to its use as well as practical and ethical considerations that must be made. We’re going to explore the key provisions of the law, considerations providers and participants should make, and how the process works.
Key Provisions of the EoLOA
The End of Life Option Act allows certain individuals to request medical assistance to end their lives. These individuals must be California residents, they must be at least 18 years old, and they must have received a diagnosis of an incurable and irreversible disease with less than six months to live. They must be able to make sound decisions as determined by a health professional, and they must be able to administer the aid-in-dying drug themselves. The person must voluntarily request the prescription, and any suspicion of coercion would be a red flag for providers. Additionally, physicians are legally required to discuss all end-of-life options, not just this one.
Key Considerations for Providers and Participants
This law has been in and out of litigation for years, and researchers and physicians have grappled with the questions it poses with vigor. There are several considerations this law requires both providers and participants to make before making this end-of-life decision.
The law prescribes the exact steps an individual must take before availing oneself of this California law’s provision.
1. A patient must make two verbal requests directly to the physician directly responsible for his or her care. These requests cannot be made less than 15 days apart.
2. After making two oral requests, the patient must make one request in writing using the state’s prescribed “Patient’s Request for Aid-in-Dying” drug form. It must be signed by the patient as well as two witnesses and provided directly to the physician that is attending to his or her care. There is not a specification as to when the written request should be made.
3. Once these steps are made, the patient must then discuss the request with his or her attending physician alone, with no one else in the room with very few exceptions. This is to determine that the request has been voluntarily made.
4. The patient is then required to consult a second physician to confirm the diagnosis, prognosis, and decision-making ability. If either physician has questions or concerns about the patient’s mental faculties, they must refer him or her to a mental health specialist to determine cognitive ability.The request for this type of medicated death cannot be made in an advance directive, by a health care agent or surrogate or any other health care decision maker. It must be made by the patient, directly to the attending physician, and following the steps as outlined in the law.
The law stipulates that this kind of end-of-life decision should not adversely impact estate planning. If done correctly, the death certificate will show that the patient died due to the underlying disease. It’s important to discuss these issues and make sure everything is in order, that the physician is well-versed in the stipulations of the law before proceeding so that you and your loved ones are protected.
There is the chance, because disease diagnosis and prognosis are difficult and imperfect, that the timing required by the law causes problems for the patient. If the disease advances too quickly, or the patient delays decision-making, they may no longer qualify. Additionally, there have been instances when the physician or health care provider will not even discuss this option with a patient, and because it is voluntary, they are not required to do so. Finding a participating physician can be emotional and complicated. Finally, there have been problems finding a pharmacy that will fill the prescription for the drug. It’s important that participating individuals know what resources are available to them to find and receive the drug.
To date, the majority of people availing themselves of the EoLOA are over the age of 60 and predominately white. Roughly 60% of the people who obtain the medication use it, and most have been diagnosed with terminal cancer. Any law such as this could be easily abused which is why it is so prescriptive. End-of-life decisions are emotionally and legally fraught, and no one should feel pressure to choose one way or the other. It’s important that patients are aware of the options, the challenges, and the impact of their decision.
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By Christopher E. Botti
The majority of our articles are written by our attorneys: Christopher Botti and