Frequently Asked Questions Regarding California's End of Life Option Law
(Right to Die Law or Physician Aid in Dying)
Friends, we will keep you as up to date on developments as we can. There is still a lot not known.
WHEN DID IT GO INTO EFFECT?
June 9, 2016.
WHO QUALIFIES UNDER THE LAW?
The requirements of the law are:
- You must be 18 years of age or older.
- You must be able to make and communicate health care decisions.
- You must be a California resident, verified with a California Driver License or California Identification Card, voter registration or tax return.
- You must have a terminal illness—a disease that will, determined by reasonable medical judgment, produce death within six months.
- You must make 3 voluntary requests, two oral (at least 15 days apart) and one written, which must be signed by two witnesses.
- You must sign a "final attestation" form before ingesting the drug, stating that you are fully informed of the consequences and alternatives. You can change your mind at any time and decide to NOT take the drug.
- You must be able to swallow the medication yourself. Injection is not permitted.
You will not qualify under the act if you are not of clear mind and are not capable of making the request, orally and in writing.
WILL I LOSE MY LIFE INSURANCE BENEFITS IF I TAKE ADVANTAGE OF THIS LAW?
No. The death certificate will indicate that you died from an underlying illness.
HOW MANY DOCTORS ARE REQUIRED?
Two; an "attending physician," who writes the prescription, and a "consulting physician," who confirms the diagnosis, prognosis and the patient's capability to make an informed decision. A doctor does not have to be present at death.
HOW WILL I FIND A DOCTOR?
Our first recommendation would be to talk to your own doctor. Do this early in case your doctor is unalterably opposed to participating. If that happens you will have time to look for another doctor.
This article on the Death With Dignity website gives excellent advice about approaching doctors. Don't expect an enthusiastic YES from your doctor, but be wary if s/he is rude, changes the subject. If your doctor says, "NEVER," you need to find a willing one.
We know that the following systems will NOT participate in this law:
Our understanding is that Kaiser healthcare systems will have specialists to help you navigate the law.
- Veterans Administration
- Catholic healthcare systems
- All California Tenet Hospital Systems, including Desert Regional, JFK in the Coachella Valley and Hi-Desert Medical Center in Joshua Tree
- Eisenhower Medical Center
Even if a healthcare system does not object to participating in the law, individuals within the system have the option to not participate.
SHOULD I STILL PLAN TO KEEP HOSPICE IN MIND IF I USE THE LAW?
Yes. It is possible that good hospice care will make it unnecessary to end your life yourself. We hope hospices will be responsive to our members' needs and wishes. Brittany Maynard chose not to have hospice because her symptoms, which could not be relieved, were causing her suffering. Be sure to find out, before enrolling in any hospice, what its policy is on the End of Life Option Act .
IF I QUALIFY, DO I JUST TAKE A PILL?
The physician can prescribe any medication s/he wants for this purpose, but commonly it is a barbiturate, or a mixture of drugs. The drug may come pre-prepared. If not, someone may empty the 100 capsules into water and mix it for you, but you must ingest it yourself. It is bitter. You must drink it quickly to prevent falling asleep before you have ingested the proper dose. Other drugs may be added to prevent nausea and vomiting. The cost for these drugs can vary from $450 to $3500. They are not covered by Medicare, although it is expected that Medi-Cal will cover a portion of the cost.
HOW CAN I BEST PREPARE FOR MY INEVITABLE DEATH AND AVOID THE ICU AND SEEKING "MEDICAL MIRACLES?" HOW CAN I GET READY TO USE THE CA DEATH WITH DIGNITY OPTION?
1. LEARN THE 'RULES.' Reading this document and the law's text is
a good start.
2. TALK TO YOUR DOCTORS regarding your end of life wishes, every last one of your doctors, while you are healthy. Do not let them forget your wishes. Keep in mind, and be sensitive to the fact that the very idea of helping someone die is abhorrent to the vast majority of doctors. Even doctors who agree with the law can experience emotional conflicts when confronted with the question. This recent article from the NY Times eloquently describes the emotions:
This article has excellent suggestions for preparing for the end of life conversation with your doctors.
