Since passage of the California End of Life Option Act in California, a number of health systems have taken firm positions on the law.
Providers in Catholic-affiliated and other faith-based organizations will not participate in the formal process, will not prescribe medical aid-in-dying drugs, and will not allow ingestion of the drugs on their premises.
Kaiser Permanente and the University of California health systems have established navigator-led programs to facilitate medical aid-in-dying requests.
Other systems and agencies may have similar stances or positions that provide support, education, and referral, but not full participation. Check the provider’s website for their “End of Life Option Act” or “medical aid in dying” policy, or call and ask to speak to their patient representative or clinical services officer.
The only organization that provides direct referrals to participating providers is the American Clinicians Academy on Medical Aid in Dying.
For patients: This process is likely to take some time. If you are seriously considering the medical aid in dying option, don’t delay beginning the process. Once the drugs have been prescribed, you can wait to have them delivered; or once they are in your possession, you can wait to take them until you are ready.
For patients: Because medical aid-in-dying is only legal in a few states and is not approved or regulated by the Center for Medicare and Medicaid Services or other regulatory agencies, there are no standards for practice or regulation/approval of the medical aid-in-dying drugs. Different physicians use different combinations of drugs based on their experience and the experience of other physicians participating in the Act. Adverse and unexpected reactions are possible; prolonged deaths are possible. You should be sure your physician fully explains what the drugs are likely to do and what you and your family should do if anything unexpected occurs. (See note below about having a POLST or DNR order.)
For physicians: Having in-depth conversations with any patient requesting medical aid in dying is not considered formal “participation” and should be undertaken even by physicians who have decided not to participate. These discussions are opportunities to correct misinformation, address concerns, improve symptom management, and marshal additional supports, according to patient needs and wishes. This article, “Curbside Consultation: Medical Aid in Dying,” may be helpful in conducting these conversations.
For both: It is a good idea to ensure that a person qualified to and intending to ingest medical aid-in-dying drugs complete a POLST selecting “NO CPR” or an out-of-hospital DNR in case of any complications or unexpected events that might result in EMS responding. If 9-1-1 is called for any reason, first responders will attempt CPR unless there is a physician’s order to withhold resuscitation.