Key Facts About the End of Life Option Act for Patients & Families

The Coalition for Compassionate Care of California does not take a position on the California End of Life Option Act. We are provide factual information on the provisions of the law, some “best practice” recommendations, and links to other helpful resources.

• The End of Life Option Act (also referred to as the California medical aid-in-dying law) went into effect on June 9, 2016.
• Under this law, only California residents who are 18 years of age or older who have received a terminal diagnosis with a prognosis of six months or less can begin the process of requesting an aid-in-dying prescription.
• Participation in the End of Life Option Act is voluntary every step of the way – for patients, healthcare providers, health systems and facilities, pharmacists, and insurers. No one can be forced to participate.
• A request for medical aid-in-dying drugs must come directly from the terminally ill patient. No one can request the drug on behalf of a terminally ill patient. Patients must be able to make their own medical decisions and speak for themselves; they must also be physically capable of taking (ingesting) the drugs themselves.
• The medical aid-in-dying  request cannot be written into an advance directive, living will, or Physician Order for Life-Sustaining Treatment (POLST). Learn more about POLST in California.
• The law requires patients and their physicians to go through several steps before the medical aid-in-dying drugs can be prescribed, including verbal requests, a written request, consultation with a second participating physician, and completion of several forms.
• The law requires the terminally ill patient’s physician to recommend that the patient inform family and significant others of their intention to take medical aid-in-dying drugs; however, the patient is not required to inform their family or significant others.
• The law requires the doctor to discuss with the patient alternatives to medical aid-in-dying, including palliative care, pain management, and hospice care. 
• Even if patients go through all the steps to obtain the prescription, they can ultimately decide NOT to take the drug.  (If the patient obtains the drugs and doesn’t take them, family members are required to return the unused drugs or safely dispose of them.)
• A terminally-ill patient must be physically and mentally able to take the drug themselves, without assistance. Usually this means the patient swallows the drugs or ingests them through a feeding tube. Family members or others may assist in the preparation of the drugs, but they cannot assist in the ingestion. For example, sometimes the drug comes in capsules that must be emptied and the contents mixed with fruit juice or pudding. A family member can prepare the mixture, but the patient must drink/eat and swallow it without help.
• California law does not require insurance plans to cover the medical aid-in-dying drugs. Some health plans have announced they will cover the cost of the drugs, others will not. Contact your health plan for details.
• 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.
  Medicare, the federal program for people over 65, will not cover the drugs.
• Under California law, patients cannot be denied health insurance, life insurance, or annuities because they are pursuing medical aid in dying. Payments of life insurance and other benefits to survivors cannot be withheld because the patient used medical aid in dying.
• Taking medical aid-in-dying drugs under the law is not considered suicide, assisted suicide, homicide, or elder abuse. If all of the requirements of the End of Life Option Act are followed, the death certificate will list the terminal illness as the cause of death and that death occurred naturally.

For an overview of the law and more information, see the main End of Life Option Act page.

Frequently Asked Questions 

What do I need to do to prove that I am a California resident?

Patients must be a California resident in order to use the End of Life Option Act.  Under the law, California residency must be demonstrated through any one of the following means:

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

How do I find participating doctors?

There is currently no statewide, comprehensive directory of participating physicians. If you are interested in exploring medical aid in dying begin by talking to your primary physician. If the primary physician is unwilling or unable to participate, they may be willing to provide a referral. If they are not willing to provide a referral to another physician, you will need to seek a participating provider on your own. Your physician must tell you whether they will participate or not, and if you request it, they must transfer your medical records to another provider as you direct.

Several large health systems in California have said they will allow their physicians and staff to participate in medical aid in dying (e.g., Kaiser Permanente, University of California), but individual physicians who work for these health systems still have the option to participate or not, depending on their own beliefs. 

You can contact the Patient Care Services department at the hospital or health system to ask questions about medical aid-in-dying and the provider’s level of participation. Healthcare entities are required to post their current policy regarding medical aid in dying on their public-facing website, though it may not be easy to find.

Catholic-affiliated health systems and hospitals, such as those under Providence or Dignity Health, will not participate, nor will their doctors and staff.

Some hospices will participate fully, as in their medical directors will serve as attendings and prescribe medical aid-in-dying drugs; others will support patients using medical aid in dying but won’t prescribe. Before enrolling in a hospice program, be sure you understand what their policy is.

California’s Veteran’s homes and providers of services operated under the U.S. Department of Veteran’s Affairs will also not participate in aid-in-dying.

The American Clinicians Academy for Medical Aid in Dying has a "Patient-to-Doctor Referral Service," which may be helpful if your own physician or health system doesn’t participate or won’t refer.

Every commercial insurance provider who provides coverage to patients in California will have a policy defining the level and type of coverage they provide for care and management of patients who are participating in the California End of Life Option Act. Likewise, each insurer will also have a policy about any offered coverage for medical aid-in-dying drugs. You should call your insurer for details.

Medicare does not cover services or drugs for participation in the End of Life Option Act.

The Medi-Cal program will cover the cost of care and drugs for patients wishing to participate in the End of Life Option Act, but you may be required to establish a relationship with a participating “Fee-for-Service” Medi-Cal provider that is outside the system where you usually get care. If you are covered by Medi-Cal you should contact your healthcare provider office for more information.

The California End of Life Option Act legislation specifically states that, as long as the prescribed process is followed, death from ingesting medical aid-in-dying drugs cannot affect any life insurance or impact any will. Death by medical aid-in-dying drugs cannot be considered suicide, and suicide will not be listed on the death certificate.

Do I need an advance directive or POLST form?

Advance care planning is important for all individuals regardless of your current health because it encourages you to examine and share your goals of life, goals of care, and treatment wishes with family and medical providers. Advance care planning is particularly important for those who are considering medical aid in dying.

An advance directive is used to legally name a healthcare decision maker and provide instructions for that individual regarding your treatment wishes. Learn more about advance directives.

POLST, or Physician Orders for life-Sustaining Treatment, is designed specifically for people who are seriously ill or near the end of life. POLST is a form that clearly states what level of medical treatment you want toward the end of life. Printed on bright pink paper and signed by you AND your physician, nurse practitioner, or physician assistant, POLST is a medical order that all healthcare professionals must honor. POLST helps give seriously ill patients more control over their treatment. California law (AB 3000, Chapter 266) requires that a POLST form be followed by healthcare providers and provides immunity to those who comply in good faith. Learn more about POLST, download the POLST form, and access tools and resources at caPOLST.org.

While instructions or requests for medical aid in dying cannot legally be written in to an advance directive or POLST form, these documents can and should be used to clarify your desire to avoid cardiopulmonary resuscitation (CPR) or life-sustaining medical treatment if you have an immediate health crisis prior to using the medical aid-in-dying drugs, or if there is an unexpected complication from the drugs or the drugs do not work as expected and emergency services are called. In that case, having a POLST that says “NO CPR” or an out-of-hospital DNR will avoid any attempt by first responders to “bring you back.”

For an overview of the law and more information on the California End of Life Option Act, click here.