End of Life Option Act Goes into Effect in California
California’s End of Life Option Act took effect on June 09, 2016 after being signed by Governor Jerry Brown during the previous fall. The law allows doctors in the state to prescribe life-ending medication in certain cases in response to requests from terminally ill patients. Doctors are not obligated to provide such medication under the law, however, they will now be able to legally prescribe the medications for the first time. California follows Washington, Vermont, Montana and Oregon in giving doctors the ability to prescribe such medications to terminally ill patients who meet specified criteria.
Proponents of the law believe that it will provide Californians with control over end-of-life decisions that was previously not available to them. Opponents, on the other hand, argue that existing end-of-life options give the terminally ill the ability to seek hospice care or similar services to provide them with comfortable conditions in their final days. Some opponents object to the law on religious or ethical grounds. Health systems refraining from participating in the law’s provisions include some Catholic-affiliated organizations. A number of large healthcare programs and facilities have announced that they will support physicians who prescribe medication according to the law, including UC-system hospitals, Sutter Health and Kaiser Permanente.
The following guidelines apply to those wishing to use the End of Life Option Act:
· Only California residents who are at least 18 years old and have been diagnosed by their doctor with a terminal disease likely to cause their death within 6 months are eligible. An individual must also be free of any mental impairment that could hinder the process of making a sound medical decision. If the drug is prescribed, an individual must possess the physical and mental means to take it.
· Once a primary physician has determined that an individual meets the eligibility criteria, the individual must ask their doctor for the drug twice, with at least 15 days separating the two requests. Whatever the doctor’s response, the requests should be documented in written form. Once this has been done, a written request must be made on a form specially designed for the purpose. This form must be signed and witnessed by two people (of the two, one must not be a relative or a person who benefits from the individual’s estate).
· Another requirement of the law is that an individual has a conversation with their doctor about their decision. The doctor is required to explain: what alternatives exist to taking the drug; the effect the medication may have and the fact that death may not be immediate; that an individual has the right withdraw their request or change their mind about ending their life at any time in the process.
Those who are considering using the option can ask their primary care physician if they would be willing to prescribe a lethal medication. If they are not willing, an individual can seek an alternate primary healthcare provider.
If an individual’s physician is attached to a hospital that is opting out of compliance with the End of Life Option Act, the physician may still be able to prescribe the medications, especially if they have their own practice. The only way to know for sure in such cases is to ask the physician what their policy is. The same applies to hospice organizations, some of which may also choose to opt out of the law to avoid any potential liability that comes with complying with it, as well as for religious or ethical reasons.
Those who can’t find a doctor to prescribe life-ending medication can still benefit from palliative medicine, which is focused on making a person’s final days as comfortable as possible. The practice can involve a variety of services, including pain medication, care designed to maximize comfort and palliative sedation.