End of Life Option Act 

• The End of Life Option Act is a California law that allows certain terminally ill adults to request a prescription for an aid-in-dying drug.
• This law is effective as of June 9, 2016. California is the fifth state to enact an aid-in-dying law.

The patient must:

• Be an adult (18 years old or older).
• Be a California resident.
• Have a diagnosis of an incurable and irreversible disease with a prognosis of less than six months to live.
• Be able to make medical decisions for themselves, as determined by health professionals.
• Voluntarily ask for a prescription for an aid-in-dying drug without influence from others.
• Be able to take (eat, drink, swallow or inject) the aid-in-dying drug by themselves.

• Ask about alternative and additional treatments available to you – such as palliative care, comfort care, home health and hospice, and pain management.
• Talk about how to involve family and significant others. Talk about how they can support you. Talk about others who can support you like faith leaders, friends or social workers.
• Ask about the process of obtaining an aid-in-dying drug.
• Ask how the drug affects patients. Ask about the risks involved.
• Talk about having a friend or family member present with you if you decided to take the drug.
• Talk about your options if you change your mind. Receiving the aid-in-dying drug does not mean you have to take it.

• Make a request for the medication to your doctor who has primary responsibility for the care and treatment of your disease. You must verbally ask two times. Your two verbal requests must be made a minimum of 48 hours apart.
• Then submit one written request for the aid-in-dying drug to your doctor using the required form. The form must be signed in the presence of two witnesses. Your written request should come after your second verbal request.
• Your doctor must receive all three requests (two verbal and one written) and must participate in all steps of the process. Your doctor cannot ask someone else to help with any part of the process.
• Obtain a referral from your doctor for a second doctor who will provide a consult to verify your diagnosis and prognosis.

• The law allows doctors to choose whether or not to participate. In fact, all members of the healthcare team can refuse to participate and they are not obligated to refer patients to participating doctors
• However, you always have the option to find another doctor who will prescribe you an aid-in-dying drug and to receive copies of your medical records.
• It is important to us that you find the support you are seeking, so if you are having difficulty, please email us at ELOAct@sutterhealth.org if you are seeking a referral to a participating doctor.

• Each health plan will determine whether or not to cover the prescription or consulting doctor fees.
• At this time, the law does not require health plans to provide coverage.
• You should contact your health insurance agency for more information.

• Taking an aid-in-dying drug should not adversely affect your will or life insurance.
• The law states that wills, insurance, contracts and annuities are not affected if qualified individuals shorten their dying process by taking an aid-in-dying drug.
• Taking an aid-in-dying drug (as the law outlines) will not be viewed as suicide, assisted suicide, homicide or elder abuse.
• When following all of the requirements of the End of Life Act, your death certificate should indicate that you died from an underlying illness and that death occurred naturally.
• You should contact your insurance agency for additional information.

• The law requires that your doctor talks to you about the importance of informing your family and significant others, though you are not required to inform your family or significant others.
• Your doctor will also discuss the matter privately with you to make sure you made your decision to take an aid-in-dying drug on your own.

• No. Including your desire to use an aid-in-dying drug in your advance directive does not meet the requirements of the law.
• You must follow the specific steps discussed above to obtain an aid-in-dying drug.
• Healthcare agents/decision makers, surrogates and conservators cannot request the aid-in-dying drug for you.
• However, including your desire to not prolong your life in your advance directive will help your treatment team understand your wishes in the event of any confusion.

• No. However, many patients who qualify for this option may choose to enroll in these programs at the same time.
• Palliative care, comfort care, hospice, et cetera, offer great resources for relief from the symptoms, pain, and physical, mental and emotional stress that comes with a terminal diagnosis.

• Most patients who take this medication choose to take it at home. But it can be taken in a health care entity, if it is allowed by that entities policy.

• Yes. Ask your doctor about other options available to you - such as palliative care, comfort care, home health and hospice, and pain management.
  If you are able to make your own decisions, you always have the right to refuse any medical treatments or to have life-prolonging interventions withheld or withdrawn.
• Patients with terminal diseases are advised to discuss advance care planning options with their healthcare provider, including the completion of Advance Health Care Directives and/or POLST (Physician Order for Life Sustaining Treatment) forms to document their end-of-life wishes.

An adult is 18 years of age or older.

An aid-in-dying drug is prescribed by an attending physician to patients who qualify under the law to administer it to themselves, bringing about their own deaths.

The attending doctor has primary responsibility for the patient’s healthcare and treatment of that patient’s terminal disease.

The attending physician checklist and compliance form is a document created by the End of Life Option Act to specify all of the attending doctor’s requirements under the law.

Capacity to make medical decisions is the ability to understand the nature and consequences of a healthcare decision as well as its significant benefits, risks and alternatives; and the ability to make and communicate an informed decision to healthcare providers.

A consulting doctor is a specialist or other qualified doctor who, independent from the attending doctor, can make a professional assessment of a patient’s terminal disease.

A physician is a doctor of medicine or osteopathy currently licensed to practice medicine.

Self-administering is a patient’s conscious and physical act of taking and swallowing the aid-in-dying drug to bring about his or her own death.

A terminal disease is an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months.