The End of Life Option Act

The End of Life Option Act is a California law that went into effect on June 9, 2016, and a revised version of the law took effect January 1, 2022. This law allows a terminally-ill adult, California resident, who meets certain qualifications, to request medication (aid-in-dying drug) from their physician that will end their life.

The end-of-life care Marshall (MMC) provides is grounded in the values of respecting the sacredness of life, providing compassionate care to dying and vulnerable persons, and respecting the integrity of health care providers. MMC believes in compassionate, end-of­ life care. MMC will not abandon dying patients or their families and is committed to provide appropriate support for dying persons and their families through the final stages of life by supporting patient self-determination through the use of advance directives, offering hospice, palliative and other supportive care, and providing effective pain and symptom management and other social, spiritual, and pastoral care support and services.

Marshall respects the rights of our patients to use this option and we also respect the rights of our physicians and staff to choose whether or not to participate in this process. If your physician chooses not to participate, you may transfer your care to another physician. MMC physicians on its medical staff who wish to prescribe aid-in-dying drug to their terminally ill patients may do so outside MMC facilities, including but not limited to the hospital, clinics, and all outpatient departments/locations. MMC will not provide aid-in-dying drug to hospitalized patients nor provide the drugs to be taken in a clinic or other outpatient setting.

Providers and patients can view MMC’s policy here.

Frequently Asked Questions:

Who can participate in the California End of Life Option Act?

To receive the aid-in-dying drug, the patient must:

• Be 18 years or older
• Be a resident of California (see: How does a patient demonstrate residency?)
• Have a terminal disease with a prognosis of six months or less to live
• Have capacity to make medical decisions
• Have the ability to self-administer the aid-in-dying drug
• Voluntarily ask for the aid-in-dying drug without influence from others

How does a patient demonstrate residency?

California residency can be demonstrated through any of the following:

• Possession of a California Driver license or other identification issued by the State of California
• Registration to vote in California
• Evidence that the patient owns or leases property in California
• Filing of a California tax return for the most recent tax year

I believe I meet the criteria. What should I discuss with my physician regarding the aid-in-dying drug?

• Discuss what’s meaningful to you in your life right now.
• Talk about the worries and fears that you are facing and what brought you to this decision.
• 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.
• 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 decide 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.

I want to request an aid-in-dying drug. How do I proceed?

• A patient must make three requests to their attending physician (the physician primarily responsible for managing their illness):
  • Two oral requests (at least 48 hours apart)
  • One written request signed in the presence of two witnesses, one of whom cannot be related to the patient.
• The attending physician must confirm the patient’s diagnosis and prognosis and determine whether the patient has the capacity to make medical decisions.
• The patient must meet with a consulting physician, who will independently verify the patient’s diagnosis and prognosis, and determine whether they have capacity to make medical decisions.
• If there are indications of a mental disorder that impairs medical decision-making, the attending or consulting physician may refer the patient to a psychologist or psychiatrist for a mental health assessment.

What if my doctor does not want to participate in this process?

• The law allows physicians to choose whether or not to participate. If an attending physician declines to participate, they must inform the patient of their refusal to participate, document the patient’s request for the End of Life Option Act in the medical record, and transfer their medical record upon request to a physician who is willing to act as a prescriber. If a patient is establishing care with a new physician for the purposes for obtaining a prescription under EOLA (eg., if their clinician has chosen not to be a prescriber), their new prescriber may require more than one visit prior to writing the prescription.

Am I guaranteed a second appointment with my attending physician 48 hours after my first request?

• No. If your provider elects to participate we will try our best to accommodate appointment requests, but we cannot guarantee that a second appointment can be scheduled 48 hours after the first request. Typically, it can take approximately 2-3 weeks before a patient can make the second oral request. Marshall recommends that patients discuss this option with their physician as early as possible to streamline the referral process.

If I start the process and I decide that I no longer want to participate, can I rescind my request?

• Yes, a patient can rescind their request at any time and in any manner. The attending physician will also offer the patient an opportunity to rescind their request at the time of their second oral request.

Will my insurance cover the aid-in-dying drug?

• At this time, the law does not require health plans to provide coverage to pay for the costs associated with the End of Life Option Act. Check with your health plan to see if they cover the prescription or other associated costs. Some patients and families choose to pay these costs out of pocket.

How should I involve my family and significant others?

• The law requires that physicians counsel patients on the importance of informing their family and significant others about their request for aid-in-dying, though it is not required. Suggestions for how to have this conversation can be found here: https://compassionandchoices.org/resource/my-end-of-life-decisions-an-advance-planning-guide-and-toolkit/best-safeguard-continuing-conversation/.

Do I need to be enrolled in hospice or another end-of-life treatment program?

• No. However, many patients who choose to pursue the End of Life Option Act may choose to enroll in hospice at that time, as the hospice team can help support the patient and their family, as well as provide expert management of pain and other distressing symptoms. The attending physician will discuss feasible alternatives with the qualified patient, including but not limited to, comfort care, hospice care, palliative care, and pain control.

Can I request the aid-in-dying drug even if I don’t plan to take it immediately?

• Yes. An attending physician may write a prescription for an aid-in-dying drug for a qualified patient, even if they do not plan to take it immediately.

Where can I take the aid-in-dying drug?

• The aid-in-dying drug may not be taken in any public place or on Marshall premises. Most patients who take the aid-in-dying drug choose to take it at home.

Must a physician be present when I ingest the aid-in-dying drug?

• The law does not require a physician to be present when the patient ingests the aid-in-dying drug. It is permissible for a physician to be present if the patient wishes it, as long as the physician does not administer the aid-in-dying drug.

What will the death certificate say?

• The death certificate will list the underlying terminal illness as the cause of death and state that death occurred naturally. The death certificate will not list suicide. Wills, insurance, contracts and annuities are not affected if qualified individuals shorten their dying process by taking an aid-in-dying drug.

Are there other end-of-life options that I should know about?

• Yes. Ask your provider 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.