If you are lucky enough to have a doctor tell you that they will help you achieve a peaceful death when the time comes, ask them if they have 100% authority to prescribe a medication to you. If they do not, find out how many other people can veto your doctor. This article describes what can happen when committees/attorneys get involved.
If you find yourself with uncooperative doctors/institutions, you may want to consider finding new doctors/institutions.
3. TALK TO YOUR FAMILY/FRIENDS. Be certain your family and friends know your end-of-life wishes. A 2006 review article (Arch Intern Med. 2006;166:493-497) concluded "Patient-designated and next-of-kin surrogates incorrectly predict patients' end-of-life treatment preferences in one third of cases." It is important to communicate openly and be clear on your wishes.
The go wish card game can suggest topics that might not have occurred to you previously.
4. WRITE IT DOWN, LEGALLY. It is important to have a health care proxy, an advance directive, and if you are in very poor health, a POLST and perhaps a Do-Not-Resuscitate ( DNR order). Both the POLST and DNR must be signed by your doctor (although a physician assistant can sign the CA POLST form). Some nursing homes, assisted living facilities have all of their residents over 80 years old fill out a POLST. Still, some of our members are the "last person standing," in their circle of family/friends and have no one to be their healthcare advocate.
5. PRAY that 1) the people trying to overturn the law do not succeed 2) that after 10 years when the law "sunsets" it is extended and 3) that when your time comes you are "lucky enough" to get a diseases that "qualifies" you to use the law. Pray that you do not get Alzheimer's.
All of the above (with the possible exception of #5) will increase your chances of having a peaceful death.
When it comes down to it, life is a lot like a casino, a game of chance. Despite all of your efforts, you could have a severe car accident, a stroke or some other calamity that puts you in an ICU in a heartbeat. If you are lucky you might exit that ICU alive and reasonably healthy. Unlucky, you could end up on a "vent farm" in Coronado, for the rest of your life.
6. Join the Hemlock Society and come to our conference on Nov. 4, 2017 - a full day where we discuss all we've learned in 30 years.
There are other things that can be done to avoid fates worse than death. We at the Hemlock Society are continually evaluating options and trying to find solutions to these vexing problems. We discuss these things and other closely related subjects at our meetings, to which all are cordially invited. We have a special Hemlock Advance Directive at our meetings. It includes a (not legally binding) a directive about your wishes if you should contract Alzheimer's. We also have a lending library at our general meetings (the third Sunday of odd numbered months) where our members can borrow books related to death and dying. Members can read the book for a two month period and return it at the next meeting.
If you join as a member you will receive our newsletter six times per year where you often hear about what is happening in the worldwide right to die movement.
HOW CAN I HELP?
We need volunteers to line up speaking engagements, to talk to members, and to enlarge the work of our board. We need funds to provide training for doctors and other medical personnel and to bring qualified speakers to educate local professionals.
California Hospital Assocation detailed information on End of Life Option Act. Required forms are included.
Preparing For The California End Of Life Option Act: How To Get Started If You Think You Might Qualify, by Carol Parrot, MD, April 27, 2016
California Request for Aid-in-Dying Drug to End my Life in a Humane and Dignified Manner.
Other forms, including interpreter's declaration.
How's the Law Working So Far ?
Right-to-Die: One Bay Area Woman's Last Days
The first person in San Diego to Take Advantage of the Law ?
Ojai woman with ALS takes advantage of California's End of Life Option Act
But, it is not so easy.
And sometimes difficult to find a doctor.
California Dept. of Health Report, first six months of the End of Life Option Act
And, a group is waging a legal fight against the law.
And this lawsuit
- where it is alleged UCSF doctors and social workers gave a terminal woman assurances that they would support her wish for a peaceful death, but backed out at the last minute. This case is horrifying.