The California End of Life Option Act (EoLOA) is a state law that permits physicians to prescribe a lethal dose of medication to terminally ill adult patients with capacity to make medical decisions if certain conditions are met. When these conditions are met, and the prescribed process followed, physicians and healthcare entities are protected from civil or criminal actions and patients are protected from adverse legal and financial consequences of a death by suicide.
Signed into law by Governor Brown in October 2015, the law went into effect on June 9, 2016. California was the fifth state to enact a medical aid-in-dying law; similar laws have been enacted in Oregon, Washington, Vermont, Maine, New Jersey, Colorado, New Mexico, Hawaii, and the District of Columbia. Read the full bill language here.
In October 2021, Governor Newsom signed SB 380, which made significant changes to California’s End of Life Option Act, including reducing the required waiting period between a patient’s oral requests from 15 days to 48 hours and eliminating the “final attestation” required from patients. The changes went into effect on January 1, 2022. [Read more about SB 380 in our May 17, 2021, and September 17, 2021, Blog posts.]
Eligibility Requirements
In order to receive medical aid-in-dying drugs in California, a person must:
- Be an adult (18 years old or older)
- Be a California resident (no timespan required)
- Have a diagnosis from the attending physician of an incurable and irreversible disease that will, within reasonable medical judgement, result in death within six months
- Be able to make medical decisions for themselves as determined by two physicians
- Make voluntary requests (two oral, one written) for a prescription for an aid-in-dying drugs without influence from others
- Be able to self-administer the aid-in-dying drug (by ingestion: either by mouth, or through PEG or rectal tube)
The request for medical aid-in-dying medications must be made solely and directly by the patient to the attending physician; it cannot be made on behalf of the patient through a power of attorney, an advance health care directive, a conservator, healthcare agent, surrogate, or any other legally recognized health care decision maker.
Participation Is Voluntary for Patients and Healthcare Providers and Healthcare Entities
Participation in the End of Life Option Act is voluntary for individual patients, healthcare providers (physicians, nurses, pharmacists, etc.), as well as healthcare entities, including health systems, HMOs, hospitals, medical offices, nursing homes, pharmacies, and hospices. Insurance providers are not required to cover aid-in-dying drugs or related physician fees. Patients should check with their health insurance company about the rules regarding coverage of costs associated with aid-in-dying drugs or related physician fees. Medi-Cal, which is California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs using nonfederal funds.
Healthcare entities are required to develop a policy with respect to their participation in the California End of Life Option Act, provide it to all physicians who may be caring for patients within their system or facilities, and post it on their public-facing website. Policies that are not provided or post cannot be enforced.
New in 2022, physicians who choose not to participate in the End of Life Option Act are required to tell the patient they will not participate and transfer the patient’s medical records upon request. A healthcare provider or healthcare entity is prohibited from engaging in false, misleading, or deceptive practices relating to their participation in medical aid in dying. In the 2022 amendments to the law, even nonparticipating providers were required to document a patient’s oral request as the first request of the two required by the End of Life Option Act. Due to a lawsuit brought by physicians concerned that this would, in effect, require them to “participate” in the process regardless of a position of nonparticipation, this provision will not be enforced. This ruling does not prevent a nonparticipating physician from documenting the request and transferring the record at the patient’s direction.